HaroldUrman
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Apr 5, 2010, 1:08 PM
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By Harold Urman Ph.D.
We all want the best care for our aging loved one, but getting that care can be frustrating. If you have an aging loved one living at home, you know what its like to drive them from appointment to appointment; manage all of their medications; or, deal with doctors who dont talk to one another. You may also struggle with leaving your loved one at home, alone and without the supervision, company and interaction they want and need.
If you or your loved one are 55 years or older, certified by your home state as meeting the needs for nursing home care and able to live safely in your community, then PACE may be the managed care program for you.
The Program of All-inclusive Care for the Elderly (PACE) model of care is centered on the belief that its better for the well-being of seniors with chronic care needs and their families to be served in the community whenever possible rather than placing them in an institutionalized care setting. To meet this goal, PACE programs focus on preventive care. Although people enrolled in PACE are eligible for nursing home care, only 7 percent are living in nursing homes.
The PACE model of care began in the early 1970s, when the Chinatown-North Beach community of San Francisco saw the critical long term care needs of families whose elders had immigrated from Italy, China and the Philippines. Dr. William L. Gee, a public health dentist, headed the committee that hired Marie-Louise Ansak in 1971 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 is Cantonese for "peaceful, happy abode."
PACE is a Medicare program that provides community-based care and services to people who otherwise need nursing home level of care and live within the service area of a PACE program. PACE provides all the care and services covered by Medicare and Medicaid, as authorized by an interdisciplinary team, as well as additional medical care and services not covered by Medicare and Medicaid. With PACE, the ability to pay will never keep a participant from getting the care they need.
The interdisciplinary team consists of professional and paraprofessional staff that assess participant needs, develops care plans and deliver all services which are integrated into a seamless provision of comprehensive care.
PACE services include but are not limited to the following:
Primary Care (including doctors and nursing services)
Hospital Care
Medical Specialty Services
Prescription Drugs and necessary over-the-counter medications
Nursing Home Care
Emergency Services
Home Health Care and Personal Care
Physical Therapy
Occupational Therapy
Adult Day Care
Recreational Therapy
Meals both at the PACE site and at home, as needed
Dentistry, Audiology, optometry, podiatry and speech therapy
Respite Care
Nutritional Counseling
Social Services
Laboratory/X-ray services
Social Work Counseling
Transportation for all medical appointments in the community
PACE also includes all other services determined necessary by the team of health care professionals to improve and maintain overall health. In addition, participants who need end-of-life care receive the appropriate medical, pharmaceutical and psychosocial services directly through the PACE program.
If you qualify for Medicare, all Medicare-covered services are paid for by Medicare. If you qualify for the States Medicaid program, you will either have a small monthly payment or pay nothing for the long-term care portion of the PACE benefits. If you dont qualify for Medicaid, you will be charged a monthly premium. However, in PACE there is never a deductible or co-payment for any medication, service, or care approved by the PACE team. In addition, you can leave a PACE program at any time and resume traditional Medicare and Medicaid benefits.
All PACE programs utilize the professional expertise of an interdisciplinary team to provide case management on all services provided to and arranged by the PACE program for each enrolled PACE participant. The PACE interdisciplinary team consists of the following members:
Primary Care Physician
Registered Nurse
Nurse Practitioner (Optional)
Masters Level Social Worker
Physical Therapist
Occupational Therapist
Dietitian
Recreational Therapist or Activity Coordinator
Home Care Coordinator
Personal Care Attendant
PACE Site Manager
Transportation Van Driver
Research shows that PACE can achieve better health outcomes. For example, in Texas, PACE enrollees have had fewer hospitalizations than the overall Medicare population, even though PACE participants have greater frailty than the average Medicare patient. Another study found that 61 percent of PACE participants reported no decline in functional skills after three months, and by 12 months, 43 percent still reported no decline.
Today there are more than 72 PACE programs operating in 31 states. For more information on PACE programs, please visit the following sites:
National PACE Association - www.npaonline.org
Centers for Medicare & Medicaid www.cms.hhs.gov/PACE
Video on PACE - www.pace4you.org/website/article.asp?id=15
Call 1-800-MEDICARE (1-800-633-4227) or 1-877-486-2048 for TTY users.
Harold N. Urman, Ph.D. is an educational psychologist and co-founder of Vital Research, a consulting firm specializing in research and evaluation. Established in 1982 and based in Los Angeles, Vital Research is a national research and consulting firm with expertise in senior living services satisfaction measurement.
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(This post was edited by HaroldUrman on Apr 5, 2010, 1:20 PM)
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