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Program of All-Inclusive Care for the Elderly

January 01, 1970

Program of All-inclusive Care for the Elderly (PACE) are programs within the United States that provide comprehensive health services for individuals age 55 and over who are sufficiently frail to be categorized as "nursing home eligible" by their state's Medicaid program.[1] The ultimate goal of PACE programs is to keep eligible older adults out of nursing homes and within their communities for as long as possible.[1] Services include primary and specialty medical care, nursing, nutrition, social services, therapies (occupational, physical, speech, recreation, etc.), pharmaceuticals, day health center services, home care, health-related transportation, minor modification to the home to accommodate disabilities, and anything else the program determines is medically necessary to maximize a member's health.[1] If you or a loved one are eligible for nursing home level care but prefer to continue living at home, a PACE program can provide expansive health care and social opportunities during the day while you retain the comfort and familiarity of your home outside of day hours.[1]

History edit

PACE was developed by On Lok Senior Health Services, a not-for-profit community-based organization launched in the early 1970s in the Chinatown-North Beach area of San Francisco, California.[2]

1971–1978

On Lok Senior Health Services was created in 1971 to address the long-term care needs of older immigrants in San Francisco's Chinatown-North Beach neighborhood.[3] After its founding, between 1973 and 1975, On Lok expanded to include day centers, in-home care, home-delivered meals, and housing assistance.[3] In 1974, On Lok started being reimbursed by Medicaid for its provision of adult day health services.[3] Later, in 1978, these health services were broadened to include comprehensive medical care for older adults certified to be nursing home-eligible.[3]

1979

The Department of Health and Human Services provided a four-year grant to On Lok to develop a model of care delivery for individuals with long-term care needs.[2]

1986-1987

10 other organizations implemented the care delivery model developed by On Lok, with approval from the federal level.[3] In 1987, the 11 existing sites received funding from the Robert Wood Johnson Foundation, John A. Hartford Foundation, and Retirement Research Foundation.[3]

1990

The care delivery model developed by On Lok became known as "Program of All-Inclusive Care for the Elderly" or PACE.[3] The first replication sites received Medicare and Medicaid waivers.[3]

1994

The National PACE Association (NPA) was formed.[3]

1997

The Balanced Budget Act of 1997 (P.L. 105–33, Section 4801-4804) established PACE as a permanent part of the Medicare program and an option under state Medicaid programs.[2]

2005-2006

The Deficit Reduction Act (DRA) of 2005 authorized a Rural PACE initiative[4] and in 2006, the Centers for Medicare and Medicaid Services (CMS) announced 15 rural PACE grantees.[5]

2015

President Obama signed the PACE Innovation Act into law.[3]

2019

As of 2019, there were 130 PACE organizations in 31 states, serving over 50,000 individuals.[3]

Eligibility edit

To be eligible for PACE, individuals must be at least 55 years old; be certified to need nursing home-level care by the state; reside near a PACE program; and be able to safely reside in the community with the help of PACE.[6]

Program description edit

PACE delivers patient-centered, comprehensive care to frail and elderly adults through a collaborative team of providers, including but not limited to physicians, nurses, registered dietitian, physical therapists, and social workers.[1] The goal of the team is to help PACE members to reside in their community independently as long as possible, by providing them with tailored services or resources that support their physical wellbeing, mental health, Activities of Daily Living (ADL), and Instrumental Activities of Daily Living (IADL).[7] PACE programs emphasize on preventional and health promotional day-care that can impact members' end-of-life care and prevent more expensive care from skilled nursing facilities.[8]

