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Program
of All-inclusive Care for the Elderly (PACE)
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Feasability Study
Programs of
All-inclusive Care for the Elderly (PACE) serve people aged 55 and
older who live in an established geographic service area, qualify
for state nursing home level of care, and can be safely cared for
in a community setting at the time of enrollment. Rather than place
people in nursing homes, PACE programs provide a comprehensive range
of services that enable the people they serve to continue living
in the community. PACE programs receive a capitated monthly payment
from Medicare and Medicaid in exchange for all health and aging
services required to meet the needs of the people they serve. PACE
is a permanent provider under the Medicare program and a state option
under state Medicaid programs.
Overview of PACE
The PACE concept developed in the early 1970s as a way for San
Francisco's Chinatown residents to provide care and services to
their elders in a culturally appropriate way. Asian families preferred
to have their elders live at home but were worried about their safety
during the day. An area social worker proposed a British Day Hospital
concept; transporting seniors to a community center during the day
and returning them home at night. The center they opened in 1973
was called, "On Lok," which means "peaceful happy abode" in Cantonese.
Providing "one-stop" comprehensive health and social services for
its clients, the On Lok program inspired a Medicare and Medicaid
demonstration program called PACE in 1987. In 1997, the Balanced
Budget Act authorized PACE as a permanent Medicare and Medicaid
provider, opening the door to greater expansion of the model. As
of 2003, all PACE demonstration programs completed the transition
to permanent provider status.
To be eligible to enroll in PACE a person must be 55 years old
or older; meet the State's nursing home eligibility requirements,
live in a PACE service area, and be able to live independently in
the community with the assistance of PACE services at the time of
enrollment.
PACE is a fully capitated managed care program, and PACE providers
have the flexibility to tailor care and services to meet the unique
individual needs of each individual enrollee. Because PACE is financially
at risk for all the care and services enrollees need, the clinical
and financial incentives for providing high quality care and services
are aligned. One result is that care is much more focused around
prevention of health status decline so that people can continue
to live as independently as possible. A key difference between PACE
and other managed care models is that in PACE, the actual providers
of care and services are the ones that make the decisions for each
person utilizing an interdisciplinary team process. Care is managed
for each person taking into account the circumstances of their health,
abilities to care for themselves, the complexity of family relationships
and participant goals and desires.
PACE programs benefit adults over the age of 55 by providing more
consumer choices in long-term care and provide a more flexible and
comprehensive menu of services, especially for individuals that
qualify for both Medicare and Medicaid. PACE benefits the state
by assisting in the goal of re-balancing its long-term care system;
by providing a degree of predictability in the states Medicaid budget
and by providing economic development opportunities for existing
providers of both long-term care and senior housing options.
Additional information related to PACE can be found at www.npaonline.org
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PACE Feasability Study
Explore these links for the final results of the October 2004 Centers
for Medicare and Medicaid PACE Market Assessment Report for the
State of Iowa:
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