VA Choose Home Program: An Intensive Geriatric Home-Based Model of Care

The population of Veterans aged 85+ eligible for VA-financed long-term care will increase 500% over the next decade. Our team recognized a gap in care for older Veterans at risk of institutionalization between our acute and longitudinal home and community-based programs. This paper describes Choose Home, an innovative interprofessional home-based model of care developed to prevent avoidable acute care and long-term institutionalization.

Multicomplex Veterans aged ≥ 65 at imminent risk of nursing home placement were eligible for program enrollment. The interdisciplinary team-geriatrician, nurse practitioner, registered nurses, social workers, and occupational therapist-provided Veterans with comprehensive geriatric assessment and management, safety evaluations, and case management. Primary outcomes included acute care episodes prevented, nursing home bed days avoided, interventions provided, and return on investment.

Over the two-year pilot period, Choose Home served 305 Veterans with an average enrollment duration of 99.8 days. Program interventions prevented an estimated 95 acute care episodes and 7146 nursing home bed days. At discharge, only 4.9% of participants required skilled nursing facility placement, while most transitioned to home-based primary care or standard outpatient management. The model demonstrated financial sustainability, generating a net return of over $7.2 million and an ROI of 239% through cost avoidance and reimbursement. In an exploratory pre-post analysis at 12 months follow-up, Veterans had 56% fewer emergency department visits (RR = 0.44; 95% CI = 0.23-0.83) and 37% fewer hospitalizations (RR = 0.63; 95% CI = 0.41-0.99) in the 121 to 180 days after program admission.

The flexible Choose Home model successfully fills a gap in the home and community-based care continuum by providing time-limited, high-intensity case management to rapidly stabilize multicomplex older Veterans. This sustainable, provider-led interprofessional approach offers a scalable strategy to support aging in place and reduce costly institutional care.