Under funding from the CMS, PACE provides all services covered by the Medicare and Medicaid.[9] PACE may also cover services outside the scope of Medicare and Medicaid funding, as long as the providers deem the service necessary.[9] Most PACE participants have co-morbidities, including cardiovascular diseases, diabetes, and hypertension.[10] PACE provides services including primary care, home care, labs, medications, recreational therapy, social services, counseling, transportation to care facilities, and more.[8] By providing all-inclusive care for the participants, PACE maintains the health of members and prevent exacerbation of current medical conditions.[1] Patients are less likely to request extensive acute care, nursing facility care, or in-patient services.[9][11] Under this method, PACE serves as a cost-saving elderly care program that emphasizes on preventative, up-stream care. Notably, PACE programs saved California State $22.6 million in health care cost for elderly.[12]

PACE programs organize their services in "PACE Centers".[10] Currently, there are 272 PACE Centers in 30 states, serving around 55,000 participants.[13] PACE Centers serve as comprehensive care centers that include services that would otherwise require accessing primary care offices, social services, rehabilitation centers, recreational facilities, and more.[14] Services such as routine care, exercise programs, dietary monitoring, strength training, and mental health services are provided out of these centers.[14] The goal is to reduce burnout from caregivers and provide support for the members.[12] The centers are regularly accessible to members; they can participate daily, weekly, or monthly depending on their needs.[14] Care decisions are made at these centers between the members, their care team, and any caregivers.[14]

Financing edit

PACE receives monthly funding from the CMS under risk-adjusted per-member payments, or capitation.[11][8] Medicaid covers the monthly premium of long-term care, and Medicare covers the rest.[11] For PACE participants who are qualified for Medicare but not Medicaid, they are responsible for monthly premium equal to the Medicaid capitation fee and the premium for medications under Medicare Part D.[9][8] Participants who are not eligible for Medicare or Medicaid can still be eligible for PACE, but will be responsible for the cost of the program.[1]

Outcomes edit

Several studies point to the numerous benefits that PACE programs have had on their patient populations, including allowing them to live safely within their communities.[15]

The more positive research on effectiveness centers on outcomes of interest tied to PACE programs. These include greater adult day health care use along with decreased numbers of hospitalizations and nursing home admissions. In fact, patients were less likely to be institutionalized when compared to those who waived 1915(c) home- and community-based services.[6]

Similarly, it has been noted that patients remain in contact with primary care longer; have greater survival rates, better health, better functional status, and better quality of life as reflected by increased social interaction; and experience less depression and fewer concerns after enrollment.[16][17][18][19][20][21][22]

There are, however, some drawbacks that patients have come to perceive with certain aspects of the PACE experience. Some patients have reported that they are not receiving enough information about their conditions and that their input into their own care is not being taken into consideration by providers.[9] In addition, there is a prevalent concern amongst enrollees centered on losing their primary care physician with whom they have established a relationship and trust with.[9]

