What is PACE – and How Can Senior Living Communities and Home Care Agencies Participate?

By 2050, the US population aged 65 and over is projected to surpass 80 million. Most of these seniors will want to age in place, maintain as much independence as possible, stay active, and continue enjoying much-loved activities and building relationships within their community.

However, over time, most seniors will inevitably require a higher level of care and support due to the natural aging process, such as developing chronic medical conditions or needing help with activities of daily living (ADLs).

This is where home- and community-based services (HCBS) are essential to support seniors and enable them to continue living safely in their own homes for as long as possible.

Unfortunately, finding, coordinating, and financing the right level of care and support can be challenging for seniors and their families, as they try to navigate disconnected services – from primary care physicians, physiotherapists, and pharmacists to personal care support, home safety modifications, and transportation.

This is where innovative programs like PACE are really starting to come into their own, benefiting thousands of seniors and their families across the US. 

In this article, you will learn:

• What is PACE?
• Which care services are included with PACE?
• How are the PACE medical and social services delivered?
• Average monthly services used by PACE participants
• Who is eligible to enroll in a PACE program?
• Average PACE enrollee
• What does PACE cost?
• Are PACE programs available in all states in the US?
• What are the main benefits of a PACE program?
• The future looks bright for PACE 
• How can senior living communities and home care agencies get involved?
• How can Smartcare Software help?

What is PACE?

PACE – Program of All-Inclusive Care for the Elderly – is a type of home- and community-based service that provides and coordinates all the medical and personal care services needed to support everyday living needs for seniors. 

It is one of only a few programs to offer a fully integrated care approach for seniors, bringing together interdisciplinary teams of professionals to provide exceptional care coordination and continuity. It basically delivers all the care a senior needs to experience the best possible outcomes without the need to go into a nursing home or other care facility.

With PACE, seniors and their families work closely with their assigned care team to design personalized care plans that address preventative and ongoing health and clinical needs. They also deal with non-medical factors impacting health and well-being, such as transportation, companionship, nutrition, and exercise. It really is ‘all-inclusive!’

PACE operates on a capitated payment system, receiving per member per month (PMPM) fixed payment amounts from Medicare and Medicaid (and/or any private pay sources).

Which care services are included with PACE?

PACE programs are focused on ‘whole-person’ client-centered care. This means participants have access to medical care, long-term care, and an array of supportive community-based services to meet their unique needs and support autonomy, dignity, and independence.

The comprehensive array of PACE services includes:

• Primary care (physician/nursing services)
• Medical specialty services
• Pharmacy/prescription drugs
• Nutritional counseling 
• Meal deliveries
• Occupational therapy
• Physiotherapy
• Recreational activities
• Lab tests, radiology, and x-ray services (outpatient services)
• Dentistry
• Hearing, vision, and foot care
• Home care caregiver support (including nursing home stays)
• Social services/pastoral care
• Hospital visits
• Emergency services
• Adult daycare
• Transportation

PACE is one of only a few programs that offer this truly integrated, all-inclusive care approach. 

Such models of senior health care are bringing a broader continuum of services to bear in a more highly connected, coordinated, and communicative way. This ensures that the most appropriate care, services, and medications can be easily accessed by each patient/client, at the most appropriate time.

How are the PACE medical and social services delivered?

PACE is a highly flexible model that guarantees every patient/client can easily access the full suite of medical and social services needed to live dignified and meaningful lives within their chosen community. 

Services are delivered in several ways, including:

Day health centers

Many enrollees attend PACE day centers to access the health services they require and to enjoy a wide range of recreational activities, too. They can visit their nearest center whenever they like, and transportation is always provided. Some participants go daily, others once a week, while a small percentage are housebound and unable to go at all.

More than 300 PACE day centers currently operate in 32 states and the District of Columbia, serving over 70,000 participants across the US.

In-person home care

Many PACE enrollees also receive supplementary support through in-home and referral services according to their needs. 

For those unable to visit a PACE center, the program’s all-inclusive care and services can be delivered directly at their homes – which includes assisted living facilities, independent living communities, and memory care units. 

Virtual home care

Since the pandemic, technology has made leaps and bounds in healthcare, meaning that some PACE services can be delivered remotely. However, PACE organizations are especially mindful of ensuring that technology tools are used to complement, not replace, direct human contact. For example, to improve care coordination and case management and increase family engagement and connection.

Nursing homes

Around 5% of PACE participants receive their all-inclusive care in a nursing home setting. These are typically enrollees who have moved into a nursing home after several years on the program and wish to continue receiving services from their PACE interdisciplinary team for continuity of care. 

Who is eligible to enroll in a PACE program?

The PACE program is designed to help seniors meet their healthcare needs at home and/or in the community rather than going into a nursing home or other long-term care facility.

The following criteria must be met to enroll in a PACE program:

• You must be 55 years old or older.
• You must be certified by your state as requiring nursing-home-level care.
• You must be able to live safely in your home (or senior living community) with the help of PACE services (at the time of enrollment).
• You must live in an area where PACE services are available.

Around 90% of PACE participants are dually-eligible for both Medicare and Medicaid. However, it is not a PACE condition that you qualify for both (or either!) of these health insurance programs. No financial criteria are considered when determining eligibility. 

