How many seniors who can no longer get along without regular assistance would benefit from a program that provided medical oversight by doctors and nurses experienced in medical care of the elderly, physical and occupational therapy on site, daily recreational opportunities, social services, personal care and homemaker services, nutritional counseling, a day program with meals, and transportation to get there and back home every day?

How many caregivers would give their right arm for a program like this that would positively support their caregiving efforts while permitting them to go to work and partake in the occasional personal activity without having to worry about their frail elderly loved one alone and unsupervised at home?

Meet PACE: The Program of All-Inclusive Care for the Elderly

PACE began over 20 years ago as a demonstration project in San Francisco. The project was so successful that it was then rolled out as "demonstration" projects in several locations throughout the U.S. These demonstration projects were just as successful as the original San Francisco model, and now PACE programs are slowly rolling out across the U.S.

Medicare and Medicaid (when the participant is eligible) now participate fully in PACE projects. Operating similarly to Medicare Advantage or other HMO-type health programs, a PACE provider accepts premiums from Medicare, Medicaid, and private payors. In exchange for a monthly "capitation" fee, a PACE organization provides all of the services noted above, as well as easy access to medical specialists, hospital care, laboratory and other diagnostic services, prescribed medical equipment, prescription drugs and some over-the-counter medications, and nursing home care if needed.

Regardless of how many of their services an individual may use, the program never charges anything extra beyond the fixed monthly monthly premium. While participants receiving Medicaid pay no additional premium, those not receiving Medicaid pay the monthly premium themselves.

For most participants the comprehensive PACE program delays or permits them to avoid a move to facility care, allowing them to continue to live at home much longer than would otherwise be possible.

Most often the bulk of these services are provided in an adult day health center. Personal care, home health care and homemaker services are provided at the patient's place of residence. Physicians, nurses and other healthcare specialists make home visits as necessary, and emergency services are available 24 hours a day, every day.

Patient Eligibility for PACE

Must be at least 55 years of age;

Must qualify as "nursing home eligible" according to the criteria of their state;

Must be able to live safely at home or "in the community" with support;

Must live in a PACE service area.

While the average age of a PACE participant is reported to be 80, the primary qualification for joining a PACE program is the health status of the individual rather than income, assets or age.

Enrollment

Enrollment in a PACE program is generally somewhat more complex than enrolling in a typical Medicare Advantage program. The center will want to meet with the applicant to assess whether a) the applicant meets their eligibility criteria, and b) whether the plan of care and any private financial committment required will be satisfactory to the applicant. Because applicants agree to receive all of their health care from PACE, they must feel comfortable that their needs will be appropriately met.

Once the applicant and the PACE organization are both comfortable that the match is good, enrollment is completed through Medicare, just as enrollment in any Medicare Advantage program would be. The PACE organization will assist with the enrollment process. Participants are always free to leave PACE at any time and return to traditional Medicare.

Because they are extremely costly to set up and maintain, PACE programs are not yet widely available. Most are located in heavily populated urban areas. You can use the Program of All-Inclusive Care for the Elderly Locator to see whether there is a program operating locally for your senior.

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