Access to Health Care – The PACE Program

Cost, quality and access have long been the standards by which we measure and judge care for the elderly in the United States. In Colorado, Programs of All-Inclusive Care for the Elderly, or PACE, has successfully addressed these three critical factors. In Denver, Total Long Term Care, now called Innovage, has administered the PACE program for many years. On the Western Slope, senior citizens receive care through PACE programs administered by Senior CommUnity in Montrose. Rocky Mountain PACE serves the Colorado Springs area. The goal of PACE is to be very patient-focused and manage well the complex medical, functional, and social needs of the frail elderly, thus keeping people in their homes for as long as possible, avoiding more expensive and often less desirable settings.

The PACE model of managing care for the elderly an be traced to the early 1970s when San Francisco’s Chinatown/North Beach community saw pressing need among immigrant families whose elders had come to America from Europe, Asia, and the Middle-East for long-term care services. Community leaders formed a nonprofit corporation, On Lok Senior Health Services – On Lok is Cantonese for “peaceful, happy abode” – and created a community-based care system. The successful results attracted a lot of government attention and today there are 92 PACE programs in 31 states.

PACE is a very innovative model of health care delivery for seniors utilizing an integrated team approach that attempts to save everyone money, and pays close attention to cost and quality. This interdisciplinary team (IDT) comprises professionals from across the healthcare continuum, including preventative, acute care, and long-term care services.

In collaboration with Medicare and Medicaid, PACE programs are granted capitation waivers to manage the healthcare needs of elders in a defined, limited area, for monthly payments. The monthly payment is “capped,” so there’s a strong incentive to keep the customer as healthy as possible.

PACE provides participants all the care and services covered by Medicare and Medicaid, as authorized by the IDT. Care and services include adult daycare that offers nursing; physical, occupational and recreational therapies; meals and nutritional counseling; social work and personal care; medical care provided by a PACE physician familiar with the history, needs and preferences of each participant; home health care and personal care; all necessary prescription drugs; social services; medical specialists such as audiology, dentistry, optometry, podiatry, and speech therapy; respite care; and, finally, hospital and nursing home care when it becomes necessary.

There are no limitations or condition as to cost, duration or scope of services and there are no deductibles, copayments, coinsurance, or other cost sharing that would otherwise apply under Medicare or Medicaid. The IDT assesses the participant’s needs and develops a comprehensive care plan that meets the needs of participants across all care settings 24x7x365.

Can this be as good as it sounds?

The answer is yes. Research by independent and academic groups shows that, as an innovative model of care serving older adults with long-term care needs, PACE is an effective use of taxpayer dollars and delivers better outcomes than other traditional care and services arrangements for seniors with chronic care needs. In addition, the research shows PACE staff serving these individuals are more satisfied working in a PACE environment. The requirement to implement effective, data-driven quality assessment and performance improvement programs is a key reason for the success of PACE across the country. Data is collected from all participating PACE sites to compare services and participant characteristics. With over 28,000 individuals participating in the PACE program nationwide, the data collected is impressive and very effective in improving the care they deliver.

To enroll in a PACE program, people must be 55 years of age or older, be Medicaid eligible for coverage of nursing facility services, reside in the PACE organization’s service area, and be able to live in a community setting at the time of enrollment without jeopardizing his/her health or safety. It is important to note that although all participants must certifiably need nursing home care to enroll in PACE, nationally only about seven percent of PACE participants reside in a nursing home. Enrollment includes a thorough and comprehensive assessment. Members of the PACE staff and the IDT make one or more visits to a potential participant’s residence. In turn, the potential participant may make one or more visits to the PACE center. PACE staff assess the potential participant to ensure that he or she can be cared for appropriately in a community setting and that he or she meets all requirements for PACE eligibility. If the assessment finds that the applicant’s health might be jeopardized by living in a community setting, the application is denied.

Participants are free to dis-enroll at any time. They also be dis-enrolled by PACE if they move out of the PACE territory, demonstrate bad behavior that threatens others, are seriously non-compliant with the IDT’s Care Plan, fails to pay, or simply grows well enough that services are no longer required.

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