Wednesday, July 30, 2014


PACE, Program for All-Inclusive Care of the Elderly, is a vital component of care and services in our society. PACE is a program that serves seniors who can live safely at home who qualify for both Medicaid and Medicare, providing all of their health care needs for a set amount of money paid for by the government. The model is popular with state/federal governments because it shifts all financial risk to the nonprofit PACE provider.

As a relatively new service, PACE has had to battle for its place in the long term care continuum. Some PACE advocates have tried to market PACE as the total replacement for assisted living and nursing homes. Assisted living and nursing homes have not wanted to share already inadequate Medicaid funding. Competing philosophies are a classic example of the silos in long term care, when partners need to be collaborating.

Lutheran Services Carolinas is in a unique position, being involved in home and community based services from PACE to nursing homes. LSC has been able to see the synergies and need for the entire continuum of long term care services.

PACE is a new and vital component that is serving the very under-served indigent elder population. PACE participants must meet the minimum requirements for Medicaid nursing home placement. Those criteria are very gray and broad, which has led to some misconceptions.

Some PACE proponents have latched on to "qualified for nursing home placement" to call PACE a replacement for nursing homes. In reality, every PACE has a contract with at least one nursing home so PACE participants can be admitted when nursing home care is needed.

What PACE can do is keep medically fragile seniors healthier and more stable, allowing them to live where we all prefer to live, in our own home. Coming to a PACE site one to five days a week for medical care, observation, socialization, good food, therapy, etc. improves health and quality of life. Thus, PACE participation can delay and in some cases prevent nursing home placement and unnecessary hospitalizations.

North Carolina nursing home residents have among the highest level of acuity in the southeast United States. While PACE participants and nursing home residents very loosely meet the nursing home placement criteria, again, they are not the same. PACE participants are more well and able to live at home in safety, a key PACE requirement. Nursing home residents have multiple, chronic health issues who require 24 hour care and services. Examples would include a person with Alzheimer's disease who could never be left alone or an unresponsive, bedridden person who is totally dependent on 24/7 staff for every activity of daily living (movement, eating, toileting, bathing, etc.).

A good example of the great difference between PACE and nursing homes is 24/7 direct care. Drive by a PACE program after 6 pm or on a Saturday and Sunday. It will be deserted, closed up. PACE participants have family or a friend to watch over them at night and on weekends, or they can get along alone. PACE does supply an emergency telephone number, but that is for emergencies, not for basic care. Drive past a nursing home at 8 pm or on Sunday afternoon and you will see the same beehive activity you see at any other time. That doesn't make one or the other less important, it only makes them different.

The long term care continuum is a continuum, an ever changing mix of physical, mental, and social needs from senior centers to promote wellness and continuing education to nursing homes to hospitals for acute care needs. People will be better cared for when the person is the center, and the providers work collaboratively to meet their needs with the right balance of quality and cost efficiency.