Visiting Nurse Home Care & Hospice of Carroll County Welcomes New Directors

June 25, 2021

Visiting Nurse Home Care & Hospice of Carroll County (VNHCH) recently announced the addition of two new leaders to their organization. Julie Limmer, APRN, FNP-C joins the agency as Director of Hospice and Palliative Care. Kelly Peckham, RN has been promoted to the role of Clinical Director. These two new positions were created to support VNHCH’s mission to provide exceptional home health care enabling independent living and quality of life for their clients and their families. 

Kelly Peckham, RN was well-positioned to assume the role of Clinical Director after her predecessor required an extended medical leave in 2020. Kelly had been working as Clinical Coordinator, but quickly took on additional duties to meet the need. She started with VNHCH in 2016 as a case manager field nurse, giving her a well-rounded background to her newly expanded job. “(VNHCH) has given me many opportunities to move up. They have been supportive, encouraging learning and growth,” Kelly explained. “I’ve found a niche in home care. I enjoy being in the client’s home which is different from in-patient care. With home care, you get to educate the client and build a relationship – another difference from working in a hospital or other facility.”

As Clinical Director, Kelly oversees clinical staff and operations, a challenging and critical function for a visiting nurse operation. She manages the logistics and clinical direction of the entire clinical team, including dozens of nurses, physical therapists, occupational therapists, homemakers and licensed nursing assistants.

It’s more than scheduling. She also screens incoming patients for appropriateness of services, ensuring that their needs meet the criteria for home care.  But an even more important responsibility is her teaching and mentoring clinical staff in the process and requirements of home care. 

“I work with the team to teach them to manage a caseload in home care, helping them through the process. I can see the big picture and work with others to see the same in terms of their case management load,” Kelly continued. When you consider the number of patients each person manages, the variety of conditions and acuity, and the physical distance to be covered, it’s easy to see the importance of this coordination. “Home care is getting more complex, including documentation and insurance requirements. Clients are sicker and staying in the hospital for shorter stays and coming home in a more acute state.”

Kelly is excited to see the agency create this Director level position, focused exclusively on clinical care. “Having a 100% focus on skilled and long-term care services will help us be more successful.”

Julie Limmer, APRN, FNP-C, shares Kelly’s enthusiasm for this new direction for VNHCH. A 30-year resident of Mount Washington Valley, Julie recently graduated from Georgetown University School of Nursing in 2020 and passed her Family Nurse Practitioner exam. Not long after, she applied for the Hospice Director position, wanting to support patients and families to live healthfully, independently and to look for ways to increase their quality of life.

Earlier in her career, she worked as a registered nurse in long-term care at Merriman House in North Conway after getting her RN at White Mountain Community College and BS from Saint Joseph’s College of Maine. “My inspiration to enter the nursing field sparked from providing care for friends and family and has remained focused on helping community members get the care they need at home when facing chronic illness. I truly aspire to work where I can use my skills and create a health care system that serves not only in the hospital and office but at home as well.”

Julie’s personal direction synchronizes well with the direction of VNHCH. The agency has identified the growth of palliative care and hospice as part of the organization’s strategic plan. “Our community is aging, and there is growing demand for hospice and palliative care in the region.  We realized we needed to invest in a full time director-level leader for hospice and palliative care to make this a reality. When we met with Julie we realized we found the right person for the role, and better yet, she was already living here and bonded with our community,” stated VNHCH Executive Director Sandy Ruka, RN. 

As part of that strategic growth, Julie hopes to work closely with her agency peers but also with the local medical community. Julie stated, “I look forward to reaching out to providers in order to create a more fluid transition to palliative care and hospice for those in need, assisting in maintaining continuity of care as a patient transitions in their health care needs and goals, from hospital and office visits to a more “in-home,” quality, and comfort-focused care.”

“I hope to develop more of an understanding of what palliative care and hospice is. It’s a mystery to a lot of people. For instance, palliative care is a caregiving approach aimed at optimizing the quality of life of those with chronic complex illnesses. I want to strengthen our connections with the providers in the community in order to help develop those conversations with patients about hospice and palliative care. I’d like to see providers refer to these services, just like they do with services such as physical therapy. We need to be an integral part of their care.” She emphasized that their role is as a collaborator with the patients’ primary care providers, not a replacement.

Julie looks forward to being part of the VNHCH team and continuing to support programs such as Crossings, their childhood bereavement group “Crossings is amazing. It’s so important. We need to raise awareness of the program and help people. I’m interested in how it uses art and music as part of the healing.”  Julie’s master’s research project focused on arts and dementia and children’s expression of emotions. Her preceptor was VNHCH board member, Sue Ruka, RN, PhD. 

Julie and Kelly are both RNs and illustrate the possible career paths for nurses. During May, National Nurse Month, they serve as inspiration for others who bring their unique skills to care for their community.

For more information on hospice, palliative care and clinical care services, go to or call 603-356-7006.