Purpose <p>Discharging patients with the addition of home health services (HHS) has been postulated to reduce the risk for perioperative complications and, thereby, 90-day ED visits and readmissions following elective total shoulder arthroplasty (TSA).</p> Methods <p>A retrospective review of primary anatomic (aTSA) and reverse shoulder arthroplasty (rTSA) cases from January 2016 through April 2024 was performed. Demographic data, including age, marital status, body mass index (BMI), smoking status, self-identified race, Area Deprivation Index (ADI) score, modified 5-item fragility index (mFI-5), and surgical indication was collected. Discharge with or without HHS, and whether a patient had access to a postoperative home health aide (HHA), were also recorded. Regression analysis was utilized to determine the association between discharge with HHS and both postoperative 90-day ED return and readmission.</p> Results <p>There were 327 patients included, including 161 (49%) aTSA and 166 (51%) rTSA. A total of 121 (37%) patients were discharged with HHS, of which 49 (40%) also had access to a HHA during the postoperative period. There was no significant difference in patients who were discharged with HHS compared with those who were discharged without HHS with regards to either 90-day return to the ED (OR 1.15, 95% CI 0.58–2.30, <i>P</i> = <i>0.692</i>) or all-cause unplanned 90-day readmissions (OR 0.79, 95% CI 0.29–2.19, <i>P</i> = <i>0.652</i>).</p> Conclusions <p>Discharge with HHS following elective TSA, even in the setting of increased patient age and fragility, results in similar 90-day postoperative healthcare utilization compared with those discharged to self-care.</p> Level of evidence <p>Level III (Retrospective cohort).</p>