What is the PACE Program for Aging Adults in the US?

Updated

Certified Care Manager, Aging Life Care Professional, and National Master Guardian Emeritus

Caring for aging parents is becoming an increasingly complex and urgent topic for families and their loved ones. As the population ages, caregiving can be left to families who are unable to afford private caregivers.

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And as more people age, the financial and emotional toll of caregiving becomes more significant. Many programs that support family caregivers have strict income and asset guidelines and waiting lists.

Most people say they want to avoid nursing home care which is expensive and finding alternatives to nursing home care can be a challenge. The states and federal government create programs to keep people out of nursing homes which is better for the client and saves money by supporting people where they live.

If you are in a position of caring for an older family member, it is well worth it to take the time to find out if there are any programs to support you. Long-term care planning is a multi-step process and one that involves taking advantage of supportive programs. One of those programs is the PACE program, known as Programs of All-Inclusive Care for the Elderly.

What’s the PACE Program?

The PACE Model of Care philosophy is based on the idea that older adults with chronic care needs and their families should be supported in the community whenever possible. It not only helps the patient, but also keeps them out of nursing home care. A person who may qualify for a nursing home may have multiple medical and social needs. This is where the PACE program steps in to provide local solutions for the patient.

The PACE program serves individuals who are age 55 or older and certified by their state to meet the qualifications for nursing home care. The participant also needs to be able to live safely in the community and reside in a PACE service area. If a PACE participant needs nursing home care while on the program, PACE will pay costs associated with that care. 140 PACE programs are operating in 30 states, so the program might not be available where you live.


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What Services Does PACE Offer?

PACE is designed to offer all of the services a person needs to live as safely and independently as possible in their community. These services will vary depending upon what the individual requires, but the list is extensive. Here are some of the following options provided by PACE: 

  • Doctor and nursing services
  • Meals and nutritional counseling
  • Social services including caregiver training and support groups
  • Transportation to a PACE center or to other medical appointments
  • Prescription drugs
  • Dentistry
  • Adult Day Care
  • Physical and Occupational therapy
  • Medical specialty services
  • Hospital care
  • Home care, including personal care attendants
  • Recreational therapy
  • Laboratory and X-ray services
  • Emergency services
  • Caregiver support with training and counseling
  • Cardiology
  • Audiology
  • Podiatry

PACE centers offer these services in a person’s home, and the community. For example, privately paying for in-home care can be beyond reach for many families, and the PACE program provides that service. Adult daycare centers often house PACE programs in the community. A team of professional and paraprofessional staff provides everything that PACE offers.

Who’s PACE Typically For?

As mentioned earlier, the PACE program is for individuals 55 or older who would otherwise need a nursing home level of care. The state where you live must certify that you meet the nursing home level of care to qualify and that there is a PACE program in your area.

Since a determination of the nursing home level of care is up to the state where you live, there could be some variability in criteria. In general, nursing home level of care includes but is not limited to the following:

  • The patient has medical needs such as help with a catheter, IV medications, ventilators, wound care, medication administration, or other services from a nurse 
  • Cognitive and memory problems that impact functioning and safety
  • Functional limitations such as difficulty with activities of daily living such as bathing, dressing, eating, toileting, hygiene, and transferring
  • Behavioral problems and mood disorders such as depression and anxiety

PACE is also helpful for patients and families who would prefer to receive their medical care, social services support, and medication management in their community.

What Are the Pros and Cons of the PACE Program?

There are pros and cons to any government program, and PACE is no exception. Even if the program is available in your area, you may opt not to take advantage of it. The PACE program is entirely voluntary, and you can leave the program at any time.


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Pros of the PACE program

The PACE program can keep your loved one at home and out of a nursing home. In some cases, nursing home care is necessary if someone has such complex and ongoing medical needs that require 24-hour nursing.

In other situations, having medical support at home is preferable for most people. With families concerned about COVID and other infections in nursing homes, there is a strong incentive to keep people at home.

Additionally, your loved one can stay in their community where they are most comfortable. One of the least talked about advantages of staying in your community are the connections and familiarity of friends, church, and neighborhood. 

The PACE program is affordable. The affordability of the program is especially true if you have both Medicare and Medicaid. But, even with Medicare, the co-pays will be far less than exhausting your financial resources to stay in a nursing home.

The program also values and supports the participant’s independence and develops an individualized plan of care. This can be of particular value to some participants who have more significant needs in some areas than other participants.

Cons of the PACE Program

For all the pros of the program, the PACE program may not be available in your area even if you qualify. There are also some additional cons to the program such as the following:

  • If your loved one has needs that exceed what the PACE program can provide, you might have to go to a nursing home.
  • If you don’t have Medicare or Medicaid, you can pay privately for PACE, but the cost might exceed what you are comfortable with.
  • You are required to use PACE physicians and other healthcare providers, which means giving up your primary care physician and other preferred healthcare workers.
  • The program does not offer 24-hour care, so the family is expected to provide some caregiving.
  • The process of applying to the PACE program can take months in some states. There may be waiting lists for participation. 

What Is the Income Level for PACE?

Medicaid and Medicare funds pay for necessary medical care for a PACE participant. You can have both Medicaid and Medicare or one or the other or neither. 

The income level for PACE depends on whether you or your loved one qualifies for Medicaid. Medicaid is a joint federal and state insurance program for low-income or disabled adults. PACE does not require that a participant is on Medicaid, but doing so eliminates co-pays.

If you don't qualify for Medicaid, but you have Medicare, you are responsible for a monthly premium to cover a portion of the PACE benefit. You will also pay a premium for Medicare Part D drugs.

If you feel you may meet the financial criteria for Medicaid, you will need to apply in the state where you live. Qualifications vary from state to state. In general, income levels must be quite low and assets below the $2000 level. Most PACE participants are “dual eligible,” which means they have both Medicaid and Medicare.

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How Else Do You Have to Qualify for the PACE Program?

The first and most important qualifier for being in the PACE program is identifying one in your community. If there isn’t one, you would have to be willing to move to a location where there is a program to participate. However, there are other conditions that you may need to meet in order to qualify. Here are some examples:

  • Having only dementia or Alzheimer’s disease with no other skilled need does not automatically qualify you for the PACE program. These conditions must contribute to difficulty with self-care.
  • If you are a veteran, you can still qualify for the PACE program.
  • The PACE programs have no financial requirements, but most people who enroll in the program have Medicaid, Medicare, or both. 
  • The family has to be willing and able to provide some of the care that the participant needs. The PACE program is not like a nursing home that has 24-hour nursing and aide service.
  • Involvement in the PACE program does mean that you are accepting the providers that work with you. People get accustomed to certain healthcare professionals, and you will have very little choice in the PACE program. There is a team assigned to your care.

The PACE Program: Keeping You at Home  

Programs like PACE understand and support a family’s decision to care for their loved ones at home by improving and maintaining health. Caring for an aging adult can be next to impossible without adequate professional medical and home care support. The PACE program does just that, and hopefully, the program can reach more families in the future.


Sources:
  1. “Is PACE for You?” PACE, National Pace Association, 2021. Npaonline.org
  2. “PACE.” Your Medicare Costs, Medicare.gov, 2021. Medicare.gov
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