Having coffee with a friend the other day when she mentioned that she disliked the choices for her aunt of assisted living or eventually even a long-term care setting, due to some chronic medical conditions. I asked her if she had ever heard of a PACE program. Like most people, she said, “No, what is that”?
The PACE program is a relatively new player in the field of health care choices and not widely known as yet. PACE is an acronym for “The Program of All-Inclusive Care for the Elderly“ and has been established as a method of delivering all types of medical services coordinated by a local PACE center. The thrust of the PACE plan and why it is thought to be a new way of delivering care is that the person receiving the care gets to live at home rather than having to move into either assisted living or skilled nursing care. The program was modeled after the On Lok Senior Health Services in San Francisco, California where the On Lok system was able to provide acute and long-term care services for area clients while they remained at home.
Although I mentioned that the PACE model of care is a newer concept, the testing for this actually began at least twenty years ago by the Centers for Medicare and Medicaid. The plan had to address the fact that most providers of care to seniors work off of a fee-for-service system and the PACE model required a different approach for providers, like Medicaid and Medicare to get paid. The way around this dilemma was the creation of “capitated financing” which allows providers of services to PACE recipients to deliver all the care services that a person may need, rather than being restricted to only the care that Medicaid or Medicare would normally reimburse for.
So what are the guidelines to participate in a PACE program? First, the recipient has to be at least fifty-five years of age and reside in a PACE catchment area. Next, the person must be deemed eligible for nursing home care by the State agency such as Medicaid. If the person applies to the PACE program and is accepted, the PACE center then becomes the unique provider and gatekeeper for the applicant’s Medicaid and Medicare services.
Just as a long-term care facility has an interdisciplinary team of staff members such as nurses, dieticians, physicians, rehabilitation therapists, recreation personnel, the PACE program also has a similar set-up where a person’s overall needs are evaluated and a treatment plan is made. This plan will include services that will be delivered in the participant’s home and even in an acute care setting if necessary but most of the social and simple medical care are managed at the actual PACE center.
The benefits for participants in the PACE model are obvious: easier access to coordinated care, opportunity to remain at home and the ability to use their existing Medicaid and Medicare programs. Providers of PACE services get a monthly capitated payment and save costs by coordinating through the PACE center.
For more information about PACE programs and to see if a PACE program exists in your area, go to: www.cms.gov/PACEPosted in Alternative Medical Care, Caring At Home, Health Insurance | 1 Comment »