Those enrolled in certain other plans (such as Medicare Advantage – Part C) or programs (like hospice services) do not currently qualify for enrollment with PACE. If looking to join a PACE program, this will become the sole source of Medicaid and Medicare benefits, so applicants would need to voluntarily disenroll from other care services they’re receiving.

You can learn more about eligibility and the enrollment process from your local PACE programs.

* Chronic conditions for seniors include vascular disease, bipolar disorder, major depression, paranoid disorders, diabetes (with complications), arthritis, chronic obstructive pulmonary disease (COPD), and congestive heart failure.

What does PACE cost?

Fees vary based on the level of services required and whether a person is eligible for Medicare and/or Medicaid benefits.

• Seniors who qualify for Medicare and Medicaid (dual eligible) do not pay anything for PACE. The PACE provider is reimbursed directly for all care services.

• Those eligible for Medicare (but not Medicaid) will need to pay a monthly premium to cover the long-term care Medicaid benefit of PACE and any prescription drugs.
  
  For these seniors, there are no deductibles or co-payments for any drug, service, or care once everything has been approved and signed off by their healthcare team. 

• Seniors without Medicare or Medicaid coverage can pay for PACE themselves. The total private-pay cost is typically $4,000–$5,000 per month. Again, there are no deductibles or co-payments required to receive additional program benefits.

Are PACE programs available in all states in the US?

PACE programs are not available nationwide… yet!

Currently, 153 PACE organizations operate in 32 states and the District of Columbia. These organizations serve nearly 70,000 participants across the US.

However, with 1.8 million PACE-eligible seniors living in the US – and PACE programs significantly outperforming others in terms of health outcomes and overall costs – there is enormous growth potential, and new programs are regularly being added.

What are the main benefits of a PACE program?

The main benefits of the all-inclusive, highly-coordinated medical and social services that PACE programs deliver include:

• Seniors with complex health conditions can remain living safely in their homes/communities for much longer.
• Reduces the burden on family members and caregivers, providing support groups and respite care as needed. 
• High-quality patient/client outcomes.
• Increased patient/client and family engagement and satisfaction (97.5% of participating families recommend PACE).
• Significantly lower rehospitalization and emergency room visits.
• Well-defined and managed personalized care plans/protocols.
• Seamless, coordinated care between all interdisciplinary team members, from primary care physicians and pharmacists to home-visit caregivers, transportation drivers, and therapists.
• Greater service flexibility and continuity of care.
• Robust compliance and reporting capabilities.
• Broad referral sources.
• Payment integrity, with fees set at a fixed monthly rate (reviewed annually).
• Cost-effective (the average cost is 13% lower than state-Medicaid programs). 

In addition, PACE organizations are both the provider and payor of all care services, which has enormous benefits for participants, including speed to address new issues. For example, if a senior requires a home modification for safety, such as a ramp or assistive seating, this can be installed within a matter of days rather than waiting weeks for paperwork to pass between multiple departments and contractors – and at no additional costs to the senior.

The future looks bright for PACE programs

The PACE model was first developed in the 1970s and has taken quite a while to become established. Like many innovative and exciting new ideas, it was way ahead of its time!

However, as the senior care market has significantly shifted towards favoring care in the community, PACE is really starting to gain speed and blossom as a sound alternative to nursing homes and similar long-term care facilities.

PACE enrollment has steadily grown in recent years and looks set to take massive strides forward in the near future. The available market is significant. There are currently 1.8 million PACE-eligible seniors in the US (of which only 3.3% participate at this time). 

This readily available market, along with an influx of capital investment, increased focus on capitated care models, and the fact that PACE programs outperform others in terms of overall costs and health outcomes, means enormous growth potential exists. 

The future looks very bright for PACE.

How can senior living communities and home care agencies get involved?

As the number of PACE organizations is rapidly growing (along with the number of PACE enrollments), there will likely be a need for more partnerships and/or contracting with senior living communities and home care providers to meet staffing needs. 

Home care providers could have some great opportunities to get in on the action and expand their client base within the community. You can search for PACE programs in your local area, look at their open positions for home care services, and contact organizations to discuss possible partnerships or coalitions.

For senior living communities, there are opportunities to apply or contract. Pairing PACE programs with your current services could greatly benefit your residents, extend their time with you, and be an excellent marketing tool. Contact the National PACE Association (NPA) for more information on options available in your area.

Of course, you can also apply to become a PACE organization in your own right (if your state has it). The NPA offers numerous tools and resources for providers to understand the PACE model, assess if adequate demand exists to support a new PACE program in their area, support financial planning, establish referral networks, and much more.

With PACE well-positioned to benefit from healthcare policy tailwinds, now could be the perfect time to take advantage of any opportunities available and ensure your business is a part of this growing, gold standard of senior home- and community-based care.

How can Smartcare Software help?

By tapping into the growing home- and community-based services (HCBS) market, Smartcare Software makes it possible to provide additional on-demand services to existing residents/clients, like homemaking, shopping, meal prep, laundry, and personal care. 

Smartcare’s comprehensive service and care platform will also help simplify the management and delivery of services, expanding your business, while helping your residents/clients stay healthier and happier for longer. As a bonus, Smartcare integrates directly into senior living platforms like PointClickCare.

If you’d like to see how easy it is to use our home care and senior living software tools to streamline operations and start growing your business successfully, call our experienced team today or request a free demo.