WHITE RIVER JUNCTION — Joan Ponzoni wasn’t feeling well when she arrived at the Bugbee Senior Center one day in January.

Staff at the White River Junction senior center connected Ponzoni with Hartford’s new community nurse Katie Williams, who took Ponzoni’s blood pressure and discovered it was too low.

“She said, ‘Let’s go for a walk,’ ” Ponzoni, 73, recalled about her meeting with Williams.

The two then strolled outside in the area surrounding the senior center in downtown White River Junction.

“It’s different. It’s more personal,” Ponzoni said about her experience with Williams.

It was the first time a health care provider had done something like that for her, she said. Instead of simply telling Ponzoni that she needed to exercise, Williams literally took those first steps with her.

That personal touch has contributed to the establishment of more community nurse programs in the Upper Valley.

On the New Hampshire side of the region, Lebanon, Hanover and Lyme have programs, while Enfield is in the process of establishing one, according to a list of providers from Community Nurse Connection, a nonprofit organization that assists community nursing programs and nurses themselves in the Twin States.

On the Vermont side of the Upper Valley, Hartland, Norwich, Reading/West Windsor (which share a program), Thetford, Strafford and Tunbridge have programs. Windsor and Chelsea are in the process of establishing them.

“I always say it’s going back to holistic nursing,” Kristin Barnum, executive director of Community Nurse Connection, said in a phone interview. “It’s just a nurse who’s embedded in the community caring for neighbors.”

Barnum’s organization helps communities assess nursing programs and offers data support, which helps nurses keep records.

Community nurse programs in the Upper Valley, on average, cost about $30,000 per year, Barnum said. Nurses are typically paid an hourly wage ranging from $26 to $58, with the majority making around $40 an hour without health care benefits. Part-time hours range from 10 to 25, with the majority working around 15 hours per week. Hartford is on the higher end, with $54,600 budgeted for the current fiscal year, according to the annual Town Report.

Hartford voters approved funding for the community nurse, which is under the purview of the Fire Department, at the March 2024 Town Meeting.

Williams started her role in Hartford in December after serving for six years as Hartland’s community nurse. She works 25 hours a week and visits nine to 10 clients each week, in addition to holding open hours at Bugbee Senior Center.

“She calls me at home to see if I’m OK,” Ponzoni said. “She’s just a wonderful person and she’s very caring.”

As of April 2, Williams had 46 referrals and 28 clients — nearly double from the numbers from late February: 27 referrals and 16 active clients.

“There’s been a lot of growth,” Hartford Fire Chief Scott Cooney said. “We’re happy to see that she’s meeting the needs of the community.”

The programs help people age in place, Barnum said. They also work with clients to make changes in their homes or lifestyles that may lead to fewer hospitalizations. For example, a community nurse may notice that a client has balance challenges, which puts them at higher risk of falling and getting hurt. A nurse who visits their home could suggest places to install grab bars to make it easier to get in and out of the shower.

“This is a very unique kind of nursing that seasoned nurses are very interested in, because without the burden of a lot of the Medicare, Medicaid regulations they’re free to do what we call ‘old fashioned nursing.’ They spend less time on documentation and more time with the client and they like that,” Barnum said.

The majority of people that community nurses see are older adults. Many have chronic conditions that they need help managing, but do not qualify for visiting nurse services through insurance because they aren’t considered sick enough.

Community nursing is different: Services are free for community members and do not take insurance payments. Some are funded by taxpayers through town budgets while others operate using donations and grant funding. Nurses do not provide direct care, Barnum emphasized, meaning they cannot perform tasks such as changing bandages or administering fluids. They can, however, help someone organize their medication, connect them with social services and communicate with family members.

“A lot of what we do is companionship and relationship building,” Williams said to a packed room at the Bugbee Senior Center in February.

A Hartford resident herself, Williams appreciates that she can serve her town and does not have to work within the bounds of the traditional health care system. To Williams, this means, in part, that she can go on walks with clients like Ponzoni and provide an ear to people who just want to talk about their daily challenges — things that aren’t covered by insurance.

“It feels like we’re making an impact and we’re walking alongside people in their journeys,” Williams said. “We get to really understand their whole experience with their health.”

That’s something Missy Ball, one of Lyme’s two part-time parish nurses, appreciates. Building trust with clients is essential and Ball, of Enfield, said it can take multiple tries to get someone to be open to accepting help.

“It’s slow going, but when that trust is there it’s so nice,” said Ball, who joined the Lyme program in October 2021 and works 15 hours per week. “You know these are your people and you’re trying to help them.”

Ball has been a nurse for almost 40 years and during that time worked in operating rooms and as a visiting nurse, among other positions. Community nursing gives her a freedom she hasn’t experienced in other settings.

“If they want to talk to you about something, they can,” Ball said. “You can be there as long as you want.”

The Lyme Congregational Church started the Lyme Parish Nurse program in 2007, and the yearly budget is around $60,000 per year — funded by private donations and grants.

An important part of a community nurse’s role is understanding a client’s family system and their daily rhythm, “what it means to wake up every morning and go into their kitchen and sit in their chair,” Williams said.

It allows the nurse to get a full picture of someone’s health, beyond what they could see in a doctor’s office or another clinical setting.

Seeing patients at home can help nurses recommend some relatively minor adjustments to help improve people’s health and safety.

“It could mean installing grab bars,” Williams said. “It could mean getting whole wheat bread instead of white bread.”

As she looks ahead to the future of Hartford’s program, Williams wants to get more community members involved to provide mutual aid to residents. That could involve setting up volunteer networks in each of Hartford’s five villages who are willing to run errands, provide transportation and shovel walkways, among other tasks.

“Involving able-bodied people to help with simple tasks (can) go a long to way to keep someone safe and independent at home,” Williams said.

Liz Sauchelli can be reached at esauchelli@vnews.com or 603-727-3221. Jennifer Hauck can be reached at jhauck@vnews.com.