Nursing home to home pilot program: Supporting Veterans by facilitating and monitoring return to the community

Abstract: OBJECTIVES: As the US veteran population rapidly ages, the Department of Veterans Affairs (VA) is exploring innovative approaches to ensure veterans age at home. In 2023, the VA developed the Nursing Home to Home (NHTH) pilot program to assist veterans living in VA-paid community nursing homes (CNHs) to be discharged home. This article describes NHTH cost savings and veteran and caregiver satisfaction with NHTH. DESIGN: Prospective cohort design for cost analyses and cross-sectional design for surveys and interviews. SETTING AND PARTICIPANTS: Cost analyses were conducted through analyzing 24 veterans discharged from CNHs through NHTH across 3 VA Medical Centers. Forty-one satisfaction surveys were administered to veterans 30 days post discharge from CNH. Interviews were conducted with 13 veterans discharged from CNHs or their caregivers. METHODS: Total VA-provided and -purchased costs were captured during 30-day intervals: 4 prior- and 4 post-NHTH discharge. Inpatient, outpatient, and VA Geriatrics and Extended Care cost components were also tracked. Benchmark comparison costs were tracked for veterans organically discharged from CNHs in Fiscal Year 2022. We applied thematic analysis to analyze veterans' and caregivers' satisfaction surveys and interview data. RESULTS: The average cost savings of long-term services and supports (LTSSs) of 24 NHTH-discharged veterans were, on average, $5496 per veteran per month (equivalent to $65,952 per veteran per year). Benchmark results showed approximately $5000 to $6000 lower costs per 30-day increment on average than veterans remaining in CNHs. Surveys and interviews showed veterans and their caregivers were highly satisfied with NHTH. LTSSs received post discharge allowed for support to keep veterans safe. CONCLUSIONS AND IMPLICATIONS: The VA NHTH pilot program shows promise in ensuring veterans placed in CNHs can transition safely to age in the community, with potentially substantial cost savings to the VA. This is important, as VA costs for long-term institutionalization are projected to double by 2037.