Rats had invaded the kitchen of an elderly woman's home in rural Sharon by the time Dena Wilkie first visited two years ago. A family member had asked Wilkie, the town's community care coordinator, to check on the woman, who was then 86 and used a wheelchair.

Wilkie has returned to the woman's home hundreds of times since. She found her client a weekly house cleaner and made sure her food was properly stored, which resolved the rat infestation. She had smoke and carbon monoxide detectors installed, enlisted a volunteer to shop for the woman once a week, and arranged for mail to be delivered directly to her door.

Wilkie even took her client to a neurologist for the first time in years. When the woman was diagnosed with dementia, Wilkie helped her through an arduous state application for at-home long-term care services. Seven Days is not identifying the woman.

Once isolated, the woman today has caregivers five days a week. "She would not be able to still live at home if it wasn't for me," Wilkie said matter-of-factly.

Wilkie's job is an unfamiliar one to most Vermonters. She is neither a visiting nurse nor a state employee, but a town-based, locally paid health care outreach worker and advocate. In some of the other 13 Vermont municipalities with a similar program, the position is called "community nurse." In either case, the workers assist residents, usually elderly, by linking them to services they need to remain in their homes.

Community nurses offer a local, low-cost service in towns with growing senior populations, filling a gap in the state's fragmented and expensive health care system. This year, Vermont legislators are being asked to expand the community nurse model, which advocates argue would not only improve older Vermonters' quality of life but also save the state money by offering consolidated and cost-saving preventative care.

"When you look at the aging population and the strong will of older Vermonters to stay home, community nurses are really helping people to get what they want," said Kristin Barnum, executive director of the nonprofit Community Nurse Connection.

Across the state, doctors have been disappearing from rural towns for decades, leaving behind mostly elderly patients without a nearby primary care provider. And Vermont's aging population is only growing. By 2030, one in three Vermonters will be over age 60.

Older Vermonters' desire for independence can be challenging and dangerous, especially for those who do not qualify for more traditional health care options such as visiting nurses.

That's when community nurses and care coordinators can step in, without cost to those they serve. They meet with patients in their homes to assess their health needs, advocate on their behalf and refer them to resources. They can help patients apply for fuel assistance, shop for groceries and even sell a car they no longer need.

"They're basically liaisons. They're a bridge between health and social services and the community," said Jan Carney, associate dean for public health and health policy at the University of Vermont Larner College of Medicine.

Community nurses and care coordinators tend to be trusted local residents. They rely on referrals from neighbors or families of patients. Because they do not work under a doctor, they cannot provide skilled nursing services, such as wound care, but can arrange for others to do so. While other in-home care providers are limited by reimbursement guidelines, community nurses have no restrictions on eligibility of clients or frequency of contact.

As a result, community nurses and care coordinators are often privy to valuable information that may not come to light in a doctor's office. Regina Downer, a community nurse for six towns in Windham County, was puzzled by a senior patient who had elevated sodium levels. Then she noticed that he was eating more than five cans of a salty soup each week. That's something she wouldn't have learned had she not spent time in his kitchen.

"Doctors don't have the ability to sit inside that person's home to see their loneliness, to see that the refrigerator has two yogurts and a bottle of milk," Downer said.

Community nurses build trust over time. One of Wilkie's patients, a stoic 93-year-old Vermonter who claims he first drove a tractor at age 6, was wary of the health care system. It took Wilkie six months to convince him to go to an eye doctor. Eventually Wilkie helped him through cataract surgery, which allowed him to function independently again.

This model is relatively new to the state. Some employ a community nurse for just 10 hours a week, while others pay for a full-time position. In Tunbridge, the town health officer prompted the selectboard to hire a part-time community nurse. In Hartland, on the other hand, the nonprofit Aging in Hartland employs two full-time community nurses with money from the town and other donors.

Hartland was one of the first towns in Vermont to fund a community nurse. In 2012, two concerned local medical workers — Laurie Harding and Dennis McCullough — formed a group to address some of the health care challenges they were witnessing.

Harding, then a visiting nurse, worried about the safety of patients who lived alone and had been discharged from her care because they had reached the limit of their Medicaid coverage.

"Those people lived at the end of dirt roads, and they were 90," Harding said.

Harding and McCullough decided to try a contemporary riff on a 19th-century practice of "parish nurses" — a model still alive in parts of the state — who were employed by churches. They convinced a handful of towns to try out a secular version of the arrangement.

The experiment was a huge success.

"They demonstrated the effectiveness of the position," Harding said.

Since then, their group, Community Nurse Connection, has become a catchall organization for a number of community nurses in Vermont and New Hampshire. While the organization doesn't directly pay community care providers, it offers support and advice for its member nurses. Since its inception, the group has grown steadily, with community nurses established last year in Stratford and Tunbridge.

Data collected by Community Nurse Connection point to a reduction in hospitalizations, anxiety and loneliness in their patients.

Other towns have noted the success. Hartford's fire chief, Scott Cooney, convinced the town's selectboard to invest $75,000 this year to hire a community nurse. He thinks having one on board could actually save the fire department money. Residents over age 65 account for about half of all ambulance calls, he said.

A bill introduced in the Vermont House of Representatives last year, H.358, seeks to provide small grants for communities that want to employ a community nurse. Cosponsor Rep. James Masland (D-Thetford) hopes the bill will pass this year and would like to lay the groundwork 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 said.

State funding would be useful in Sharon, where Wilkie has worked for the past two years. She puts in 15 hours a week for roughly $35 an hour but could earn more elsewhere with her occupational therapy degree. Wilkie also runs a home modification company called Home and Able, which helps Vermonters age in place. The town contributed about $5,000 this year to her salary, and the rest comes from grants she obtains. Wilkie worries about the sustainability of the program, though, which currently has more than 15 clients. Without her fundraising, it could cease to exist.

The community sees the value of what she does. Last year, the Sharon Congregational Church started paying her to visit older churchgoers. For years, the congregation's minister made those visits, taking the time to chat and check in on their health. But as the congregation searches for a new minister, it has come to rely on Wilkie for home visits.

"A lot of our older seniors miss and remember when the pastor would visit them," Wilkie said.

On a recent Thursday, Wilkie helped the Sharon woman, who is now 88, to refill her time-automated pillbox. As her dementia progresses, the woman has started taking pills at the wrong time.

"I want to stay in my home for as long as I can," the woman told Wilkie, who went over some of the upcoming doctor's appointments she would help her client attend.

Later, on the way to the next home visit, Wilkie reflected on her role in her patients' lives: "I know in my heart that for each one of these people, their quality of life is much better with me and the support that I bring," she said. "I think that they just feel looked after and cared for. Somebody's paying attention."

Correction, January 30, 2024: Wilkie had smoke and carbon monoxide detectors installed for a client. A previous version of this story contained an error.