What is PACE (Programs of All-Inclusive Care For The Elderly) and How Do You Qualify?0 USER TIPS ADD YOUR TIP
When federal and state government agencies began to develop community-based health services in the 1970s, the federal government, through the use of Medicaid waivers, allowed states to come up with various fee-for-service programs for older adults. The Programs of All-Inclusive Care for the Elderly, or PACE, was one such program that was developed at a health services community center in San Francisco, California. The program was intended for the frailest in the community, many of whom were considered most at risk and otherwise needing long-term care, and it was innovative because it allowed participants to stay in their homes while health care services were brought to them, or administered at the local community facility. (Related: Paying for Long-Term Care.)
How do you qualify for PACE?
Since then, PACE has expanded to 31 states. The model of care hasn’t strayed too far from the original and provides older individuals who are eligible for Medicare and Medicaid benefits with coordinated care from a team of health professionals. The program has helped many people from moving to a long-term care facility. The financing for PACE is capped by federal and state budgets, so not everyone can join at any time. There can be waiting lists and specific income requirements, depending on the program and state. The general criteria for individuals to join PACE are:
- Be age 55 or older,
- Live in the service area of the PACE organization,
- Be eligible for nursing care as defined by your state,
- Be able to live safely in the community with help from PACE.
A typical PACE participant, according to the National PACE Association, is an 80-year-old woman with eight medical conditions and limitations in three activities in daily living. About half of PACE participants have been diagnosed with dementia.
What services come with PACE?
The programs are team-based, and many professionals are available to treat patients with multiple conditions outside a hospital setting. Team staff members include health care providers, such as doctors and nurses, home care coordinators, transportation drivers, social workers, physical and occupational therapists and nutritionists. An on-call physician is available 24-hours, seven days a week.
PACE facilities also offer daily meals and social activities. Many programs coordinate providing dental, podiatry, vision and behavioral health services at the center as well. Outpatient services may include lab tests and X-rays. Some centers also have medical equipment rental services. Once part of a PACE program, the participant will get their Part D-covered drugs and medications through the program, so there’s no need to join a separate Medicare prescription drug plan.
Enrollment in any state PACE is free, and services are paid for by a combination of Medicare, Medicaid and private funds. It is generally thought to be cheaper than paying for nursing homes or other long-term care because the participant stays in their own home (or lives with family members) and therefore eliminates room and board expenses. To find a PACE program in your area, visit the interactive map available from the National PACE Association, or call your Medicaid office.