Can I eat grapefruit?"

48% less often

Among WellAWARE clients of at least 6 months, non-emergency ER visits are down by nearly half

Dorothy Bishop, 71, wanted to know. She’d heard, she told community health nurse Betsy Peyton (BSN ’98), that eating the acidic fruit might interfere with her medications. Kneeling on the floor in Bishop’s living room, Peyton laid it out.

Better to lay off grapefruit, she told Bishop, who lives in a subsidized basement apartment in an old Scottsville elementary school, because it can interfere with the stomach’s natural enzymes and cause too much or too little of her medicines to be absorbed.

[VIDEO] Meet Betsy Peyton (BSN ’98), founder of WellAWARE

Peyton changed topics amiably. How was Bishop’s foot pain? Were her medications organized? Did her neighbor’s bathroom finally get fixed, or was he still showering at Bishop’s apartment? And had the mildew problem gotten any better?

WellAWARE staff organize medications, offer nutrition counseling, purchase AC units, and intervene with difficult landlords. They give rides to food banks and pharmacies, pass out $25 gas and grocery cards, figure out what to do if the electricity or water’s been cut off, or handle dealing with a snake in the house.

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The questions were all part of a home visit with Bishop, one of about 60 clients that Peyton and community health workers Deanna Harris and Tracy Cooper regularly see across Charlottesville, Southern Albemarle, Western Fluvanna, and Northern Buckingham counties. Targeting people who frequently use local emergency rooms for low-acuity health problems while avoiding preventative primary care, WellAWARE’s two-year–old goal is to be the connective tissue between high-need clients’ often low-tech, high-touch needs. Like the grapefruit guidance.

“Maybe you’re not hanging an IV like you’d do in a hospital,” said Peyton, the pilot program’s founder, “but you’re talking about some really important stuff.”

WellAWARE’s three staffers are professional problem solvers who help their clients overcome entrenched barriers to good health and healthcare. Along the way, they organize medications, offer nutrition counseling, purchase AC units, and intervene with difficult landlords, among other things. They give rides to food banks and pharmacies, pass out $25 gas and grocery cards, figure out what to do if the electricity or water’s been cut off, or handle dealing with a snake in the house.

Zeroing in those who might otherwise fall through the cracks, WellAWARE’s help is grass roots, person-to-person, and in the form, depth, and breadth that clients want.

So how does Peyton know? Because she asked.

For the first nine months of 2021, Peyton knocked on doors, chatted on porches, attended neighborhood association meetings, and really tuned in. Guided by census-tract maps showing areas where citizens were frequently turning to emergency rooms for primary care, Peyton’s approach built trust and gave community members ownership of the project’s direction.

“Maybe you’re not hanging an IV like you’d do in a hospital, but you’re talking about some really important stuff.”

Betsy Peyton (BSN '98) founder of WellAWARE

Begun as a collaboration among founding organizations including the Charlottesville Free Clinic, UVA Primary Care, and Central Virginia Health Services, WellAWARE today offers help that’s both adjacent and tailored to these groups' and clients’ real-time needs. The care is both intimate and expansive. Peyton, Harris, and Cooper do house calls, the kind of nursing Peyton was drawn to early on.

As a student at UVA, Peyton had loved her mental health clinical rotation and was inspired by assistant professor and mentor Vickie Southall (MSN ’85), who, she said, "taught and led by her own example." After becoming a nurse, she worked in group homes, with dementia patients, on a locked psychiatry unit, finding “a passion and a calling for being with people when they’re not at their best.”

“I really respect the dignity of people when they’re struggling,” Peyton said. “Psychiatric nursing is a field where you’re often called just to be with people and hear their stories . . .  I’ve always appreciated the therapeutic value of listening to people’s stories.”

Just shy of its three-year birthday, WellAWARE’s story already speaks volumes: clients who’ve been with the organization for at least six months now use the emergency room 48% less often and are hospitalized 30% less frequently. Peyton, who hopes to secure funding to continue and expand the program, sees its value to human beings and hospitals’ bottom lines in real time.

“When the healthcare system saves money, it’s good for everyone, across the board. But that’s not what I wake up most excited about.” Peyton said. “It’s the benefits to the community, to our neighbors, to local families and individuals that makes this work so worthwhile. It really works.”

Curious about the work WellAWARE does? Visit the organization's web site. As WellAWARE grows out of its initial pilot phase, Peyton looks forward to welcoming nursing students for their community health clinical rotations.