The Pace Senior Care Program, standing for Program of All-inclusive Care for the Elderly, is an innovative healthcare model designed to provide comprehensive medical and social services to older adults. This program is a Medicare initiative that aims to support frail individuals aged 55 and above in maintaining their independence and well-being within their communities. By coordinating and delivering a wide range of services, PACE helps participants avoid or delay the need for long-term nursing home care. A dedicated interdisciplinary team of professionals customizes and provides care, ensuring each participant’s unique needs are met in a community-based setting and at home.
Originating in San Francisco in the 1970s as ON LOK, a community-based alternative to nursing homes for the Chinese American population, the PACE model has since been recognized for its effectiveness. In 1997, the Centers for Medicare & Medicaid Services (CMS) formally established PACE as a permanent option under Medicare Advantage, making it accessible to more seniors across the nation.
Who Can Benefit from a PACE Senior Care Program?
Eligibility for the PACE program is structured to target those older adults who require a level of care similar to that provided in a nursing home but who can safely live in their community with the support of PACE services. Specific criteria include:
- Age 55 or Older: Applicants must be at least 55 years of age.
- Need for Nursing Home Level Care: Individuals must require a level of care that is typically provided in a nursing home setting. This is determined through assessments by the PACE team.
- Safe Community Living with PACE Support: At the time of enrollment, individuals must be able to live safely in a community setting with the services offered by the PACE program. This ensures that PACE can effectively support their needs outside of a nursing home.
- Residency in a PACE Service Area: Participants must reside within the geographical service area of a PACE organization. PACE programs operate in specific locations, so residency within these areas is crucial for enrollment.
It’s important to note that PACE participants retain the flexibility to disenroll from the program at any time, for any reason. For those who are enrolled in Medicare or Medicaid and choose to disenroll, assistance is provided to facilitate a smooth return to their previous healthcare coverage.
What Services Does the PACE Program Offer?
One of the key advantages of the PACE program is its comprehensive service coverage. PACE programs are designed to provide participants with all services covered by Medicare and Medicaid, eliminating many of the usual limitations associated with these programs. Furthermore, PACE goes beyond standard coverage to include any additional services deemed necessary by the interdisciplinary team to enable participants to live independently in their communities.
The extensive range of services provided by PACE includes, but is not limited to:
- Primary Care Services: Access to doctors, dentists, and nursing services for routine and specialized medical care.
- Prescription Medications: Coverage for necessary prescription drugs, ensuring medication management and adherence.
- Adult Day Health Care: Engaging and therapeutic day programs at PACE centers, offering social interaction, activities, and healthcare services.
- Home Care and Personal Care Services: In-home assistance with daily living activities, personal care, and support to maintain independence at home.
- Nutritional Services: Meals and nutritional counseling to support dietary needs and health.
- Hospital and Nursing Home Care: Coverage for hospital and nursing home care when medically necessary, ensuring seamless transitions and coordinated care across settings.
- Transportation: Transportation to and from the PACE center and for all medically necessary off-site appointments, removing a significant barrier to care access.
This all-inclusive approach ensures that PACE participants receive holistic care that addresses their medical, social, and emotional needs, all within a coordinated framework.
How is the PACE Program Funded?
PACE programs operate under a unique capitated funding model. PACE organizations receive a predetermined monthly payment from Medicare and Medicaid for each participant. This fixed funding amount is intended to cover all necessary care services, whether they are delivered in the participant’s home, at the PACE center, in the community, or in a nursing home.
This funding structure incentivizes PACE providers to be flexible and innovative in delivering high-quality care. It also encourages proactive care coordination across various settings and medical disciplines. By managing a fixed budget, PACE programs are motivated to focus on preventive care and efficient service delivery to maintain participant health and well-being while remaining financially sustainable.
In addition to Medicare and Medicaid funding, PACE programs may also accept individuals who choose to pay privately for the program, expanding access to those who may not qualify for government assistance but still desire the comprehensive care PACE offers.
Is a PACE Senior Care Program Available Near Me?
The availability of PACE programs varies by location. In Washington State, for example, the Department of Social and Health Services (DSHS) contracts with several organizations to administer PACE, including Providence ElderPlace (PEP), International Community Health Services (ICHS), and PNW PACE Partners (PNW PACE). These organizations operate multiple PACE centers across the state.
