What is PACE?
The Program of All-inclusive Care for the Elderly (PACE) is a comprehensive healthcare provider model for nursing home-eligible individuals ages 55 and older. PACE provides the following services:
- Medical care provided by a PACE physician.
- Medical specialists.
- Adult day care including nursing; physical, occupational and recreational therapies; nutrition services; and social work services.
- All necessary prescription drugs.
- Hospital and nursing home care when appropriate.
- Home health care and personal care assistance.
The PACE model of care can be traced to the early 1970s, when the Chinatown-North Beach community of San Francisco saw the pressing need for long term care services for families whose elders had immigrated from Italy, China and the Philippines. In 1971, Dr. William L. Gee headed the committee that hired Marie-Louise Ansak to investigate solutions. They, along with other community leaders, formed a nonprofit corporation, On Lok Senior Health Services, to create a community based system of care.
On Lok began national PACE replication in 1987 with support from the Robert Wood Johnson and John A. Hartford Foundations and Federal legislation, which authorized an organized replication demonstration. On Lok successfully led the PACE replication effort by using seasoned On Lok service professionals as trainers and technical assistance providers. At the conclusion of the grant period in 1994, 10 sites in nine states had obtained Medicare and Medicaid waivers and were serving the frail elderly with the PACE model and the National PACE Association (NPA) had been formed. In 1997 PACE became a permanent Medicare benefit. Today there are nearly 90 PACE organizations in 29 states throughout the nation, with many more in development.
PACE has now grown to what many consider to be the country’s leading model of care for seniors. PACE serves individuals who are 55 or older, certified by their state to need nursing home care, and are able to live safely in the community at the time of enrollment. In addition, participants live in a PACE service area and receive most of their care at an inviting and comfortable center where a team of physicians, nurses, social workers, rehab therapists, dietitians, van drivers and aides meet regularly to plan and provide services for the seniors.
Key features of the PACE model include:
- Flexibility. PACE coordinates the care of each participant enrolled in the program based on individual needs to enable continued residence in the community as long as possible.
- All-inclusive Care. PACE delivers all needed preventive, primary, acute and long-term care.
- Interdisciplinary Team. PACE teams—of physicians, nurse practitioners, nurses, social workers, therapists, van drivers and aides—meet regularly to solve problems as PACE participants’ situations change.
- Capitated Payment. PACE programs receive monthly per-person payments from Medicare, Medicaid and private individuals, depending on the individual’s eligibility for public programs.
The Centers for Medicare and Medicaid Services (CMS) and a State Administering Agency oversee PACE. The vast majority of PACE enrollees are dually eligible (that is, qualify for both Medicare and Medicaid), but this is not a requirement. PACE programs receive approximately two-thirds of their revenue from Medicaid and one-third from Medicare. A small percentage of revenue comes from “share of cost” payments by Medicaid-eligible enrollees. In some cases, enrollees pay privately for PACE services. PACE provides a “win-win” for seniors, providers and the State, offering essential benefits to seniors in declining health. In an ever-changing Medicaid landscape, integrated programs, like PACE, can reduce service and payment fragmentation. PACE addresses the needs of the rapidly aging population without building new nursing homes. Most importantly, seniors prefer the opportunity PACE offers to remain living independently in their own residence rather than receive nursing home care.
For a glimpse into the history of On Lok (including old footage!), take a look at this video created in 2012 in celebration of On Lok’s 40th anniversary.
Learn more about PACE here: