By Laura Mahoney RN, BA / 2011 MSW Candidate GWB School of Social Work Washington Univeristy - Over the past ten years, an increased demand for nursing home alternatives has created significant growth in home and community-based programs for older adults. Since the population of people over the age of 65 is expected to double over the next twenty years, more community-based services will be needed. The Program of All-Inclusive Care for the Elderly (PACE) is a unique program designed to help keep older adults living in the community longer.
PACE is a capitated, Medicare & Medicaid funded, managed care program for older adults with disabilities. PACE utilizes an interdisciplinary team approach to coordinate services and develop an individualized plan of care. The majority of services are provided at a PACE health center. Services available include: adult day care, meals, transportation, dental care, eye exams and glasses, hearing aids, prescription drugs, physical, occupational, and speech therapy, social services, medical equipment, recreational activities, caregiver education, respite, and pastoral care. PACE covers all doctor visits, diagnostic procedures (labs and x-rays), hospitalizations, and nursing home stays. In addition, PACE provides in-home services such as nursing care, personal assistance, cleaning, cooking, laundry, and errands.
PACE was recently approved as an evidenced-based model of care by the Department of Health and Human Services. A recent study done by Grabowski (2006) found that PACE participants had fewer hospitalizations and nursing home stays, spent longer time living in the community, and demonstrated improved health, functional status, and overall quality of life. Likewise, another study by ABT Associates found that PACE participants have improved health status, lower mortality rates, and greater autonomy (National Pace Association, 2003).
To be eligible, the person must be at least 55 years old, live in the PACE service area, and be certified by the state for needing nursing home care. Ninety-five percent of program participants are dual eligible for Medicare and Medicaid (Gross et al, 2004). Medicaid participants only have to pay a small monthly payment to receive PACE services. However, Medicare only pays for one-third of the program’s monthly costs. People that are not dually eligible must pay the remaining cost. This can range anywhere from $1,624 to $4,706 a month depending on geographical location (National Pace Association, 2003). This high out-of-pocket cost is a major deterrent for program participation by Medicare only recipients.
A few PACE centers have developed partnerships with long-term care insurance companies. Therefore, it has been suggested that states with public/private partnership programs require those insurers to offer PACE as a benefit (Gross et al, 2004). However, these policies also have high monthly premiums which are not affordable for many lower income and middle class older adults. The Veterans Administration has considered adding PACE as a benefit. This could allow more socioeconomic inclusiveness to the program. The Balanced Budget Act of 1997 called for the expansion of PACE services nationwide. However, unless the program is made more affordable to lower income individuals, participation growth will remain slow.