Betsy Peyton is a community health nurse in Virginia who founded WellAWARE, a program that connects high-tech medicine with clients’ low-tech, high-touch needs—the grassroots, person-to-person program zeroes in on those who might fall through the cracks.
Peyton and two other community health workers regularly visit about 60 clients across central Virginia, focusing on people who frequently use local emergency rooms for low-acuity health problems while avoiding preventative primary care.
During a recent visit with her patient, Dorothy Bishop, Peyton was asked if eating grapefruit would interfere with her medications. Peyton advised avoiding grapefruit because it can hinder the stomach’s natural enzymes and cause too much or too little of her medicines to be absorbed. The discussion then went to Bishop’s foot pain and whether her landlord had resolved a mildew issue in her apartment.
WellAWARE is just shy of its third anniversary and has already shown great results, with clients using the emergency room 48% less often and being hospitalized 30% less frequently for at least six months. Peyton hopes to secure funding to continue and expand the program and sees its value to humans and hospitals’ bottom lines in real-time.
Daily Nurse proudly names Betsy Peyton the Nurse of the Week for using home visits to build relationships with patients and her appreciation of the therapeutic value of listening to people’s stories to help clients overcome entrenched barriers to good health and healthcare.
Peyton and WellAWARE’s staffers are professional problem-solvers who organize medications, offer nutrition counseling, purchase air conditioning units, and intervene with difficult landlords. They also provide rides to food banks and pharmacies, pass out gas and grocery cards, figure out what to do if the electricity or water’s been cut off, and even handle a snake in the house.
As a University of Virginia (UVA) School of Nursing student, Peyton was inspired to pay special attention to the patients who sometimes got overlooked. After becoming a nurse, Peyton worked in group homes with dementia patients in a locked psychiatry unit and found a passion for being with people when they’re “not at their best.”
“I love going on visits and reminding myself of how great and rewarding it is to sit with someone. Sometimes, people who are not at their best bring about healthy outcomes through this. It’s not hanging IV, but you’re talking about important stuff and motivating change. Sometimes you’re strengthening their relationship with the health system,” she says.
Peyton says she respects the dignity of people when they’re struggling.
“Psychiatric nursing is a field where you’re often called to be with people and hear their stories. I’ve always appreciated the therapeutic value of listening to people’s stories,” she says.
For most of 2021, Peyton knocked on doors, chatted on porches, attended neighborhood association meetings, and tuned in. Guided by census-tract maps showing areas where citizens frequently turned to emergency rooms for primary care, Peyton’s approach built trust, giving community members a sense of ownership in the project.
“We want people to trust that the system wants what’s best for them, wants to know their stories, and cares deeply about their situations. And so trust is key to trust. It all comes down to trust,” says Peyton.
What began as a collaboration with the Charlottesville Free Clinic, UVA Primary Care, and Central Virginia Health Services, WellAWARE now offers help that augments the groups’ services and the clients’ needs. Peyton and her colleagues do house calls, the kind of care she was drawn to, which has been demonstrated to save money.
“When the healthcare system saves money, it’s good for everyone. But that’s not what I wake up most excited about,” says Peyton. “The benefits to the community, neighbors, local families, and individuals make this work worthwhile. It really works.”
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