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HOMEAging at the Right PACE
This article was originally published on The Daily Sentinal.
Sarah Burke, 84, has always loved her independence and the excitement of experiencing something new.
She has lived in Massachusetts, Florida, Grand Junction and, when Burke was 79, she returned to live in her home country of Ireland. After a couple of years, it became apparent to Burke and her daughter that it would be best if she returned to Grand Junction.
But, that wasn’t the end of Burke’s independence and excitement for life. Since returning and joining HopeWest’s Program of All-Inclusive Care for the Elderly (PACE), Burke said it has never been easier to be independent and experience new things daily.
“Life keeps getting better the older I get because the things I worried about, I don’t worry about anymore,” Burke said. “It was good before (PACE), but this is like the icing on the cake.”
PACE is a Medicare-funded program that provides eligible older adults with comprehensive, wrap-around services to maintain their safety and independence while keeping them out of the hospital, long-term care or assisted living.
There can be variations between each of the 171 PACE programs across the U.S., but they generally offer home care, facility-based medical and dental care, laboratory testing, medical equipment and prescription drugs, meals, transportation and recreation opportunities.
According to HopeWest President and CEO Cassie Mitchell, PACE coordinates all aspects of care for participants into one team so that it is easier to address health concerns and contributing social determinants. Most participants are enrolled in Medicaid and Medicare, so there are no monthly premiums — instead, Medicare and Medicaid foot the bill.
“At the beginning of the month, Medicare and Medicaid give us a fee per participant based on their risk-adjusted score,” Mitchell said. Then for that month, we are responsible for all the care, to meet their needs, keep that patient safe and secure.”
It is possible to enroll if you are Medicare only, in which case the participant would pay for the Medicaid component as they would a premium. Given the complicated nature of insurance, PACE has enrollment specialists who can assist those who are interested but unsure if they can qualify or pay.
“As a family member, the one helping mom and getting her set up, (the enrollment specialists are) huge because you don’t need all the answers,” Sarah Burke’s daughter, Eileen Donohue, said. “You just need to be able to provide what it is they need to get them signed up for the program.”
However, Mitchell said enrolling people without the two government insurances can be difficult — even with philanthropy funding — given the cost of all the different services.
HopeWest’s PACE program also debuted in 2021; because the program is still new and scaling in size, funds are even tighter.
“This has been a multimillion-dollar investment on behalf of HopeWest and its donors, there was a huge capital campaign to buy and refurbish this building to be the PACE Center,” Mitchell said. “Even with the (monthly) payment, we still run really tight as we’re scaling because we’re still investing.”
According to Mitchell, some of the primary expenses have been staff and vehicles. She said there are approximately two staff for each participant, and that ratio would have to be maintained as they add participants.
When the program opened for enrollment, they had around 40 participants; now, 183 people are enrolled. Mitchell estimates there are between 350 and 400 residents in Mesa County eligible for PACE.
In the past two years, the program has purchased at least 10 new buses for participant transportation. Transportation is a critical component to the PACE program, as Mitchell said many participants are unable to drive themselves or leave the home otherwise.
