Virginia at Home

Virginia at Home (VaH) is UVA Health’s flagship home-based primary care (HBPC) program for older adults living with complex medical concerns and needs. This service provides care for those confined to their home, assisted living, or memory care facility due to medical, functional, and/or cognitive difficulties.

VaH brings UVA Health care to the homebound patient’s doorstep to improve the quality of care while reducing avoidable hospitalizations and costs. The VaH team makes house calls to participants’ homes throughout Charlottesville and its surrounding counties, within 40 miles of the UVA Health University Medical Center. VaH also serves participants residing in several assisted living and memory care facilities in the service area. Instead of office-based care, VaH focuses on individualized, holistic, primary care that revolves around the patient. This may include ordering home health services for identified skilled nursing and therapy needs. VaH clinicians partner with patients and their loved ones and caregivers to augment medical care at their home or facility.

For homebound persons, which number in the millions across the United States, HBPC is a model that has been shown to improve the quality of care and patient satisfaction by bringing primary care directly to patients’ homes and communities. HBPC programs have also significantly reduced participants’ need for emergency department visits and hospitalizations.

VaH believes in comprehensive, individualized primary care that is responsive and available for all older homebound patients. We offer the following services to enrolled participants:

• Regular House Calls to streamline care and prevent avoidable acute care utilization
• Caregiver Support and education through house calls, telehealth visits, and referrals to existing community resources
• Telehealth Visits to extend VaH into rural communities and to allow frequent contact
• Advance Care Planning to document and support participants’ care goals