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PACE YOURSELF

An Innovative Alternative To Nursing Home Care

Thanks to a variety of factors including medical advances and nutrition and wellness programs, Americans today are living longer, healthier lives. Yet with increased life expectancy comes the need for greater resources to ensure quality senior healthcare for aging Americans. Aging adults will face many unique challenges, yet too often seniors and their families fail to prepare for future needs and the possibility that long-term care may be needed to manage physical and cognitive changes—80 percent of older Americans are currently living with a chronic disease, such as high blood pressure, heart disease, diabetes and cancer. Additionally, seniors often face a decline in cognitive and physical function, and many are coping with depression and feelings of loneliness as the result of physical limitations that prevent active social engagement with family and friends.

When the time comes, many opt for senior healthcare that requires a loved one to leave their home and enter an institution, an emotionally wrenching decision that can have lasting physical, cognitive and social effects. But there is a nursing-home alternative that allows seniors to stay in their home, even when critical care is needed.

Programs of All-Inclusive Care for the Elderly, or PACE®, offer an innovative model of care with coordinated medical and rehabilitative services in an integrated system that allows aging seniors to remain in their own homes, maintain independence and lead healthier more fulfilling lives. PACE programs improve on the care individuals often receive in the traditional fee-for-service system by emphasizing timely preventive, primary and community-based care over avoidable high-cost specialty and institutional care. Specifically designed to help frail elderly seniors maximize their functional capacity, PACE organizations provide the majority of healthcare to participants through an integrated network of professionals including physicians, nurses, therapists, social workers, health care aides, and more. PACE is focused on treating the whole person, not just their combination of medical conditions. That is why PACE programs have social workers who are experts in listening and helping seniors and their families better
understand the aging process.

PACE organizations provide care and services in the home, the community and the PACE center. They have contracts with many specialists and other providers in the community to make sure that participants get the care they need, even providing all medically-necessary transportation to the PACE center for activities, medical appointments or other appointments in the community. Many PACE participants get most of their care from staff employed by the PACE organization in PACE centers, which meet State and Federal safety requirements and include adult day programs, medical clinics, activities, and occupational and physical therapy facilities. Through PACE programs, aging seniors receive individualized care delivered in a setting that revolves around each person’s unique medical and social needs, resulting in far more favorable outcomes compared to traditional care options.

Though many people are unaware of PACE, it was developed over 30 years ago and each PACE program is consistently reevaluating the services offered and the integration of delivery in an effort to keep its frail elderly participants healthy. The PACE model has a proven track record in preserving wellness, supporting healthy outcomes and promoting quality care. PACE achieves high quality, cost-effective results because incentives are aligned among patients, providers and payers. For example, PACE participants utilize, on average, fewer than three days of hospital care annually. Further evidence of PACE’s success is detailed in an interim 2009 report to Congress from the US Department of Health and Human Services, which conducted a study of the quality and cost of providing PACE program services. Specifically, the study found higher quality of care and better outcomes among PACE enrollees that the comparison group; PACE enrollees reported better self-rated health status, better preventive care, fewer unmet needs, less pain, less likelihood of depression and better management of health care. PACE enrollees also reported high satisfaction with their quality of life and the quality of care they received.

In addition to providing care that offers excellent outcomes for seniors, PACE’s financing mechanism reduces the cost of care compared to that of a nursing home by 10 to 20 percent. PACE programs are healthcare providers, not insurers. While the programs utilize a combination of Medicare and Medicaid funds to pay for services, the heart of a PACE program is a unique care delivery model that requires patient assessment, care management, and input integrated with a team of doctors, nurses, therapists, and other providers. Together they continuously oversee participants’ needs and update care plans as necessary. PACE programs’ integrated financing from Medicare and Medicaid support improvements in frail seniors’ health by facilitating the delivery of all health and long term care services, with an emphasis on preventive care, wellness and social programs. This PACE emphasis reduces the need for acute care, and contributes to more efficient use of resources, in turn reducing nursing home costs, a major driver of Medicaid spending.

As a nursing home alternative, the focus of every PACE organization is to help you live in the community for as long as possible. To meet this goal, PACE organizations focus on preventive care. Although all people enrolled in PACE are eligible for nursing home care, only 7 percent live in nursing homes.

HOW PACE WORKS

PACE provides comprehensive care using Medicare and Medicaid funds to cover all of your medically-necessary care and services. You can have either Medicare or Medicaid or both to join PACE. Most enrollees in PACE are qualified for both Medicare and Medicaid and have all of their acute and long term care needs provided for by the PACE program. PACE centers meet state and Federal safety requirements and include adult day programs, medical clinics, activities and occupational and physical therapy facilities. PACE provides all the care and services covered by Medicare and Medicaid, as  authorized by the interdisciplinary team, as well as additional medically-necessary care  and services not covered by Medicare and Medicaid. PACE services include but aren’t limited to:

  • Doctor and nursing care
  • Hospital care
  • Medical specialty services
  • Prescription drugs
  • Nursing home care
  • Emergency services
  • Home care
  • Physical therapy
  • Occupational therapy
  • Adult day care
  • Recreational therapy
  • Meals
  • Dentistry
  • Nutritional counseling
  • Social services
  • Laboratory /X-ray services
  • Social work counseling
  • Transportation


PACE also includes all other services determined necessary by your team of healthcare
professionals to improve and maintain your overall health. You can join PACE if you are 55 years old or older, live in the service area of a PACE organization, are certified by the state in which you live as meeting the need for the nursing home level of care and are able to live safely in the community when you join with the help of PACE services. You and your family participate as the team develops and updates your plan of care and your goals in the program. PACE organizations support your family members and other caregivers through training, support groups, and respite care to help families keep their loved ones in the community.

What you pay for PACE depends on your personal financial situation. If you qualify for  Medicare, all Medicare-covered services are paid for by Medicare. If you also qualify for  your state’s Medicaid program, you will either have a small monthly payment or pay  nothing for the long-term care portion of the PACE benefit. If you don’t qualify for  Medicaid you will be charged a monthly premium to cover the long-term care portion the  PACE benefit and a premium for Medicare Part D drugs. However, in PACE there is  never a deductible or copayment for any drug, service or care approved by the PACE  team. An important point to remember is that with PACE, a person’s ability to pay will never keep them from getting the care they need. PACE organizations offer Medicare Part D prescription drug coverage. If you join a PACE program, you’ll get your Part D-covered drugs and all other necessary medication from the PACE program. Keep in mind, if you are in a PACE program, you don’t need to join a separate Medicare drug plan. If you do, you will lose your PACE health and prescription drug benefit.

To learn more about PACE and see if a PACE program is available in your community, visit www.PACE4You.org or call 1-800-MEDICARE; TTY users should call 1-877-486-2048.