Virginia at Home Program (VaH)

The VaH team offers person-centered care for older adults with complex multimorbidity


Virginia at Home (VaH) is UVA Health’s flagship home-based primary care (HBPC) program for older adults living with complex medical concerns and needs who are confined to their home, assisted living, or memory care facility due to medical, functional, and/or cognitive difficulties.

VaH is designed to bring UVA Health care to the homebound patient’s doorstep to improve quality of care while reducing avoidable hospitalizations. The VaH team makes house calls to participants’ homes throughout Charlottesville and its surrounding counties, as well as to select assisted living and memory care facilities in the Charlottesville area. Instead of office-based care, VaH focuses on person-centered, holistic care that revolves around the patient. VaH clinicians partner with patients and their loved ones and caregivers to augment medical care at their home or facility.

VaH currently serves homebound participants living in the city of Charlottesville, and in Albemarle, Greene, Madison, Orange, Louisa, Fluvanna, Nelson, Buckingham, Augusta, and Rockingham counties. VaH also serves assisted living and memory care residents of The Blake Senior Living, Rosewood Village Greenbrier, Linden House, and Our Lady of Peace.

For homebound persons, which number in the millions across the United States, HBPC is a model that has been shown to improve the quality of care and patient satisfaction by bringing primary care directly to patients’ homes and communities. HBPC programs have also significantly reduced participants’ need for emergency department visits and hospitalizations.

VaH believes in comprehensive, person-centered primary care that is responsive and equitable. We offer the following services to enrolled participants:

  • Regular House Calls to streamline care and prevent avoidable acute care utilization
  • Caregiver Support and education through house calls, telehealth visits, and referrals to existing community resources
  • Telehealth Visits to extend VaH into rural communities and to allow frequent contact
  • Advance Care Planning to document and support participants’ care goals

 

 

 

Justin Mutter, MD

Medical Director

Ava Thomas, MD

Geriatrician

Karen Duffy, AG-ACNP

Nurse Practitioner

Pamela Tetro, FNP-C, CDCES

Nurse Practitioner

Jeanette Johnson, BSN, RN

RN Care Coordinator

Jessica Knight, BSN, RN

RN Care Coordinator

Jack Hooppaw, MSW

Population Health Case Manager

Ralph Watson

Population Health Specialist
Post-Acute Liaison
Email: rjw2j@uvahealth.org
Tel: 434.982.2035*
*This number should not be called for clinical purposes