What is PACE?
The Program of All-Inclusive Care for the Elderly
The top priority for nearly all older adults—and their family members and caregivers—is to be able to maintain as much health, strength and independence as they can, for as long as they can. While some of us may need full-time care in a nursing home at some point, many of us would prefer to remain living in our own homes and communities whenever possible.
The Program of All-Inclusive Care for the Elderly, known by the acronym PACE, was designed to promote this goal. It brings a pragmatic, common-sense approach to help deliver care to older folks with chronic health care needs, and do so in a way that results in better outcomes for them, their caregivers, and government and private health insurers.
But to understand how PACE works, it helps first to understand why the care structure available to older adults sometimes falls short.
The Problem of Uncoordinated Care
For most older folks, health care and the insurance coverage to pay for it is poorly coordinated. A typical older person with multiple health problems will be seen by a variety of doctors, therapists and other service providers, all of them working independently, with little insight into what others are doing. The separate providers send separate bills, and that usually results in a lot of insurance claims and paperwork.
Then, too, the way we pay for care does not always promote what is best to help older adults remain living in their own homes and communities. Medicare, Medicaid and private health insurance often place limits on the types and amount of care they will pay for. For instance, if an older person is injured in a fall, physical therapy might be part of his or her recovery treatment. But the amount of physical therapy sessions the person received would likely be limited by what Medicare, Medicaid and any private health insurance would authorize.
In practice, the system leads to older adults with chronic health care needs experiencing a series of urgent medical episodes in their later years, and then receiving just enough care to get them past each episode. For many, that does not promote the highest possible quality of life during their remaining years of living independently. Furthermore, it does not do much to prevent future episodes, or keep them from eventually needing full-time nursing home care.
In short, no one has a big picture view of what the older person needs to stay at his or her healthiest and most independent, and to prevent costly acute care episodes.
These are the problems that PACE was designed to address. Though PACE services are not available in every state, the field is growing quickly, which is a testament to its effectiveness and the satisfaction it delivers to its clients.
How PACE Works
To be eligible for PACE services, a person must be over 55 and certified by their state as needing full-time residential nursing care, such as in a nursing home.
Despite the fact that 100% of PACE clients qualify for nursing home care, only around 7% of PACE clients actually live in nursing homes. That statistic alone is a remarkable benchmark of the methodology’s success at helping older adults remain in own their homes and communities.
When an older adult enrolls in a PACE program, the program agrees to provide the complete continuum of care necessary to keep the person healthy, safe and as independent as possible. PACE services include but aren’t limited to the following:
- Primary Care (including doctor and nursing services)
- Hospital Care
- Medical Specialty Services
- Prescription Drugs
- Nursing Home Care
- Emergency Services
- Home Care
- Physical Therapy
- Occupational Therapy
- Recreational Therapy
- Adult Day Care
- Nutritional Counseling
- Social Services
- Laboratory/X-ray Services
- Social Work/Counseling
Each PACE client is assigned to a team of caregivers staffed by experts in the needs of older adults. The care is coordinated, and the emphasis is on prevention. So, to revisit our earlier example, if the members of the PACE team feel like ongoing physical therapy is what a client needs to avoid future accidents, that is what the client gets. In exchange for predictable, managed costs (more on that shortly) Medicare, Medicaid and private insurers agree to let the PACE team determine the level and quantity of care best for their patients.
Typically, some of the client care and activities will take place at the PACE center. Transportation to the PACE center will be provided if the client needs it. This ensures that clients get out of the house and have some productive social and therapeutic contact.
PACE also provides for care in the home, as needed, on days when the client does not go to the PACE center. This can include help with meals, bathing and other activities of daily living.
Support for Family Caregivers
A key feature of PACE is providing support for their clients’ existing caregivers. Often family members must make great sacrifices of their time and quality of life to help their loved ones remain in their homes as long as possible. What often happens is that caregivers become stressed and ill themselves, which can compromise the care they provide. PACE addresses this problem head on. First, it relieves much of the caretaking burden from family members or other loved ones. Secondly, it includes the caregiver on the PACE team and gives them tools and strategies to make their caregiving contributions more effective for their loved ones, and easier on themselves.
How PACE Is Paid For
A PACE center is run by an organization. It may be a non-profit group or a private, for-profit company. The key is that the PACE center assumes all of the care needs covered by Medicare for its patients. If the client is on Medicaid, some combination of Medicaid and Medicare typically covers the entire cost. If the client has Medicare but not Medicaid, Medicare usually covers most of the cost, with the remainder being paid in regular, predictable installments by the client’s supplemental insurer, or out-of-pocket. But PACE clients are never faced with co-payments for doctor’s visits, therapy or Medicare Part D covered prescriptions.
Since the costs are fixed and predictable, this helps Medicare, Medicaid and private insurers manage their expenses. And since there is a single provider for all of the client’s health care needs, paperwork is greatly reduced. Both of these factors are a boon to clients and insurers alike.
How to Find a PACE Center
PACE is not available in every state, but it is expanding rapidly. There are around 100 PACE programs operating in 31 states. The National Pace Association provides a PACE locator tool that can help you determine whether there is a program near you. If you’re looking for full-time care instead, you can find listings of assisted living in Dallas, Houston, or anywhere else in the country on SeniorAdvisor.com.
Written by Rich Malley