H2 Depressive Symptoms: Patients of CAREPATH home nurses with clinically significant depressive symptoms will have greater reduction in depressive symptomatology (HDRS change from baseline) by 3, 6 and 12 months of the baseline interview than patients receiving usual care. This analysis will be tested using data collected from patient research interviews. A mixed-effects linear regression analyses will compare patients in the intervention and usual care groups on change in severity of depressive symptoms from baseline. Covariates in the model will be selected as described in H1.