Program of All-Inclusive Care for the Elderly

Eligibility

To be eligible for PACE, individuals must be at least 55 years old; be certified to need nursing home-level care by the state; reside near a PACE program; and be able to safely reside in the community with the help of PACE.

Program description

PACE delivers patient-centered, comprehensive care to frail and elderly adults through a collaborative team of providers, including but not limited to physicians, nurses, registered dietitian, physical therapists, and social workers. The goal of the team is to help PACE members to reside in their community independently as long as possible, by providing them with tailored services or resources that support their physical wellbeing, mental health, Activities of Daily Living (ADL), and Instrumental Activities of Daily Living (IADL). PACE programs emphasize on preventional and health promotional day-care that can impact members' end-of-life care and prevent more expensive care from skilled nursing facilities.

Under funding from the CMS, PACE provides all services covered by the Medicare and Medicaid. PACE may also cover services outside the scope of Medicare and Medicaid funding, as long as the providers deem the service necessary. Most PACE participants have co-morbidities, including cardiovascular diseases, diabetes, and hypertension. PACE provides services including primary care, home care, labs, medications, recreational therapy, social services, counseling, transportation to care facilities, and more. By providing all-inclusive care for the participants, PACE maintains the health of members and prevent exacerbation of current medical conditions. Patients are less likely to request extensive acute care, nursing facility care, or in-patient services. Under this method, PACE serves as a cost-saving elderly care program that emphasizes on preventative, up-stream care. Notably, PACE programs saved California State $22.6 million in health care cost for elderly.

PACE programs organize their services in "PACE Centers". Currently, there are 272 PACE Centers in 30 states, serving around 55,000 participants. PACE Centers serve as comprehensive care centers that include services that would otherwise require accessing primary care offices, social services, rehabilitation centers, recreational facilities, and more. Services such as routine care, exercise programs, dietary monitoring, strength training, and mental health services are provided out of these centers. The goal is to reduce burnout from caregivers and provide support for the members. The centers are regularly accessible to members; they can participate daily, weekly, or monthly depending on their needs. Care decisions are made at these centers between the members, their care team, and any caregivers.

Financing

PACE receives monthly funding from the CMS under risk-adjusted per-member payments, or capitation. Medicaid covers the monthly premium of long-term care, and Medicare covers the rest. For PACE participants who are qualified for Medicare but not Medicaid, they are responsible for monthly premium equal to the Medicaid capitation fee and the premium for medications under Medicare Part D. Participants who are not eligible for Medicare or Medicaid can still be eligible for PACE, but will be responsible for the cost of the program.

Outcomes

Several studies point to the numerous benefits that PACE programs have had on their patient populations, including allowing them to live safely within their communities.

The more positive research on effectiveness centers on outcomes of interest tied to PACE programs. These include greater adult day health care use along with decreased numbers of hospitalizations and nursing home admissions. In fact, patients were less likely to be institutionalized when compared to those who waived 1915(c) home- and community-based services.

Similarly, it has been noted that patients remain in contact with primary care longer; have greater survival rates, better health, better functional status, and better quality of life as reflected by increased social interaction; and experience less depression and fewer concerns after enrollment.

There are, however, some drawbacks that patients have come to perceive with certain aspects of the PACE experience. Some patients have reported that they are not receiving enough information about their conditions and that their input into their own care is not being taken into consideration by providers. In addition, there is a prevalent concern amongst enrollees centered on losing their primary care physician with whom they have established a relationship and trust with.