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VA Choose Home Program: An Intensive Geriatric Home-Based Model of Care
Caroline Madrigal1, Meghan Makela1, Alexandra Nothern1
1VA Boston Healthcare System, Boston, Massachusetts, USA.
Journal of the American Geriatrics Society
|August 15, 2026
Summary
The Choose Home program successfully reduced acute care and nursing home placements for older Veterans at risk. This innovative model provides cost-effective, high-intensity case management, supporting aging in place.
Area of Science:
- Gerontology
- Healthcare Management
- Public Health
Background:
- The population of Veterans aged 85+ requiring long-term care is projected to increase by 500% in the next decade.
- A care gap exists for older Veterans at risk of institutionalization between acute and long-term care services.
- The Choose Home program was developed to address this gap by preventing avoidable acute care and institutionalization.
Purpose of the Study:
- To describe the innovative, interprofessional home-based model of care called Choose Home.
- To evaluate the effectiveness of the Choose Home program in preventing institutionalization and acute care episodes.
- To assess the financial sustainability and return on investment of the Choose Home model.
Main Methods:
- Eligible participants were multicomplex Veterans aged 65+ at imminent risk of nursing home placement.
- An interdisciplinary team (geriatrician, NP, RNs, social workers, OT) provided comprehensive geriatric assessment, management, safety evaluations, and case management.
- Primary outcomes measured included prevented acute care episodes, avoided nursing home bed days, interventions, and return on investment.
Main Results:
- The two-year pilot served 305 Veterans, preventing an estimated 95 acute care episodes and 7146 nursing home bed days.
- Only 4.9% of participants required skilled nursing facility placement post-discharge; most transitioned to home-based or outpatient care.
- The model demonstrated significant financial sustainability with a net return over $7.2 million (239% ROI) through cost avoidance and reimbursement.
Conclusions:
- The Choose Home model effectively bridges the gap in home and community-based care for older Veterans.
- This time-limited, high-intensity case management approach rapidly stabilizes complex older Veterans.
- The sustainable, interprofessional model supports aging in place and reduces costly institutional care, offering a scalable strategy.
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