A community-based, multicenter, prospective, two-arm, parallel-group, outcome assessor-blinded, pragmatic, randomized encouragement design trial with a 12-month follow-up period, conducted at the Institute for Community Care and Health Equity of Chung-Ang University, following the SPIRIT Statement. Participants are recruited through community screening in five urban areas, selected based on eligibility criteria using the Clinical Frailty Scale, and randomized to either a home-based primary care (HBPC) group or usual care group. The study employs a post-randomization consent design and uses both modified intention-to-treat and complier average causal effect analytic methods to estimate treatment effects, aiming to reduce LTC facility admissions and potentially avoidable hospitalizations.