The Nursing Home to Home (NHTH) Team is being recognized in Category 3: Using Innovation, Data, and Breaking Down Organizational Barriers for creating a scalable, Veteran-centered solution that helps older adults safely transition from institutional care back to their homes - restoring independence, reuniting families, and saving more than $1.3 million in care costs.

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Launched in 2024 across three VA Medical Centers (Cleveland, OH; Houston, TX; and Muskogee, OK), the NHTH Pilot Program combines clinical expertise with intensive care coordination to identify Veterans who can safely return home or move to less restrictive settings.

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Staffed by a Registered Nurse and Licensed Social Worker, the team conducts comprehensive assessments, engages families, and removes barriers to care. Their compassionate, Veteran-centered approach has already enabled the safe discharge of 20 Veterans, improving health outcomes while generating over $1.3 million in savings. Participants report profound benefits, with 94% noting improved life satisfaction and 91% reporting improved mood.

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Designed to be replicated across the VA system, NHTH represents a cost-effective, person-centered model that delivers better health, greater dignity, and the freedom for Veterans to age at home, where they want to be most.