Reducing Institutionalization Among Older Veterans With the VA Choose Home Program

Key Takeaways:

• The US Department of Veterans Affairs (VA) Choose Home initiative was developed to support the growing number of older veterans at risk of long-term institutionalization.
• Veterans enrolled in the Choose Home program spent fewer days in nursing homes and had fewer emergency care visits, with most transitioning to home-based or outpatient care rather than skilled nursing facilities after discharge.
• Choose Home generated a net return of more than $7.2 million through cost-avoiding and reimbursement practices, highlighting the financial stability of the program.

The number of older US veterans eligible for VA-financed long-term care is projected to increase by 500% over the next decade, highlighting the growing population of veterans at risk of institutionalization.

The VA Choose Home Program is an interdisciplinary home-based care model developed to address gaps in care for older veterans by reducing acute care utilization and long-term institutionalization.

To be eligible for the program, veterans had to be aged 65 years or older and be at risk of nursing home placement. The Choose Home interdisciplinary team—composed of a geriatrician, nurse practitioner, nurses, social workers, and an occupational therapist—offered comprehensive geriatric assessment, safety evaluations, and case management.

Researchers assessed the program’s impact on acute care episodes, nursing home stays, and return on investment (ROI).

Over 2 years, Choose Home enrolled 305 veterans, who participated in the program for a mean of 99.8 days.

The program was estimated to have prevented 95 acute care episodes and 7146 nursing home bed days. Most participants transitioned to home-based or outpatient care after discharge, with only 4.9% of patients discharged to skilled nursing facilities.

A 12-month follow-up analysis found that the program was associated with 56% fewer emergency department visits and 37% fewer hospitalizations.

Choose Home yielded a net return of more than $7.2 million and an ROI of 239%, supporting the program’s potential financial sustainability.

Implications for Veteran Care

These findings highlight the potential of the Choose Home program to support older veterans by reducing long-term care utilization.

According to the authors, “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.”

Reference

Madrigal C, Makela M, Nothern A, et al. VA choose home program: an intensive geriatric home-based model of care. J Am Geriatr Soc. 2026. doi:10.1111/jgs.70595