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Hartford Community Nurse Katie Williams talks with Joan Ponzoni in Jan. 2025, at the Bugbee Senior Center in White River Junction. File photo by Jennifer Hauck\/Valley News<\/p>\nHartford Community Nurse Katie Williams talks with Joan Ponzoni in Jan. 2025, at the Bugbee Senior Center in White River Junction. File photo by Jennifer Hauck\/Valley News<\/p>\n
Jodi Hoyt\u2019s office is a nurse\u2019s bag and an accordion file folder in a rainbow of colors.<\/p>\n
She totes those items from house to house while checking on patients in her role as the community nurse for the towns of Chelsea and Tunbridge.\u00a0<\/p>\n
It\u2019s a role that\u2019s gotten a fair amount of airtime recently as the Democratic\/Progressive candidate for governor, Amanda Janoo, touts the virtue of community nurses and cites their work as a model for the type of publicly funded primary care<\/a> she hopes to bring to Vermont.<\/p>\n In Vermont Public\u2019s Oct. 21 debate<\/a>, where Janoo and Republican Gov. Phil Scott pitched their competing visions<\/a> for healthcare reform, Janoo specifically cited Hoyt\u2019s job.<\/p>\n \u201cIn Tunbridge, for example,\u201d Janoo said, \u201ctheir community nurse is just a municipal employee, and that ensures that everybody has some sort of local healthcare. And I love that model, right?\u201d she said.\u00a0<\/p>\n The shoutout came as a surprise. \u201cOh, I had no idea!\u201d Hoyt said the next morning, smiling as she read a text from a friend letting her know about it.<\/p>\n Mostly she keeps her head down and focuses on the work. \u201cI help everyone,\u201d she said. \u201cI\u2019m trying to reach the demographic that doesn\u2019t see a doctor regularly, whether that\u2019s college students or the elderly, for whatever it may be.\u201d<\/p>\n Hoyt said she started the program in Tunbridge in 2022 after refining her pitch to the town more than once. She\u2019s since grown it to 12 hours a week, from the original five to eight hours. A year ago she expanded to Chelsea, where she grew up, and now works 10 hours a week there as well.\u00a0<\/p>\n Spending a college semester in Botswana first exposed Hoyt, then a young nursing student, to the idea of community nurses \u2014 a caretaker who is deeply embedded in the community. She loved the concept, which has now become her reality, that a nurse might be flagged down at the market or a soccer match to look at someone\u2019s rash or address a concern about an elderly neighbor.<\/p>\n Coincidentally, the idea was already taking root around the same time in Vermont\u2019s Upper Valley, where Hoyt grew up. Community Nurse Connection began as a project in 2010<\/a>. The nonprofit network has evolved to now include 12 community nurse programs in Vermont and five in New Hampshire.\u00a0<\/p>\n Each community approaches the role a bit differently, said Kristin Barnum, the executive director of Community Nurse Connection. Some towns, such as Tunbridge, fund the position as a municipal employee, while others create a nonprofit fund. What\u2019s important, Barnum said, is that the nurses\u2019 services are free to patients and not billed to Medicare or any other insurer.\u00a0<\/p>\n \u201cA lot of people will say to me, \u2018Well, you know, this is such a great idea. Don\u2019t you think it should be billable?\u2019 and my quick answer is no,\u201d Barnum said.<\/p>\n The salary model gives the community flexibility to administer care broadly. A nurse might sit and talk with a patient for half an hour about nutrition or help them sign up for food assistance. The nurse can develop a care plan according to the patient\u2019s own goals, rather than seeing them for a set number of visits in a set number of weeks to meet goals defined by a doctor or insurer.<\/p>\n It also means that anyone can refer a patient to a community nurse, whether that\u2019s another healthcare professional discharging a patient from the hospital, a person worried about their aging parent or someone recognizing a need for help themselves.\u00a0<\/p>\n But the funding model also limits the amount of direct care the nurses can give. Because they are not under any physician\u2019s orders, community nurses cannot perform hands-on care the way a home health nurse billing Medicare would.<\/p>\n Katie Williams, Hartford\u2019s community nurse, calls her approach \u201cslow medicine.\u201d\u00a0<\/p>\n The ability to tailor the care to patients\u2019 needs over time enables relationships to build, \u201cwhich allows for trust, which allows for really understanding the patient\u2019s complexity,\u201d Williams said. \u201cWhat I like to say is (we get) the ecology of their whole health picture.\u201d<\/p>\n On average, Williams spends an hour per visit with each of her patients, who normally number about 45. She supplements that work with daylong drop-in clinics at Hartford\u2019s senior center.\u00a0<\/p>\n The town is able to connect with Dartmouth Hitchcock Medical Center to see patients\u2019 records and medication lists and help coordinate ahead of medical appointments, Williams said.<\/p>\n \u201cI like to say that the community nurse role is this hybrid between social care and personal health. The line between those two is so thin and perhaps even invisible,\u201d she said.\u00a0<\/p>\n Hoyt sees her role as more directly clinical than a social worker\u2019s.\u00a0<\/p>\n \u201cI\u2019m always evaluating. I can\u2019t turn it off,\u201d she said of her tendency to be attuned to symptoms no matter the context. \u00a0<\/p>\n Hoyt cites an example. While addressing the patient\u2019s mobility issues in a home visit, Hoyt noticed that the woman\u2019s husband had what looked like a large melanoma on his chest where his shirt was unbuttoned. When Hoyt asked about it, he brushed it off, she said. But with some persuading and his eventual permission, Hoyt sent a picture to a dermatologist friend, who confirmed Hoyt\u2019s concern. He needs to get that removed as soon as possible, Hoyt remembers the friend saying.\u00a0<\/p>\n But the husband didn\u2019t have a doctor to make the needed referral. So Hoyt helped him fill out the paperwork to establish a relationship with a primary care provider. The couple had no internet at their house, so when it was time for the husband\u2019s virtual care visit, Hoyt set up her phone for him to take the call. She walked him through each step to eventually get the melanoma removed.<\/p>\n \u201cI don\u2019t think anyone else would have caught it,\u201d she said. It was only because she was in the home and able to shift her responsibilities beyond the one patient that she was able to help, she said.<\/p>\n Catching cancers early can avert much more costly care later. Reducing the need for hospital care and 911 calls is one of the community nurse program\u2019s biggest selling points.<\/p>\n \u201cMany of these clients, especially if they live alone, if they fall, they call 911, even if there\u2019s no physical injuries,\u201d Barnum said. Medicare doesn\u2019t reimburse<\/a> emergency medical services if they do not take a patient to the hospital, so often the patient goes to the emergency room. Barnum said community nurses have averted those kinds of calls by removing fall risks \u2014 such as installing handrails or ramps.\u00a0<\/p>\n In Hartford, Williams\u2019 job is housed within the fire department. The department connects her with residents who have had multiple nonreimbursed falls \u2014 usually people who are not taken to the hospital. The department also turns to Williams when staff respond to a call and see red flags in the home, such as a lack of heat or signs of dementia.\u00a0<\/p>\n Older patients sometimes call 911 because they\u2019re lonely and scared, Barnum added. But knowing a visit with the nurse is on the calendar can lower their anxiety and avert calls.\u00a0<\/p>\n In Tunbridge, Town Clerk Bonnie McCrillis sees Hoyt\u2019s role as invaluable.\u00a0<\/p>\n \u201cTo be honest with you, just here in Tunbridge, Jodi could be kept busy eight hours, 10 hours a day, six, seven days a week,\u201d McCrillis said. \u201cIf she could clone herself three times, I think she would have a good start on being able to service the people like she would like to.\u201d<\/p>\n