Considerations for Combining PACE with Housing

In recent years, there has been a recognition of the importance of social determinants of health, including the impact of where a person lives on their overall health and well-being. This is especially true for older adults, for whom safe, accessible, housing with integrated health and long-term care services (such as home care, housekeeping, and nutrition support) is the key to remaining in the community.

Housing providers have been increasingly interested in seeking programs and developing relationships aimed at enabling older residents to remain safely in their homes for as long as possible. In Massachusetts, there are many organizations that operate programs designed to assist older adults. These range from organizations that provide companionship, villages that support affinity groups, home health agencies that provide in-home assistance with activities of daily living, adult day health centers, adult foster care, and care coordination programs.

The Program of All-Inclusive Care for the Elderly (PACE) offers all these services and more and has proven to be a valuable partner to housing agencies that operate affordable housing for older adults.

Massachusetts recently launched an initiative to expand PACE to every zip code in the Commonwealth, making this an ideal time for housing agencies to learn more about PACE and PACE-Housing Partnerships.

There are already many PACE-Housing partnerships in place across the state, and while these models can vary in their design and structure, all PACE-Housing models seek to maximize the ability of residents to remain in their homes through access to housing stabilization services, enhanced support, health-related services, and collaboration between PACE Organizations and housing partners.

This document is designed to introduce and provide examples of PACE-Housing partnerships to stakeholders in the housing arena (e.g., landlords, property managers, developers, etc.), and to highlight opportunities for housing agencies to further support tenants through relationships with PACE Organizations.

Continue reading this article by downloading the Considerations for Combining PACE with Housing PDF here.

EBNHC + TND + PACE =A New Era for our Senior Citizens

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In 1965, the rock band The Who gave us this iconic line in their anthemic 1960s song, My Generation:

“Hope I die before I get old.”

Well, anyone old enough to remember that song (and reading this column) obviously didn’t follow their advice — and those now-senior citizens are far from alone.

Just as the Baby Boomers (those born from 1945-64) had an outsize-effect on American life and culture because of their sheer numbers in the 1960s and 70s, so too, they continue to alter the landscape of American life as they reach their 60s and 70s.

For the first time in the history of the world, persons aged 65 or above outnumber children under five years of age.

That is why the announcement last week by the East Boston Neighborhood Health Center (EBNHC) of the expansion of its neighborhood PACE program with the completion of a new location in Everett, located at the former St. Therese Parish on 801 Broadway, marks a milestone in the health care for our city’s senior citizens.

The goal of PACE (the Program of All-inclusive Care for the Elderly ), which is administered by MassHealth and Medicare, is to provide a wide range of medical, social, recreational, and wellness services to eligible participants in order to allow participants to live safely in their homes and communities instead of in nursing homes.

The new Everett site will increase access to coordinated medical care, nutrition, rehabilitative therapy, recreation, and transportation services to help a diverse group of adults age in place.

There has been a 19% increase in the number of Everett residents over the age of 55 in the past 10 years. EBNHC has partnered with The Neighborhood Developers (TND), a community development corporation and nonprofit organization, to build the new site which is part of a larger development project including affordable rental homes and townhouses for sale at below-market price. (TND also redeveloped a park on the site to enhance its accessibility and functionality for residents.)

Thanks to modern drugs and medical advances, Americans are living longer than ever (athough the COVID pandemic slowed that growth in the past two years). However, living a longer life is not the same as living a better life. The American healthcare system and our nursing homes are being overwhelmed with the volume of senior citizens whose lives are being prolonged, but whose quality of life is not so great.

PACE aims to change that dynamic and we look forward to the ever-increasing role that the EBNHC’s new facility will play in the lives of our community’s senior citizens.

PACE is transforming the lives of older adults and their families

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Nilda Goodridge couldn’t stop worrying about her mom, Sheila. At 87, Sheila lived alone in Cambridge. She grew increasingly isolated, cried often, and lost weight at an alarming rate. Nilda wasn’t sure what was happening to the strong, independent mother she remembered raising her, a woman who had risen at 4 a.m. for her job as a food service worker for a local hospital.

