Caring for older Veterans at home after emergency visits

Approximately half of Veterans enrolled in VA care are over the age of 65. Veterans in this age group are more frequent users of emergency care, and more likely to be readmitted to the emergency department (ED) than younger Veterans.

VA's Age-Friendly Health Systems Initiative aims to provide comprehensive care for older Veterans founded on practices known as the 4Ms: Medication, Mentation, Mobility and What Matters. However, integrating these practices into emergency medicine can be challenging because of the unique needs of older Veterans.

Dr. Colleen McQuown, emergency medicine physician at Louis Stokes VA, developed Supporting Community, Outpatient, Urgent Care & Telehealth Services (SCOUTS) in 2020 after recognizing the need for follow up care to reduce older adult repeat ED visits.

SCOUTS provides at-home care after an ED visit for Veterans at risk for physical, cognitive or functional decline, as well as hospitalization, falls and repeat ED visits.

A deeper understanding through continued care

SCOUTS addresses the challenges of integrating the 4Ms into emergency medicine by enlisting intermediate care technicians (ICTs) to conduct a home visit 48-72 hours after an at-risk Veteran is discharged from the ED. ICTs, like former military medics and corpsmen, are uniquely positioned to understand and relate to Veterans' journeys, ensuring they feel supported and have their needs addressed.

During a home visit, ICTs observe a Veteran's condition, screen for unmet care needs and check for signs of caregiver burden. Home visits also provide an opportunity for ICTs to establish telehealth connections and facilitate virtual visits between Veterans and acute care providers.

"The whole reason I came to VA was to help take care of my fellow Veterans as my mother did before me," said Dr. Bill Kalacinski, ICT at White River Junction VA. "It's been an awesome experience with SCOUTS going into the homes and getting that deeper connection with the Veteran."

For Veterans in rural areas and those not enrolled in VA's Home Based Primary Care program, telehealth connections enable acute post-ED care in their home.

Minimizing readmission after emergency care

Since 2021, SCOUTS has significantly improved access and quality care for Veterans. Between May 2021 and May 2022, SCOUTS decreased the rate of 72-hour ED return visits by 71% compared to those not in the program. Following this success, SCOUTS entered the 2023 VHA Shark Tank Competition, earning a winning bid to replicate at Pittsburgh VA.

That same year, VA's Office of Rural Health recognized SCOUTS as an Enterprise-Wide Initiative, a distinction granted to VA programs that deliver increased care and support to Veterans living in rural areas nationwide. SCOUTS has now expanded to 17 VA facilities. As of July 2024, SCOUTS has benefited over 2,500 Veterans across the country.

Satisfaction with the program extends beyond providers, as 98% of Veterans participating in the program report being satisfied or extremely satisfied with the services and 72% of Veterans note that SCOUTS has increased their likelihood of choosing VA for future care.

"SCOUTS provides an opportunity for ICTs to both provide Veterans with high quality care and build trust with them and their families," explained Dr. McQuown. "We are able to really hear their story and bring VA to them. You just don't get that when you're in a busy emergency department where the Veteran is outside of their comfort zone."

The SCOUTS team plans to expand to additional sites, including additional rural VA facilities and to Veterans using the VA Tele-Emergency Care program, which enables Veterans at participating VA facilities to receive timely access to care virtually or via phone for non-life-threatening symptoms.

"Being able to monitor and care for our elderly Veterans at home after an emergency department visit provides them with an option to safely recover in a convenient and familiar environment while avoiding some of the risks of being hospitalized," said Dr. Neil Patel, acting director of emergency medicine.

More information

SCOUTS is one of many innovations helping to reimagine the landscape of health care for older Veterans. VA is on track to become the largest integrated age-friendly health system in the nation with over 140 facilities currently engaged.

To learn more about SCOUTS and follow their innovation journey, visit Diffusion Marketplace. If you are a Veteran looking to learn more about post-emergency care, contact your VA primary care provider.

Want to learn more about innovation at VA? Visit our website, subscribe to our weekly newsletter and explore VA Pathfinder to learn more about our opportunities.

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