To determine if you are located within a PACE service area, it is essential to check the coverage area of local PACE organizations. For Washington State, specific PACE center locations include:
- Providence ElderPlace Seattle: 4515 Martin Luther King Jr Way S, Seattle, WA 98108
- Providence ElderPlace West Seattle: 4831 35th Ave. SW, Seattle, WA 98126
- Providence ElderPlace Kent – North: 7829 S. 180th Street, Kent, WA 98032
- Providence ElderPlace Kent – South: 1404 Central Ave. S, Kent, WA 98032
- Providence ElderPlace Redmond: 8632 160th Ave. NE, Redmond, WA 98052
- Providence ElderPlace Spokane: 6018 N. Astor, Spokane, WA 98208
- Providence ElderPlace Everett – South: 1615 75th Street SW, Everett, WA 98203
- International Community Health Services ICHS Pace at Legacy House: 803 S. Lane St., Seattle, WA 98104
- PNW PACE Partners: 6442 S. Yakima Ave, Tacoma, WA 98408
Prospective participants in Washington State must reside within specific zip codes to be eligible for PACE. A detailed list of eligible zip codes is available on the DSHS website. To find PACE programs in other states, resources like the National PACE Association website can be invaluable.
How to Get More Information About PACE Enrollment
For those interested in learning more about the PACE program and the enrollment process, several resources are available.
For specific policy and contract inquiries, individuals can contact the PACE Program Manager, Kathryn Pittelkau, at (360) 725-2366 or via email at [email protected].
General information about PACE can also be found on the National PACE Association (NPA) website: https://www.npaonline.org/. The NPA website offers comprehensive details about PACE programs nationwide, resources for participants and professionals, and program locators.
Further information is also available on the Centers for Medicare & Medicaid Services (CMS) website: https://www.medicaid.gov/medicaid/long-term-services-supports/program-all-inclusive-care-elderly/index.html. The CMS website provides official details about the PACE program, regulations, and guidelines.
Becoming a PACE Contractor or Expanding a Program
For organizations interested in becoming PACE providers in Washington State, or for existing PACE programs looking to expand their service areas, there are specific processes and requirements to follow.
Becoming a PACE Contractor:
Prospective PACE organizations can be for-profit or non-profit entities, either private or public, primarily focused on delivering PACE services. The process to become a PACE organization involves several steps and can take up to two years. Key stages include:
- Feasibility Study: Conducting a comprehensive study to demonstrate the organization’s potential to be cost-neutral or generate savings for state long-term care services within the proposed service area.
- Letter of Intent and Application: Submitting a letter of intent and a formal PACE application to the ALTSA PACE Program Manager.
- State and Federal Approvals: Gaining approval from both the Washington State Aging and Long-Term Support Administration (ALTSA) and the Centers for Medicare & Medicaid Services (CMS).
- Readiness Review: Undergoing a readiness review, including a site visit by ALTSA.
- Contracting and Enrollment: Entering into agreements with ALTSA and CMS, and subsequently enrolling beneficiaries.
Expanding an Existing PACE Program:
For PACE organizations seeking to expand their service areas, whether within an existing county or into a new county, specific documentation is required:
- Letter of Intent (LOI): Submitting an LOI to HCS outlining expansion plans, proposed service area (including zip codes and a service area map), and the location of the proposed PACE center.
- Market Feasibility Study: Providing a market analysis of the proposed service area, including estimates of PACE-eligible individuals, competitive factors, market capture projections, and demonstration of unmet need for PACE services.
Entities interested in becoming PACE organizations or expanding existing programs in Washington State are encouraged to contact ALTSA for state-specific requirements and guidance.
Resources for Further Information
- PACE Contract Model: PACE Contract Model PDF – Detailed information on the PACE contract model.
- PACE WACs: Information on Washington Administrative Codes (WACs) related to PACE programs.
By offering an all-inclusive model of care, the PACE Senior Care Program stands as a vital resource for older adults seeking to maintain their independence and health within their communities, offering a valuable alternative to traditional nursing home care.
