Objective To explore the effects of specialist nurse-led health coaching program on home-based rehabilitation in elderly patients with post-stroke dysphagia (PSD). Methods A total of 90 elderly patients with PSD admitted between July 2024 and June 2025 were selected and divided into a control group and an intervention group (45 cases each) based on their admission time. The control group received traditional home transitional care, while the intervention group was subjected to a specialist nurse-led health coaching program for home rehabilitation intervention in addition to the routine care provided to the control group. Results In this study, 44 cases from the control group and 43 cases from the research group fully participated in the research. At 4 and 8 weeks after discharge, the scores for swallowing dysfunction, self-management, and quality of life in the intervention group were significantly better than those in the control group (all P<0.05), with significant group, time, and group-by-time interaction effects observed between the two groups (all P<0.05). The difference in unplanned readmission rate between the two groups was not statistically significant (P>0.05). Conclusion The application of specialist nurse-led health coaching program in the home rehabilitation of elderly patients with PSD can promote the recovery of swallowing function, improve the level of home self-management, and enhance the overall quality of life.