An elderly Asian woman stands in front of a bus she is about to boardBeing disabled herself, Nilda knew she needed help caring for her mom. She spoke with Sheila’s doctor, who recommended Cambridge Health Alliance’s PACE, or Program of All-Inclusive Care for the Elderly. The result, Nilda says, transformed both of their lives.

Three days a week, Sheila Goodridge takes PACE’s van to their adult day program in Cambridge, where she socializes with other older adults, enjoys musical performances and pet therapy, and expresses herself through art projects that she shares with her children and grandchildren. “I love coming here. There’s a lot going on and it keeps my mind interested,” says Sheila, whose laugh comes easily now. “I like the people I’ve met. I say that from my heart because it’s true.”

The colorful, light-filled site is just the start of PACE’s services for Sheila. The program provides her with a primary care physician and other medical professionals, some of whom see her at home when needed. The van transports Sheila to medical appointments, a task that Nilda says previously fell to her. “They took a whole lot of weight off my shoulders.”

What does PACE consist of?

As an interdisciplinary, coordinated program of health care and social services, PACE is designed to enrich the lives of lower-income adults aged 55 and older who typically qualify for nursing home care. “Our goal is to provide comprehensive services for them so they can stay in their homes safely,” says Tara Sherman, PACE’s director of nursing. The program promotes independence and helps participants continue to live in their own homes, which generally, they greatly prefer Sherman says.

In addition to two adult day programs — one in Cambridge and one Malden — PACE’s team of physicians, nurse practitioners, nurses, social workers, and many other professionals supply a striking array of services. Offerings range from exercise and assistance with chores, to personal care aides and mental and nutritional counseling, as well as physical, occupational, and speech therapy. As for any medications a participant may need, all prescriptions are covered in full and delivered to their home for free. Specialty care such as dental and optometry is also covered.

Cambridge Health Alliance (CHA) is dedicated to providing care for all, regardless of income. The structure of PACE reflects that core belief. Low-income older adults receive PACE services for free. More than 600 older adults from 13 cities in the region — including Cambridge, Arlington, Medford, Malden, Everett, and Revere — currently take part.

PACE is one of several CHA programs dedicated to serving the needs of older adults in the Boston-area, helping to fulfill the organization’s commitment to caring for all older adults in the community regardless of income or level of need.

Individualized care is key

PACE’s hallmark is one-on-one attention and care for each participant and family. That approach begins from the first day an older adult or caregiver inquires about the program. During the enrollment process, a team of PACE leaders talks through how best to enhance the participant’s quality of life and recommends a suite of services based on that person’s unique needs.

Every participant benefits from a custom treatment plan. PACE’s flexibility means it can “achieve the participant’s life goals in a way that a traditional fee-for-service practice isn’t able to provide,” says Serena Chao, MD, CHA’s geriatric division chief. Plans are updated every six months.

A group of elderly women sit in a drum circle with big and colorful drumsThe structure of PACE makes it possible to get to know elders in an intimate way. “When we visit participants in their homes, we get to see things that practitioners in offices never know about,” says Sherman, like an empty fridge or a shower stuffed with sweaters when the participant says they shower daily. PACE professionals gently build relationships and trust over time to address those issues, including assistance with daily living.

Meeting participants where they’re at

More than 90% of PACE participants are able to continue living at home, whether in a single family home, senior apartment, supportive housing, or assisted living. PACE maintains contracts with assisted living communities in multiple cities and also partners with the Cambridge Housing Authority. In three Housing Authority buildings, PACE offers supportive 24-hour personal care, such as housekeeping, meal preparation, assistance with appointments, medication reminders, and general orientation about what will happen that day. “If a participant falls or an emergency happens, someone is there for them,” Sherman says.

One beneficiary of PACE housing assistance is Tomiko Matsuda. Soon after she moved to the United States from Brazil, her daughter passed away suddenly. Matsuda lived for a time at the YWCA. When PACE got her into supportive housing with wraparound services, many of her medical conditions improved. She began attending the PACE adult day program. “Before I came, I was very depressed,” says Matsuda in her native Portuguese through an interpreter – another CHA service. “I lost my mother, my daughter, and my brother. But I’m happy now. I came out of my depression.”

