Community Nurses In Vermont. A success story in door-to-door home healthcare.
Community Nurses In Vermont. A success story in door-to-door home healthcare.
Richard Starr, an 80-year-old resident of Thetford, Vermont, lives alone in the two-story home that he designed and largely built himself after his wife died a few years ago. While Starr may live alone, he is not alone. Sunny Martinson, Thetford’s Community Nurse, visits Starr every week, while an FCP Live-In caregiver is with him around the clock. FCP Live-In provides live-in caregiving services to Vermont residents.
Because of Starr’s memory issues, the FCP Live-In caregiver took up residence in a spare room earlier this year to help him with his daily living activities. Since the live-in caregiver cannot provide medical care, Martinson visits to help with his medications, but she does much more than that.
Last fall, Starr’s refrigerator broke down and Martinson helped him get a new one. She found someone to plow his driveway in the winter and helped him get snow tires for his car. On a recent visit, Martinson brought Starr a newspaper with a listing of community events. She checked his blood pressure and they talked about adding a railing to his staircase. Martinson became a big part of his life.
“So I mean, I’m doing more than just filling the pill box,” Martinson told Vermont Public.
Martinson is among a growing number of community nurses across Vermont who connect residents—particularly older adults living in rural areas—to essential services that help them stay in their homes. Community nurses are not widely recognized yet among Vermont residents. These professionals do not take the place of visiting nurses, social workers, health care providers, or caregivers. However, the locally compensated workers help residents navigate the health care and social service systems.
“Right now, the health care system is reactive,” Kristin Barnum, executive director of Community Nurse Connection, told Vermont Public. “Something has to happen, and then you call 911, and then you go. But these community nurses are health coaches, health advocates, to prevent bad things from happening.”
The positions cost an average of $30,000 a year, but residents do not pay for the services of these innovative programs. Barnum believes these programs save the town’s money in the long run by “preventing unnecessary 911 calls and expensive trips to the hospital.”
“It’s a very inexpensive way to take care and keep older adults safe and in their towns,” Barnum said. Based in Lebanon, New Hampshire, the nonprofit Community Nurse Connection runs programs in both New Hampshire and Vermont.
Similarly, My Community Nurse Project, based in Weston, Vermont, assists seniors who want to stay in their homes. The program provides services such as in-home nursing assessments, patient safety checks, and care and advocacy for residents of mountain towns.
Since My Community Nurse Project launched in 2020, data show that community nurse Regina Downer has made:
362 home visits
12 calls to the rescue squad
Delivered (along with volunteers) 750 hot suppers and 160 loaves of fresh bread, baked and donated by local innkeepers
15 telemedical visits between patients and primary care providers
Most importantly, the My Community Nurse Project never charges the residents or their insurance for what the organization calls “the only project of its kind in southwestern Vermont.”
Community Nursing Programs Are Free to Residents
Some Community Nursing programs are paid for by local governments, others are paid for through grants and donations, while a combination of the towns, donations, and grants funds some. For instance, the Community Nurse Thetford program that Martinson works for primarily operates with grants. In Hartland, the nonprofit Aging in Hartland program is funded by the town and other donors and employs two full-time community nurses. The community nurse program in Sharon operates through the Sharon Health Initiative and is paid for by the town of Sharon, as well as individual donations and grants. In addition, some towns employ a community nurse for just 10 hours a week, while others pay for a full-time position.
Older adults are not only appreciative of having someone to help them, but they are also grateful that they do not pay for these services. For instance, the Norwich Community Nurse program in Norwich, Vermont is free of charge and helps people navigate the health care system by offering such services as:
Physical assessments
Fall risk assessments and preventative measures
Communicating with primary care providers
Communicating with families and caregivers regarding the plan of care
COVID-19 assistance, education, and support
Delivering essential items to the home
Address financial issues, rising costs of living, food insecurities
Assistance with medical equipment
Advance directive care planning and completing Clinician Orders for Life-Sustaining Treatment form with clients to have signed by their primary care provider
Community nursing programs are so successful and needed that state lawmakers introduced a bill last year to increase funding for the programs. The legislation pending in the Vermont House of Representatives would provide small grants for communities wanting to hire a community nurse.
If the bill is passed this year, State Rep. James Masland (D-Thetford), said the groundwork can be laid “for a more ambitious, state-coordinated program.”
“Initiatives such as this—with some regional and statewide coordination—will provide better health care for those who need it, for a lot less money than putting everybody in nursing homes,” Masland told Seven Days.
Community Nurses Establish Trust and Provide Companionship
What’s worth more than money is the trust that community nurses say they are able to build with their clients over time. For example, Dena Wilkie, the town of Sharon’s community health care coordinator, helped her 93-year-old client, who was leery about the healthcare system, get an eye examination. Wilkie’s position as community health care coordinator in Sharon is comparable to the other 13 municipalities’ community nursing programs.
It took six months, but Wilkie was able to convince him to see an eye doctor. With Wilkie’s encouragement and support, her client had cataract surgery, which helped him to function independently again.
Wilkie helped another client, one she met two years ago. When Wilkie first visited the home of the elderly woman in rural Sharon, rats had infested the woman’s kitchen. A relative of the woman asked Wilkie to check in on her. The woman was 86 years old at the time and relied on a wheelchair for mobility.
Wilkie arranged for her to have a weekly housecleaner who ensured that her food was stored correctly, and this took care of the rat infestation. She also set up mail delivery to the woman’s home, recruited a volunteer to shop for her once a week, and installed smoke and carbon monoxide detectors.
Since then, Wilkie has visited her client hundreds of times and even took her to see a neurologist. After finding out that the woman had dementia, Wilkie helped her sign up with the state for at-home long-term care services. Now, thanks to Wilkie, caregivers come to the woman’s house five days a week.
“She would not be able to still live at home if it wasn’t for me,” Wilkie told Seven Days.
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