See also edit

References edit

  1. ^ a b c d e f g "All Inclusive Care for the Elderly". www.dhcs.ca.gov. Retrieved 2021-09-12.
  2. ^ a b c Polska, Urszula (2017-03-01). "The Program of All-Inclusive Care for the Elderly (PACE): The Innovative and Economically Viable Model of American Geriatric Care". Pielegniarstwo XXI Wieku / Nursing in the 21st Century. 16 (1): 51–61. doi:10.1515/pielxxiw-2017-0008. ISSN 2450-646X.
  3. ^ a b c d e f g h i j k "The History of PACE | National PACE Association". www.npaonline.org. Retrieved 2021-09-10.
  4. ^ Gregg, Judd (2006-02-08). "S.1932 - 109th Congress (2005-2006): Deficit Reduction Act of 2005". www.congress.gov. Retrieved 2021-09-10.
  5. ^ "Rural PACE® Provider Grant Program | National PACE Association". www.npaonline.org. Retrieved 2021-09-10.
  6. ^ a b Gonzalez, Lori (2017). "A Focus on the Program of All-Inclusive Care for the Elderly (PACE)". Journal of Aging & Social Policy. 29 (5): 475–490. doi:10.1080/08959420.2017.1281092. PMID 28085633. S2CID 6378863.
  7. ^ "Program of All-Inclusive Care for the Elderly | Medicaid". www.medicaid.gov. Retrieved 2021-09-12.
  8. ^ a b c d "PACE | CMS". www.cms.gov. Retrieved 2021-09-13.
  9. ^ a b c d e f "PACE | Medicare". www.medicare.gov. Retrieved 2021-09-13.
  10. ^ a b "What Is PACE?". www.seniorsbluebook.com. Retrieved 2021-09-13.
  11. ^ a b c "Programs of All-Inclusive Care for the Elderly Benefits | Medicaid". www.medicaid.gov. Retrieved 2021-09-13.
  12. ^ a b "PACE health care in California is honored". 2019-09-20. Retrieved 2021-09-13.
  13. ^ "PACEFinder: Find a PACE Program in Your Neighborhood | National PACE Association". www.npaonline.org. Retrieved 2021-09-13.
  14. ^ a b c d "An Overview of PACE and How the Genesis of This Critical Solution For Seniors was Inspired by a Local Community Effort in San Francisco Over 40-years Ago - CiminoCare". www.ciminocare.com. 31 October 2019. Retrieved 2021-09-13.
  15. ^ Hirth, Victor; Baskins, Judith; Dever-Bumba, Maureen (March 2009). "Program of All-Inclusive Care (PACE): Past, Present, and Future". Journal of the American Medical Directors Association. 10 (3): 155–160. doi:10.1016/j.jamda.2008.12.002. ISSN 1525-8610. PMID 19233054.
  16. ^ Friedman, S. M.; Steinwachs, D. M.; Rathouz, P. J.; Burton, L. C.; Mukamel, D. B. (2005-04-01). "Characteristics Predicting Nursing Home Admission in the Program of All-Inclusive Care for Elderly People". The Gerontologist. 45 (2): 157–166. doi:10.1093/geront/45.2.157. ISSN 0016-9013. PMID 15799980.
  17. ^ Grabowski, David C. (February 2006). "The Cost-Effectiveness of Noninstitutional Long-Term Care Services: Review and Synthesis of the Most Recent Evidence". Medical Care Research and Review. 63 (1): 3–28. doi:10.1177/1077558705283120. ISSN 1077-5587. PMID 16686071. S2CID 29427385.
  18. ^ Mukamel, D. B.; Temkin-Greener, H.; Delavan, R.; Peterson, D. R.; Gross, D.; Kunitz, S.; Williams, T. F. (2006-04-01). "Team Performance and Risk-Adjusted Health Outcomes in the Program of All-Inclusive Care for the Elderly (PACE)". The Gerontologist. 46 (2): 227–237. doi:10.1093/geront/46.2.227. ISSN 0016-9013. PMID 16581887.
  19. ^ Sands, L. P.; Yaffe, K.; Lui, L.-Y.; Stewart, A.; Eng, C.; Covinsky, K. (2002-07-01). "The Effects of Acute Illness on ADL Decline Over 1 Year in Frail Older Adults With and Without Cognitive Impairment". The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 57 (7): M449–M454. doi:10.1093/gerona/57.7.m449. ISSN 1079-5006. PMID 12084807.
  20. ^ Temkin-Greener, Helena; Mukamel, Dana B. (January 2002). "Predicting Place of Death in the Program of All-Inclusive Care for the Elderly (PACE): Participant versus Program Characteristics". Journal of the American Geriatrics Society. 50 (1): 125–135. doi:10.1046/j.1532-5415.2002.50018.x. ISSN 0002-8614. PMID 12028257. S2CID 8128177.
  21. ^ Wieland, Darryl; Lamb, Vicki L.; Sutton, Shae R.; Boland, Rebecca; Clark, Marleen; Friedman, Susan; Brummel-Smith, Kenneth; Eleazer, G. Paul (November 2000). "Hospitalization in the Program of All-inclusive Care for the Elderly (PACE): Rates, Concomitants, and Predictors". Journal of the American Geriatrics Society. 48 (11): 1373–1380. doi:10.1111/j.1532-5415.2000.tb02625.x. ISSN 0002-8614. PMID 11083311. S2CID 34732766.
  22. ^ "Program of All-Inclusive Care for the Elderly (PACE)", Health Care Policy and Politics A to Z, CQ Press, 2009, doi:10.4135/9781452240121.n316, ISBN 9780872897762, retrieved 2021-09-13

