{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,15]],"date-time":"2026-08-15T06:26:50Z","timestamp":1786775210495,"version":"build-2736575974"},"reference-count":23,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T00:00:00Z","timestamp":1786665600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T00:00:00Z","timestamp":1786665600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["agsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J American Geriatrics Society"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The population of Veterans aged 85+ eligible for VA\u2010financed long\u2010term 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\u2010based programs. This paper describes Choose Home, an innovative interprofessional home\u2010based model of care developed to prevent avoidable acute care and long\u2010term institutionalization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Multicomplex Veterans aged \u2265\u200965 at imminent risk of nursing home placement were eligible for program enrollment. The interdisciplinary team\u2014geriatrician, nurse practitioner, registered nurses, social workers, and occupational therapist\u2014provided 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Over the two\u2010year pilot period, Choose Home served 305 Veterans with an average enrollment duration of 99.8\u2009days. 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\u2010based 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\u2010post analysis at 12\u2009months follow\u2010up, Veterans had 56% fewer emergency department visits (RR\u2009=\u20090.44; 95% CI\u2009=\u20090.23\u20130.83) and 37% fewer hospitalizations (RR\u2009=\u20090.63; 95% CI\u2009=\u20090.41\u20130.99) in the 121 to 180\u2009days after program admission.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The flexible Choose Home model successfully fills a gap in the home and community\u2010based care continuum by providing time\u2010limited, high\u2010intensity case management to rapidly stabilize multicomplex older Veterans. This sustainable, provider\u2010led interprofessional approach offers a scalable strategy to support aging in place and reduce costly institutional care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.70595","type":"journal-article","created":{"date-parts":[[2026,8,15]],"date-time":"2026-08-15T05:38:43Z","timestamp":1786772323000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["<scp>VA<\/scp>\n                    Choose Home Program: An Intensive Geriatric Home\u2010Based Model of Care"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8182-4276","authenticated-orcid":false,"given":"Caroline","family":"Madrigal","sequence":"first","affiliation":[{"name":"VA Boston Healthcare System  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meghan","family":"Makela","sequence":"additional","affiliation":[{"name":"VA Boston Healthcare System  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Nothern","sequence":"additional","affiliation":[{"name":"VA Boston Healthcare System  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wendy","family":"Abrams","sequence":"additional","affiliation":[{"name":"VA Boston Healthcare System  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Howe","sequence":"additional","affiliation":[{"name":"VA Providence Healthcare System  Providence Rhode Island USA"},{"name":"Warren Alpert School of Medicine at Brown University  Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4318-7373","authenticated-orcid":false,"given":"Daniel","family":"Harris","sequence":"additional","affiliation":[{"name":"VA Providence Healthcare System  Providence Rhode Island USA"},{"name":"Department of Epidemiology, College of Health Sciences University of Delaware  Newark DE USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malisa","family":"Barber","sequence":"additional","affiliation":[{"name":"VA Providence Healthcare System  Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Halladay","sequence":"additional","affiliation":[{"name":"VA Providence Healthcare System  Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"VA Boston Choose Home Team","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James L.","family":"Rudolph","sequence":"additional","affiliation":[{"name":"VA Providence Healthcare System  Providence Rhode Island USA"},{"name":"Warren Alpert School of Medicine at Brown University  Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane A.","family":"Driver","sequence":"additional","affiliation":[{"name":"VA Boston Healthcare System  Boston Massachusetts USA"},{"name":"Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,14]]},"reference":[{"key":"e_1_2_12_2_1","unstructured":"Disabled American Veterans \u201cLong\u2010Term Care Issue Brief \u201d 2025 accessed December 18 2025 https:\/\/www.dav.org\/wp\u2010content\/uploads\/Long\u2010Term\u2010Care\u2010Issue\u2010Brief\u20102025.pdf."},{"key":"e_1_2_12_3_1","unstructured":"United States Department of Veterans Affairs \u201cVA Strategic Plan 2022\u20132028 \u201d 2022 accessed December 18 2025 https:\/\/www.va.gov."},{"key":"e_1_2_12_4_1","unstructured":"US Government Accountability Office \u201cVA Health Care: Veterans' Use of Long\u2010Term Care Is Increasing and VA Faces Challenges in Meeting Demand \u201d 2020 accessed December 18 2025 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