Background Cognitive impairment (CI) is a strong predictor of six-month mortality and risk for re-admission in older hospitalized heart failure (HF) patients. We sought to develop a novel, multidisciplinary CI inpatient intervention to improve post-acute care discharge planning and reduce 30-day hospital re-admissions. Methods From July 2016 to July 2018 at a large, community-based hospital, we developed a CI inpatient screening program using the Mini-Cog test for eligible patients over the age of 65 admitted with a primary diagnosis of HF. The Mini-Cog is a three word recall and clock drawing test, scored between 0 and 5 points. A score of 2 or below identifies CI. In May 2017, Mini-Cog (+) patients received a multidisciplinary CI intervention led by palliative care nurses and speech therapists which included: a) family meeting b) goals of care discussion c) family-directed HF education and d) speech therapy evaluation. We compared the pre-intervention cohort (10 months prior to intervention) with the post-intervention cohort (15 months after intervention) with respect to discharge disposition and 30-day re-admission rates. Results We screened 740 patients for CI, of which 11.4% were Mini-Cog (+). In Mini-Cog (+) patients, the CI intervention increased the percentage of home health discharges (46% vs 20%, p=0.02, OR 3.4) and decreased the percentage of home discharges (44% vs 15%, p=0.008, OR 0.23), while rates of skilled nursing and hospice discharges were not significantly different (29% vs 26%, p=0.93 and 7% vs 8%, p=1.0), respectively). In the Mini-Cog (-) patients, there were no significant differences in pre vs post intervention cohort discharge disposition. In the combined pre and post intervention cohorts, a greater percentage of Mini-cog (+) patients were discharged to skilled nursing facilities and hospice compared to Mini-cog (-) patients (36.9% vs 19.8%, P Conclusions CI represents an important marker of HF post-acute care morbidity and mortality. Our CI multi-disciplinary intervention had a significant impact on discharge disposition with increased utilization of home health services. While not achieving statistical significance likely due to inadequate power, our intervention numerically lowered rates of 30-day re-admissions in a high-risk CI impaired population. Moreover, re-admission rates were similar to those noted in the Mini-Cog (-) group in this high-risk population. Hence, we believe these data justify further validation of this novel, multi-disciplinary approach in a larger multi-center study.