24 Apr Are PACE Programs Right for Your Elderly Care?
It’s no secret that Americans are living longer these days. A report from the United Nations shows that the number of people 65 years and older rose from 8% to 12% between 1950 and 2000. That number will rise to 20% by 2050.
As we age, our health care often becomes more complicated. Finding the right care for ourselves or our loved ones is challenging, as it often involves the coordination of care among health care providers, pharmacies and insurance companies.
PACE programs are designed to simplify the process. Read on to learn more about PACE and if the program is right for your elderly care.
What are PACE Programs?
PACE stands for Programs of All-Inclusive Care for the Elderly. A PACE program provides the entire spectrum of care and services to seniors with chronic care needs. Seniors can receive care through the PACE program in their homes or in a nursing care facility.
The idea behind the PACE model is caring for the elderly through one, consolidated program, rather than an à la carte approach where seniors are treated in multiple locations by providers who don’t always communicate with each other.
The PACE program started back in the 1970s, when a community in San Francisco realized the need for long-term care services for the elderly who had immigrated from Italy, China and the Philippines.
Simply put, PACE programs try to honor what our elderly loved ones want. They want to stay in familiar surroundings, to maintain their independence and to maintain the maximum level of physical, social and cognitive function.
Who Is Eligible?
To qualify for a PACE program, an individual must:
- Be age 55 or over
- Live in a PACE service area
- Be certified by the state to need a nursing home level care
However, just because someone is certified as needing nursing home care doesn’t mean they have to live in a care facility. Only about 7 percent of PACE participants live in nursing homes. Through the PACE program, seniors can receive nursing home level care while living in their own homes.
If a PACE participant does need to live in a nursing home or assisted living facility, the PACE program pays for it and continues to coordinate the senior’s care.
Who Pays for PACE?
Most of the people enrolled in PACE are eligible for both Medicare and Medicaid benefits. Those benefits cover the cost of the program. States can choose to provide PACE services as an optional Medicaid benefit. The PACE program would then become the only source of Medicaid and Medicare benefits for PACE participants.
Right now, 122 PACE programs operate in 31 states, including Florida. You can find out if your state participates here. You can also search for a program by zip code, so you can find one close to home.
PACE programs receive monthly payments from Medicare and Medicaid. PACE also receives money from private insurance companies for participants who aren’t eligible for government programs.
About 90% of the people enrolled in PACE are eligible for Medicaid and Medicare.
You can find more information about the Medicaid application process on our blog.
The money goes into a pool, and services are provided after a comprehensive assessment of a participant’s needs. The payment pool provides an incentive to avoid duplicate or unnecessary services.
What Happens After Enrollment?
Once you or your loved one is enrolled in a PACE program, you’ll meet with a team of caregivers. That team will include doctors, nurses, therapists, social workers, dietitians, personal care aides, and drivers. Your needs will be assessed, and the team will develop an individualized care plan.
The philosophy behind PACE is to provide care for all of the participant’s needs, 24 hours a day, seven days a week, 365 days a year.
What Services Are Provided?
PACE receives money from Medicare and Medicaid. Therefore, it is required to include all Medicare and Medicaid-covered services. Additionally, PACE is required to provide any other services that a person’s care team identified as medically necessary.
Services include the following:
- Adult day care that offers nursing care, physical, occupational and recreational therapies, meals, nutritional counseling, social work, and personal care
- Medical care provided by a PACE physician
- Home health care and personal care
- Prescription drugs
- Social services
- Medical specialties like audiology, dentistry, optometry, podiatry and speech therapy
- Hospital and nursing home care
PACE participants can receive services in their own homes or in nursing care facilities. For participants who are able to stay in their homes, PACE offers the skilled care services listed above. The program also provides things like ramps, grab bars and other tools that help to keep seniors safe.
Who Participates in PACE Programs?
According to PACE, the typical participant is similar to the average nursing home resident. She is an 80-year-old woman with eight medical conditions. She has limitations in three activities of daily living.
Interestingly, about half of PACE participants have been diagnosed with dementia. Yet, more than 90 percent of them are able to continue to live in their community. The reason for that is the comprehensive care they receive that makes it possible to live at home. PACE provides home nursing care, along with personal care services.
As more and more of us are living longer, our health care needs are growing more complicated and expensive. Consider that the life expectancy for women is 81.2. It’s 76.4 for men.
Americans spend $300 billion a year through government spending, private insurance, and our own personal income. And private insurance only covers about 7% of long-term care.
PACE offers us and our elderly loved ones a chance to stay in our homes, if that’s what we want. We have the security of knowing we’ll have skilled nursing care and even a ride to doctors’ appointments and social gatherings. Perhaps most important, we won’t have to try and keep track of all of our doctors and other medical professionals, not to mention all our medications. Through PACE, our team will coordinate all of that on our behalf.
We are happy to provide support and assistance with the Medicaid application process and have a 100% success rate in obtaining state and government benefits available to aging and disabled Florida residents. Contact us for a free consultation.