Abstract: Objective: To evaluate health behavior change theory to the rehabilitation effect of patients with elderly bedridden at home after discharge from hospital. Method: 120 cases of elderly patients in bed were randomly divided into control group and experimental group by in hospital time order. Respectively, the outreach team evaluate patients family rehabilitation nursing plan.The control group was given conventional propaganda and telephone follow-up after discharge. Experimental group was developed family rehabilitation nursing plans according to the health behavior change integration theory. Compared the two groups of patients discharged from hospital, 6 and 12 months after discharge in daily living, quality of life and other aspects of rehabilitation by using Activity of Daily Living Scale (ADL) and Quality of Life Questionnaire. Results: The patients discharged from hospital for 6 months, 12 months physiological and psychological field, the individual subjective feeling of the overall quality of survival ,the overall subjective health, daily life ability scores were higher than in the control group, the difference was statistically significant(P<0.05). Two groups in environmental, social, differences are not significant (P>0.05). Conclusion: The application of the theory of health behavior change for elderly patients in bed home rehabilitation, can significantly improve the patients' quality of life and daily life ability.