Most seniors want to stay at home as long as they can. The little-known Program for All-Inclusive Care of the Elderly (PACE) allows persons to do just that instead of going into a nursing home.
PACE’s inception dates to the 1970s when the federal and state governments were developing community-based services for some of their most in-need constituents. As part of this effort, states explored fee-based services for the elderly and disability communities. PACE was among the programs developed during this time.
Today’s PACE model comprises managed care services serving a population of very frail community-dwelling elderly or disabled individuals. These people are usually dually eligible for Medicare and Medicaid and also qualify for nursing home placement.
Significantly, participants receive core services – not in nursing homes – but rather, in their home and at an adult day health center. For many, this markedly enhances their quality of life.
Currently, 155 PACE centers operate in 32 states. One of those centers is located in Bethlehem, Pennsylvania, called Senior Life. See www.seniorlifepa.com
What is PACE?
PACE provides pre-paid, comprehensive health care designed to enhance quality of life and autonomy for frail older adults, enabling them to live in their homes as long as possible while preserving their existing family structure.
To be eligible, participants must:
- be at least 55 years old
- qualify for Medicare or Medicaid (or both)
- live safely in a PACE service area
- meet their state’s criteria to qualify as a nursing home care candidate
Participants must meet any additional program-specific conditions imposed by their local PACE program.
If a senior joins PACE, the program becomes the sole provider of Medicaid and Medicare services. The enrollee must agree to forgo their usual sources of care and receive all their services through PACE. For example, participants may not also enroll in any other Medicare Advantage, Medicare prescription drug, or Medicaid prepayment plan, or optional benefit. This includes a 1915c Home and Community Based Services waiver, referred to, in Pennsylvania, as Community Health Choices, or the Medicare hospice benefit.
PACE provides a team of doctors, nurses, social workers, personal care attendants, and dietitians to assist each senior. Participants can also receive therapeutic, ancillary, and social support services.
All care is centralized in an adult health center and supplemented by in-home and referral services. Other covered services include adult day care, dentistry, and prescription drugs.
Enrollees get Medicare Part D-covered drugs and all other necessary medications through the program. They don’t need to join a separate Medicare Part D prescription drug plan; doing so disenrolls them from PACE.
In addition, PACE provides transportation to the health center or to doctor’s appointments at other locations. It also provides meals and social activities along with other non-medical care.
Once a person enrolls in PACE, it becomes their sole source of services. Participants can, however, leave the program at any time.
In Pennsylvania, PACE can typically cost $8,000 per month. Consequently, as noted by Stanley M. Vasiliadis, an attorney with the law firm of Vasiliadis Pappas Associates, “it makes sense to seek the assistance of an elder law attorney experienced in Medicaid planning to shelter assets for family and then qualify for Medicaid to pay for PACE services, same as one would do to qualify for payment for nursing home care.”
At enrollment, PACE verifies whether an individual is dually eligible for Medicare and Medicaid and whether they have Medicare Part A and/or Part B. Unless a person is dually eligible, and to the extent they would normally be required to pay, they will need to continue to pay their Medicare Part A, Part B, and/or Part D premiums. PACE then determines the amounts payable by the person, which likely won’t change over the course of their program participation.
Research shows that PACE reduces hospitalizations, emergency room visits, and nursing home stays. Some states have documented that participants receive better preventive care, with higher rates of community residence and caregiver satisfaction.
To learn more about whether PACE may be right for your loved one contact the lawyers at Vasiliadis Pappas Associates. We can help!