The purpose of this study is to examine the feasibility of providing a medication optimization program to improve patient health outcomes during the transition from hospital to home. This is because the period after hospital discharge is critical to long-term recovery, overall quality of life, and prevention of future hospitalizations.

Patient Inclusion Criteria:

• 65 years of age and older
• currently hospitalized or having been hospitalized in the previous 2 weeks
• having a discharge disposition of home with a referral to receive HHC services from URMHC, or currently receiving HHC services from URMHC
• taking more than 10 regular medications daily
• having a primary care provider who is in the URMC system
• Ability to self-consent
• English-speaking

Patient Exclusion Criteria:

• end-of-life prognosis in the following 6 months
• currently receiving hospice care, end-of-life care, or palliative care
• conditions that impact the receipt of the intervention, such as severe cognitive impairment that interferes with the subject's ability to communicate with interventionists;
• substantial difficulties in hearing, vision, and verbal expression that disable the participant from communicating effectively while receiving the HomeMed intervention