Ralph Stepney’s home on a quiet street in north Baltimore has a welcoming front porch and large rooms, with plenty of space for his comfortable recliner and vast collection of action movies. The house is owned by Joann West, a licensed caregiver who shares it with Stepney and his fellow Vietnam War veteran Frank Hundt.

“There is no place that I’d rather be. … I love the quiet of living here, the help we get. I thank the Lord every year that I am here,” Stepney, 73, said.

It’s a far cry from a decade ago, when Stepney was homeless and “didn’t care about anything.” His diabetes went unchecked and he had suffered a stroke — a medical event that landed him at the Baltimore Veterans Affairs Medical Center.

After having part of his foot amputated, Stepney moved into long-term nursing home care at a Veterans Affairs medical facility, where he thought he’d remain — until he became a candidate for a small VA effort that puts aging veterans in private homes: the Medical Foster Home program.

The $20.7 million-per-year program provides housing and care for more than 1,000 veterans in 42 states and Puerto Rico, serving as an alternative to nursing home care for those who cannot live safely on their own. Veterans pay their caregivers $1,500 to $3,000 a month, depending on location, saving the government about $10,000 a month in nursing home care.

To be considered for the program, veterans must be enrolled in VA health care; have a serious, chronic disabling medical condition that requires a nursing home level of care; and need care coordination and access to VA services. It can take up to a month to place a veteran in a home once they are found eligible, according to VA.

It has been difficult to scale up, though, because VA accepts only foster homes that meet strict qualifications. VA medical foster home providers also must pass a federal background check, complete 80 hours of training before they can accept patients, plus 20 hours of additional training each year, and allow VA to make announced and unannounced home visits. They cannot work outside the home and must maintain certification in first aid, CPR and medicine administration.

The Medical Foster Home program has slightly more than 700 licensed caregivers who live full time with no more than three veterans and provide round-the-clock supervision and care, the VA said. Akin to a community residential care facility, each foster home must be state-licensed as an assisted-living facility and submit to frequent inspections by VA as well as state inspectors, nutritionists, pharmacists and nurses.

Unlike typical community care facilities, foster home caregivers are required to live on-site and tend to the needs of their patients themselves 24/7 — or supply relief staff.

But one prerequisite cannot be taught — the ability to make a veteran feel at home. West has grown children serving in the military and takes pride in contributing to the well-being of veterans.

Stepney and Hundt, 67, are in good hands with West, who previously ran a home health care services company. And they’re in good company, watching television together in the living room, going twice a week to a center that offers daytime care and sitting on West’s porch chatting with neighbors.

West, who considers caring for older adults “her calling,” also savors the companionship and finds satisfaction in giving back to those who spent their young lives in military service to the United States. “I took care of my mother when she got cancer and I found that I really had a passion for it. I took classes and ran an in-home nursing care business for years. But my dream was always to get my own place and do what I am doing now.”

“It’s a lot of joy taking care of them,” she said of Stepney and Hundt. “They deserve it.”