This resource offers a description and evaluation of House Calls, a well-established program in Southern California that provides home-based care for high-risk frail and homebound older adults.

• House Calls provides medical, behavioral health, and psychosocial care, palliative care management, and other kinds of support.
• House Calls care teams typically consist of a physician, nurse practitioners, social workers, and medical assistants. Other practitioners—including psychologists, psychiatrists, and podiatrists—may be called upon for consultations.
• The care teams were initially led by physicians, but over time, nurse practitioners have assumed a much broader role. They have proved equally effective and more cost-effective.
• Social workers conduct in-home assessments of patients and their environment, addressing such issues as fall risks and needed home modifications, food and nutrition counseling, transportation needs, and social isolation.
• In the first three months and first six months after enrollment, spending on behalf of House Calls enrollees decreased.