External links edit

  • Medicare page on PACE
  • PACE Overview from CMS/HHS website
  • National Pace Association

January 01, 1970
program, inclusive, care, elderly, program, inclusive, care, elderly, pace, programs, within, united, states, that, provide, comprehensive, health, services, individuals, over, sufficiently, frail, categorized, nursing, home, eligible, their, state, medicaid, . Program of All inclusive Care for the Elderly PACE are programs within the United States that provide comprehensive health services for individuals age 55 and over who are sufficiently frail to be categorized as nursing home eligible by their state s Medicaid program 1 The ultimate goal of PACE programs is to keep eligible older adults out of nursing homes and within their communities for as long as possible 1 Services include primary and specialty medical care nursing nutrition social services therapies occupational physical speech recreation etc pharmaceuticals day health center services home care health related transportation minor modification to the home to accommodate disabilities and anything else the program determines is medically necessary to maximize a member s health 1 If you or a loved one are eligible for nursing home level care but prefer to continue living at home a PACE program can provide expansive health care and social opportunities during the day while you retain the comfort and familiarity of your home outside of day hours 1 Contents 1 History 2 Eligibility 3 Program description 4 Financing 5 Outcomes 6 See also 7 References 8 External linksHistory editPACE was developed by On Lok Senior Health Services a not for profit community based organization launched in the early 1970s in the Chinatown North Beach area of San Francisco California 2 1971 1978On Lok Senior Health Services was created in 1971 to address the long term care needs of older immigrants in San Francisco s Chinatown North Beach neighborhood 3 After its founding between 1973 and 1975 On Lok expanded to include day centers in home care home delivered meals and housing assistance 3 In 1974 On Lok started being reimbursed by Medicaid for its provision of adult day health services 3 Later in 1978 these health services were broadened to include comprehensive medical care for older adults certified to be nursing home eligible 3 1979The Department of Health and Human Services provided a four year grant to On Lok to develop a model of care delivery for individuals with long term care needs 2 1986 198710 other organizations implemented the care delivery model developed by On Lok with approval from the federal level 3 In 1987 the 11 existing sites received funding from the Robert Wood Johnson Foundation John A Hartford Foundation and Retirement Research Foundation 3 1990The care delivery model developed by On Lok became known as Program of All Inclusive Care for the Elderly or PACE 3 The first replication sites received Medicare and Medicaid waivers 3 1994The National PACE Association NPA was formed 3 1997The Balanced Budget Act of 1997 P L 105 33 Section 4801 4804 established PACE as a permanent part of the Medicare program and an option under state Medicaid programs 2 2005 2006The Deficit Reduction Act DRA of 2005 authorized a Rural PACE initiative 4 and in 2006 the Centers for Medicare and Medicaid Services CMS announced 15 rural PACE grantees 5 2015President Obama signed the PACE Innovation Act into law 3 2019As of 2019 there were 130 PACE organizations in 31 states serving over 50 000 individuals 3 Eligibility editTo be eligible for PACE individuals must be at least 55 years old be certified to need nursing home level care by the state reside near a PACE program and be able to safely reside in the community with the help of PACE 6 Program description editPACE delivers patient centered comprehensive care to frail and elderly adults through a collaborative team of providers including but not limited to physicians nurses registered dietitian physical therapists and social workers 1 The goal of the team is to help PACE members to reside in their community independently as long as possible by providing them with