VA home-based primary care interdisciplinary team structure varies with Veterans' needs, aligns with PACE regulation.

Background: Interdisciplinary team (IDT) care is central to home-based primary care (HBPC) of frail elders. Traditionally, all HBPC disciplines managed a patient (Full IDT), a costly approach to maintain. The recent PACE (Program of All-inclusive Care for the Elderly) regulation provides for a flexible approach of annual assessments from a core team with involvement of additional disciplines dependent upon patient needs (Core+).

Home-based primary care: the care of the veteran at home.

Home-Based Primary Care is a program designed by the Department of Veteran Affairs (VA) to care for frail, medically complex, elderly veteran patients in their home setting. Unique to the VA, the program has similarities and differences in relation to typical Medicare/Medicaid home health and hospice programs. The VA has demonstrated success in maintaining the patients' independence and quality of life as well as exceptional management of chronic disease and prevention.