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Program of All-inclusive Care for the Elderly (PACE)

February 16, 2023
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The Program of All-inclusive Care for the Elderly, or PACE, provides geriatric patients with complete healthcare under Medicaid or Medicare. As a future doctor working with patients young and old, you should understand the importance of the PACE program for your elderly patients. Providing care for patients in PACE helps reduce the workload for providers and paraprofessionals by allowing for a broader range of care. With the number of patients over 55 increasing daily, specialized care for the elderly has become a top priority for the healthcare system. Patients who benefit most from PACE typically have six or more chronic conditions that require a team of healthcare professionals to create an interdisciplinary treatment plan. With the pandemic highlighting areas in our healthcare system that max out quickly, such as nursing homes, PACE has become crucial for patients and healthcare workers. PACE can alleviate nursing home congestion by allowing elderly individuals to remain in their communities while receiving the care they require. Keep reading to understand who qualifies for PACE, who serves PACE patients, and how you can get involved.

Eligibility Requirements for PACE

Patients must meet specific requirements to qualify for PACE. Eligible members can leave PACE anytime and resume their standard coverage under Medicare or Medicaid. To qualify for PACE, patients must be:
    • 55 years or older
    • Located near a PACE organization
    • Eligible for a nursing home

PACE Availability

Currently, 32 states offer PACE for qualified individuals under Medicare with about 60,000 enrollees. States elect to provide PACE for Medicare programs with Medicaid beneficiaries as well. PACE enables individuals to remain in their homes and communities rather than going into nursing homes. With a rapidly aging country, encouraging states to participate in PACE remains essential for providing all-inclusive care to elderly patients.

PACE Provider Teams

A PACE provider team includes medical professionals and staff from many disciplines dedicated to comprehensive care. The interdisciplinary team works together to ensure that individuals have their needs met. As a PACE provider, working with an all-inclusive team to care for your elderly patients ensures they get the best care possible. The medical and paraprofessional staff usually consists of the following at minimum:
    • Social worker
    • Driver
    • Primary care physician
    • Physical therapist
    • PACE supervisor
    • Nurse
    • Home care worker
    • Dietician
    • Activity coordinator
    • Occupational therapist

Benefits of PACE for Geriatric Healthcare

PACE remains the most comprehensive program available to geriatric patients. The benefits include all covered services from Medicare and Medicaid, with additional benefits should they be found necessary for the patient. These include the following:
    • Dental care
    • Lab work
    • Meals
    • Nursing home services
    • Prescription coverage
    • Transportation
    • Counseling
    • Adult daycare
    • Emergency care
    • Therapy (occupational, physical, recreational)
    • Diagnostic testing (x-ray)
    • Social services
    • Hospital care
    • Home care
PACE is a capped program allowing providers to give comprehensive care to its patients without paying per service under Medicare or Medicaid.

PACE Organization Qualifications

With more and more states incorporating PACE into their healthcare systems, institutions must abide by certain standards to join the program. First and foremost, the organization must be a non-profit or public institution participating in PACE activities. In addition, organizations wishing to join PACE must meet the following criteria:
    • A physical location for care services
    • An adequate service area
    • Protection against any conflicts of interest between care activities
    • An organizational chart identifying key officials, their titles, and relationships to other entities

Extending Existing PACE Program

Presenting a service area with unmet individuals who need more care can call for an extension of a PACE entity. Requirements for extending an existing PACE institution include the following:
    • Letter of intent to extend
    • Feasibility of market study
    • Define an underserved area

Paying for PACE

Medicare and Medicaid handle monthly payments for each enrollee for qualified PACE organizations to provide all-inclusive care. This form of capitated payment offers an incentive for providers to supply excellent and flexible care for PACE members. PACE members can also opt to pay privately for enrollment.

More Information on PACE From Saint James School of Medicine

PACE provides superior care for those who require the most medical support in the healthcare system. Elderly patients who have multiple chronic conditions, are over 55, and live near a PACE organization can qualify for this program to receive all-inclusive care. PACE provides a roadmap for excellent care for elderly patients while allowing them to receive care from their homes and communities. As our society ages rapidly, the PACE model ensures patients get the care they need in the most cost-effective way. With nearly 10,000 Americans turning 65 every day, including PACE programs countrywide can help reduce the overcrowding of nursing homes by keeping the elderly in their own homes. As future Saint James School of Medicine graduates navigate the healthcare system, we hope they will consider Geriatric medicine and participation in the local PACE program so our senior community can avail themselves to the highest quality of care.
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