The vision for this blog is to create a community of harmonious professionals across the care continuum who encourage each other in exploring digital media as a way to support businesses and families dealing with elder care.
Written on October 5th, 2010 by tasha
My own nearby city of San Francisco is the host to the National PACE Association conference this year. I am currently writing from the gorgeous Hyatt Regency with a twinkly city view before me. Exhausting day, as it often is at a conference. So much information and so many inspired people to learn from! But this one gives me a special kind of optimism because the PACE model is so, well, all-inclusive.
PACE stands for Program for All-Inclusive Care of the Elderly. One way to describe it is hospice for frail elders who are not terminally ill, but who meet the criteria for nursing home placement.
Like hospice, the PACE model revolves around an inter-disciplinary team (IDT) and includes family members in their services. The professional side of the team involves doctors, nurses, social workers, physical therapists—even dentists! Some PACE programs have chaplains as well.
Each participant has an individualized plan of care created jointly by the elder, the team, and the elder’s engaged family members. I have often thought it was a shame that we have to be dying to have an IDT manage our care. I want an IDT now at my age to help me with any health issues that may arise because I am more than just a collection of organ systems! I am a body, mind, heart and spirit. At least with PACE, we are starting to inch the whole-person perspective upstream in the continuum. Plus, family caregivers have access to support groups, educational classes, and respite care. The family members are definitely included in the system of services.
So, you might think of PACE as a medical home with psychosocial/family care. But PACE is more than this.
The goal of PACE is to help elders to remain in the home of their choosing for as long as is safely possible. Typically participants have multiple chronic conditions which need extensive monitoring and frequent adjustments. Many elders are not able to monitor themselves as regularly as their condition warrants. They are not homebound, so home health is not an option. At the same time, other than limited personal care assistance, they really don’t need the 24/7 access to skilled care that a nursing home provides (at no small expense).
PACE, therefore, has created a clinic with van transportation provided, where participants can come several times a week for monitoring, physical therapy, dental care, etc. Participants enroll in PACE and then receive all of their medical care at the center. As determined by their care plan, they may also receive some help at home with ADLs, medication management, and in some cases even technology to monitor falls, changes in daily life patterns, etc.
So you might add that PACE does case management and home care. But PACE is more than this.
When elders enroll in a PACE program, it is like joining a health plan. The PACE program is responsible for paying for hospitalizations, nursing home placements (if they are needed), medication, lab tests, durable medical equipment, etc. Participants must agree to be treated by the PACE staff.
“I get it,” you are now saying, “PACE is like Medicare Advantage, or an Accountable Care Organization.” Guess what? PACE is more than that.
The PACE center not only provides medical care, it also provides social activities and lunch!
“Ah,” you say, “PACE is also an adult day center.” Yes, PACE is an adult day center and all of the above.
PACE is comprehensive elder health plan that offers medical care in an adult day context, with transportation provided. An interdisciplinary team creates a care plan with the elder and his/her family members. Coverage not only includes primary care, rehabilitative therapies, medications and medical equipment, it also includes dentistry, hospitalization, skilled nursing and in-home support as needed.
PACE is an adult day center and accountable care organization combined with an interdisciplinary medical home. Wow! What’s more, this comprehensive care is available to persons who are low-income (dual-eligible Medicare/Medicaid) as well as private pay.
So, as we look to changes coming about with health reform, I truly hope we can build on the PACE model. PACE in its current format has been around since the early 1990’s, although its roots began in the Chinatown/North Beach communities of San Francisco in the 1970’s.
At the least, I know that when I need this kind of support, I am hoping there is a PACE program in my community! PACE is the kind of future in elder care that I can get very excited about.
For a consumer-oriented description of PACE, go to www.PACE4you.org. For a professional description, check out the website of the National PACE Association.