tailored services or resources that support their physical wellbeing mental health Activities of Daily Living ADL and Instrumental Activities of Daily Living IADL 7 PACE programs emphasize on preventional and health promotional day care that can impact members end of life care and prevent more expensive care from skilled nursing facilities 8 Under funding from the CMS PACE provides all services covered by the Medicare and Medicaid 9 PACE may also cover services outside the scope of Medicare and Medicaid funding as long as the providers deem the service necessary 9 Most PACE participants have co morbidities including cardiovascular diseases diabetes and hypertension 10 PACE provides services including primary care home care labs medications recreational therapy social services counseling transportation to care facilities and more 8 By providing all inclusive care for the participants PACE maintains the health of members and prevent exacerbation of current medical conditions 1 Patients are less likely to request extensive acute care nursing facility care or in patient services 9 11 Under this method PACE serves as a cost saving elderly care program that emphasizes on preventative up stream care Notably PACE programs saved California State 22 6 million in health care cost for elderly 12 PACE programs organize their services in PACE Centers 10 Currently there are 272 PACE Centers in 30 states serving around 55 000 participants 13 PACE Centers serve as comprehensive care centers that include services that would otherwise require accessing primary care offices social services rehabilitation centers recreational facilities and more 14 Services such as routine care exercise programs dietary monitoring strength training and mental health services are provided out of these centers 14 The goal is to reduce burnout from caregivers and provide support for the members 12 The centers are regularly accessible to members they can participate daily weekly or monthly depending on their needs 14 Care decisions are made at these centers between the members their care team and any caregivers 14 Financing editPACE receives monthly funding from the CMS under risk adjusted per member payments or capitation 11 8 Medicaid covers the monthly premium of long term care and Medicare covers the rest 11 For PACE participants who are qualified for Medicare but not Medicaid they are responsible for monthly premium equal to the Medicaid capitation fee and the premium for medications under Medicare Part D 9 8 Participants who are not eligible for Medicare or Medicaid can still be eligible for PACE but will be responsible for the cost of the program 1 Outcomes editSeveral studies point to the numerous benefits that PACE programs have had on their patient populations including allowing them to live safely within their communities 15 The more positive research on effectiveness centers on outcomes of interest tied to PACE programs These include greater adult day health care use along with decreased numbers of hospitalizations and nursing home admissions In fact patients were less likely to be institutionalized when compared to those who waived 1915 c home and community based services 6 Similarly it has been noted that patients remain in contact with primary care longer have greater survival rates better health better functional status and better quality of life as reflected by increased social interaction and experience less depression and fewer concerns after enrollment 16 17 18 19 20 21 22 There are however some drawbacks that patients have come to perceive with certain aspects of the PACE experience Some patients have reported that they are not receiving enough information about their conditions and that their input into their own care is not being taken into consideration by providers 9 In addition there is a prevalent concern amongst enrollees centered on losing their primary care physician with whom they have established a relationship and trust with 9 See also editNursing homeReferences edit a b c d e f g All Inclusive Care for the Elderly www dhcs ca gov Retrieved 2021 09 12 a b c Polska Urszula 2017 03 01 The