How PACE Avoids Institutional Bias To Keep People In Their Homes

This article was originally published on Home Health Care.

The Program of All-Inclusive Care for the Elderly (PACE) is designed to keep older adults in their homes by using multidisciplinary care teams, including home-based care providers, and leveraging alternative payment structures to help avoid institutional bias.

“People want to stay at home, and we want them to stay at home as well,” Rob McCommons, a PACE development consultant, said on a Health Dimensions Group webinar on Wednesday. “We’re really able to do this. One of the mechanisms of this is that we have the flexibility to provide for participant needs without fee-for-service restrictions.”

Health Dimensions Group is a management and consulting organization that supports the senior living, assisted living, post-acute and long-term care industries.

PACE provides medical care and social services to frail and older adults living at home. The program is a permanent Medicare benefit and an optional state Medicaid benefit. Home-based care providers regularly interact with PACE, with some specializing in the program or offering it themselves. Home-based care is a critical cost-saving component of the program.

The health care system is fragmented, McCommons said, with discontinuity occurring throughout discharge and transition processes. Moving away from fee-for-service reimbursement systems, like with PACE, ensures continuity across an interdisciplinary care team, McCommons said.

“We really have the flexibility to design the care plan around what the person’s needs are, including the community support services,” he said. “A common one would be an air conditioner for somebody with congestive heart failure or COPD during the summer heat, in order to really help manage their care at home.”

With all-inclusive captation, full risk and really no benefit restrictions, PACE avoids institutional bias, McCommons said, which he described as “gravity” that pulls people into institutions.

Maintaining a collaborative, interdisciplinary team that includes parties such as registered nurses, primary care providers, physical therapists and personal care providers is key to PACE’s success.

Other elements critical to a PACE program’s success include whether the community requires PACE and whether the operator has the necessary relationships in place, McCommons said.

“Some of those keys to success include identifying referral sources and developing support from government and community organizations,” Tom Stitt, senior vice president of consulting services at Health Dimensions Group, said. “Enrollment growth is the most critical factor in getting through the first couple of years and having a financially sustainable program, so having referral sources in place and support from the community is critical.”

When successful, a PACE program allows older adults to receive the optimal level of services in the “least restrictive” environment, McCommons said.