The Programs of All-Inclusive Care for the Elderly (PACE) fall under the umbrella of the Medicare Care Choices Model (MCCM). PACE programs are designed to offer in-home, interdisciplinary, and all-inclusive care for those seniors who qualify for Medicare and Medicaid. Because the programs vary by location and provider, the details about them can sometimes be muddy or confusing. As we at CareXM serve to field questions about the programs to free up medical personnel, here we give a general synopsis on PACE programming.

PACE is billeted under Medicare, and each state has the opportunity to decide to offer PACE services to the beneficiaries of Medicaid as an additional benefit. Those who are dually eligible for Medicare and Medicaid have received care under PACE programming for decades. Once a patient enrolls in the PACE program, it becomes their only source of Medicare and Medicaid benefits. 

What the Programs Include

The precise services offered within PACE programs varies with each one, but PACE’s goal to provide holistic and interdisciplinary care for individuals ensures that many services are consistent. The chief benefit is medical care administered by a PACE physician. These providers familiarize themselves with the patient’s medical history, needs, and preferences. Home care is also offered, as are hospital and nursing home care when necessary. 

A PACE patient may see that their meals, transportation, and social services are taken care of, along with all necessary prescription drugs. Access to professional treatment can include dentistry; nutritional counseling; occupational, physical, recreational, and speech therapies; audiology; optometry; and podiatry.

Who is Eligible for a PACE Program?

To qualify for PACE, patients must fall under certain criteria:

• 55+ years old
• Live within a PACE service area
• Eligible for nursing home care as certified by the state

Though not an eligibility requirement, nearly half of those patients who enroll in PACE programs have been diagnosed with dementia.

History

The PACE Model of Care can be traced to the early 1970s, when a San Francisco community sought to develop a plan for the care of their elderly. They created a nonprofit called On Lok Senior Health Services and a system of community-based care. In the mid-80s, the program began to expand, and in 1990 the first true PACE programs received funding from Medicare and Medicaid. Today, more than 200 programs are in operation across the country, helping seniors get the care they need without leaving their homes.

Benefits of PACE Programing

PACE programs are meant to make the golden years as comfortable as possible, thus the services provided by these programs are designed to improve patients’ quality of life both medically and socially. Because of this, participating patients can continue to live in their communities or homes without removing to a nursing home. If nursing home care is called for, PACE pays for it while continuing to coordinate care. 

Those who provide care are specialists in their own fields, ensuring that a participant in a PACE program gets the best care available. Enrollees have at their disposal the expertise of nurses and other physicians; physical, occupational, and speech therapists; and social workers. Chronic care is provided according to a patient’s needs. This host of programs is meant to help patients with physical, mental, and cognitive conditions.

Disadvantages of PACE Programs

Every program has its pros and cons, the PACE programs’ may be limited accessibility. Though they provide quality care for elderly participants, they are not available to everyone. This is true based on location as well as suitability. Not every state adopts PACE programing, and even in states that do, eligibility applies to a defined geographic area. The application process can also be lengthy.

PACE programming does not treat any participant as an island. While this is better for a patient’s mental and emotional care, it is not always very easy on participating families. Family members are not to expect the program to provide 24-hour care; they should anticipate providing some personal care themselves. Patients enrolling in a PACE program agree to receive all their health care from PACE physicians, which may not include the GP they are familiar with. This can be unsettling for some participants. 

Further Questions

For information about the specific PACE programs available in your area, we encourage you to review Medicare’s official website. They also have information regarding pricing and cost comparisons. Our dispatch operators at CareXM can field PACE questions if a patient is already enrolled in a program. We wish you success in finding the right PACE program for you or your loved one.