Program of All Inclusive Care for the Elderly PACE The Innovative and Economically Viable Model of American Geriatric Care Pielegniarstwo XXI Wieku Nursing in the 21st Century 16 1 51 61 doi 10 1515 pielxxiw 2017 0008 ISSN 2450 646X a b c d e f g h i j k The History of PACE National PACE Association www npaonline org Retrieved 2021 09 10 Gregg Judd 2006 02 08 S 1932 109th Congress 2005 2006 Deficit Reduction Act of 2005 www congress gov Retrieved 2021 09 10 Rural PACE Provider Grant Program National PACE Association www npaonline org Retrieved 2021 09 10 a b Gonzalez Lori 2017 A Focus on the Program of All Inclusive Care for the Elderly PACE Journal of Aging amp Social Policy 29 5 475 490 doi 10 1080 08959420 2017 1281092 PMID 28085633 S2CID 6378863 Program of All Inclusive Care for the Elderly Medicaid www medicaid gov Retrieved 2021 09 12 a b c d PACE CMS www cms gov Retrieved 2021 09 13 a b c d e f PACE Medicare www medicare gov Retrieved 2021 09 13 a b What Is PACE www seniorsbluebook com Retrieved 2021 09 13 a b c Programs of All Inclusive Care for the Elderly Benefits Medicaid www medicaid gov Retrieved 2021 09 13 a b PACE health care in California is honored 2019 09 20 Retrieved 2021 09 13 PACEFinder Find a PACE Program in Your Neighborhood National PACE Association www npaonline org Retrieved 2021 09 13 a b c d An Overview of PACE and How the Genesis of This Critical Solution For Seniors was Inspired by a Local Community Effort in San Francisco Over 40 years Ago CiminoCare www ciminocare com 31 October 2019 Retrieved 2021 09 13 Hirth Victor Baskins Judith Dever Bumba Maureen March 2009 Program of All Inclusive Care PACE Past Present and Future Journal of the American Medical Directors Association 10 3 155 160 doi 10 1016 j jamda 2008 12 002 ISSN 1525 8610 PMID 19233054 Friedman S M Steinwachs D M Rathouz P J Burton L C Mukamel D B 2005 04 01 Characteristics Predicting Nursing Home Admission in the Program of All Inclusive Care for Elderly People The Gerontologist 45 2 157 166 doi 10 1093 geront 45 2 157 ISSN 0016 9013 PMID 15799980 Grabowski David C February 2006 The Cost Effectiveness of Noninstitutional Long Term Care Services Review and Synthesis of the Most Recent Evidence Medical Care Research and Review 63 1 3 28 doi 10 1177 1077558705283120 ISSN 1077 5587 PMID 16686071 S2CID 29427385 Mukamel D B Temkin Greener H Delavan R Peterson D R Gross D Kunitz S Williams T F 2006 04 01 Team Performance and Risk Adjusted Health Outcomes in the Program of All Inclusive Care for the Elderly PACE The Gerontologist 46 2 227 237 doi 10 1093 geront 46 2 227 ISSN 0016 9013 PMID 16581887 Sands L P Yaffe K Lui L Y Stewart A Eng C Covinsky K 2002 07 01 The Effects of Acute Illness on ADL Decline Over 1 Year in Frail Older Adults With and Without Cognitive Impairment The Journals of Gerontology Series A Biological Sciences and Medical Sciences 57 7 M449 M454 doi 10 1093 gerona 57 7 m449 ISSN 1079 5006 PMID 12084807 Temkin Greener Helena Mukamel Dana B January 2002 Predicting Place of Death in the Program of All Inclusive Care for the Elderly PACE Participant versus Program Characteristics Journal of the American Geriatrics Society 50 1 125 135 doi 10 1046 j 1532 5415 2002 50018 x ISSN 0002 8614 PMID 12028257 S2CID 8128177 Wieland Darryl Lamb Vicki L Sutton Shae R Boland Rebecca Clark Marleen Friedman Susan Brummel Smith Kenneth Eleazer G Paul November 2000 Hospitalization in the Program of All inclusive Care for the Elderly PACE Rates Concomitants and Predictors Journal of the American Geriatrics Society 48 11 1373 1380 doi 10 1111 j 1532 5415 2000 tb02625 x ISSN 0002 8614 PMID 11083311 S2CID 34732766 Program of All Inclusive Care for the Elderly PACE Health Care Policy and Politics A to Z CQ Press 2009 doi 10 4135 9781452240121 n316 ISBN 9780872897762 retrieved 2021 09 13External links editMedicare page on PACE PACE Overview from CMS HHS website National Pace Association Retrieved from https en wikipedia org w index php title Program of All Inclusive Care for the Elderly amp oldid 1220512308, wikipedia, wiki, book, books, library,

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