Strengthening relationships

An elderly Black woman has her heart checked by a short haired nurseAs much as PACE benefits participants, its services are equally essential for caregivers. Adult children of participants may be raising their own children, work full time, or have other responsibilities. Caregiving alone can be an exhausting, never-ending job, especially taking care of older adults with mild to moderate dementia.

“We say to families, ‘We’re partnering with you,’” says Sherman. “Let us help with the medications and the showers so you can enjoy your time with your loved one. When your relationship isn’t so task-oriented, you can focus on really enjoying your [loved one].”

Twenty percent of current 65-year-olds will need long-term care for more than five years, according to U.S. government projections. CHA’s PACE program is one model for keeping older adults healthy and engaged. Once enrolled, there are no terms or time limits. They can stay in the program for life.

Local couple take on spinal cord injury together

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Tracy Leedberg’s story is rife with sadness, triumph, hope and perseverance.

And when Leedberg reconnected with her high school friend after more than two decades, her life came full circle. James Radcliffe found his way back to Leedberg and, in 2018, the two settled comfortably in Tyngsboro. But one year later, a devastating event left the couple in grief and turmoil.

“In July 2019, Jimmy dove into the pool and couldn’t move,” Leedberg said. “I thought he was just messing around at first.”

But he was not messing around. Radcliffe, 56, had broken his neck. The traumatic C5 injury left him paralyzed from the waist down.

Leedberg became overwhelmed by the new responsibilities in her life. She had no idea how to provide care for someone in Radcliffe’s condition, nor where to find specialized care. Moreover, she felt sadness that her once-strong construction worker partner had been rendered so immobile and helpless. It affected the couple in every aspect of life — mentally, spiritually, romantically and especially financially.

“I had to quit my job because Jimmy needed me at home,” she said. “I became a full-time caregiver.”

She did not object to this new role, but acquiesced to the fact that she needed assistance.

Hope arrived in the subtlest of gestures.

“One day, a few months after my final surgery, I was laying in bed and tried to wiggle my toe,” Radcliffe explained. “And it moved.”

This flicker of hope led him to a physical rehab center in Salem, N.H. He began making slow progress but after the months-long regimen, was released back to home care. At home, he hoped to continue his forward momentum toward recovery with the help of visiting professionals. Then came COVID-19. The home aid they had waited for was curtailed due to travel restrictions and health care protocols.

He again fell into despair. All the physical gains he had made plateaued, then began regressing. His hope and confidence atrophied as well. Leedberg’s health also took a turn as she suffered a stress-related heart attack.

“When I couldn’t care for Jimmy anymore, I became despondent,” she said. “The doctors wanted to put him into a nursing home facility. I didn’t want that and he certainly did not. I didn’t know what to do.”

As the mother of three daughters, now adults, Leedberg has experience in caregiving, but she also knows her limits and they had been reached. Financially, physically and emotionally depleted, the couple did not know where to turn.

Like most things in life, great challenges are overcome by great teamwork. And, like the cavalry, a team appeared. In a happy accident while Googling for something else, Leedberg found out about a program called Summit ElderCare. They said the Fallon Health-run program at 1081 Varnum Ave. in Lowell was the Holy Grail of treatment they had been so desperately seeking.

Fallon, a Worcester-based corporation, has five Summit ElderCare facilities throughout Massachusetts, including in Leominster. For Leedberg and Radcliffe, having one so close to home is an added blessing. The outpatient center offers comprehensive care including physical therapy, occupational therapy, regular medical exams, transportation, even at-home visits as well a social atmosphere conducive to the maintenance of mental health.

Summit ElderCare is a Program of All-inclusive Care for the Elderly, or PACE, and is exactly what Radcliffe needed.

“I started here in March and have made so much progress since then,” he said.

His hands still show signs of strength gained as a construction worker skilled in sheet-metal work. His smile comes easier now, a result of hope and progress.

“When I first got hurt, doctors said I may never walk again. That became a challenge that I intended to face,” Radcliffe said. “Since starting at Summit, I have made steady progress in my therapy.”

With each success comes more confidence.

“And with more confidence, I get more motivated,” he said.

Radcliffe enjoys the five-days-per-week visits to the center, enjoying the activities but always focused on the objective. His physical therapist, Michael Fitzgerald, is part coach and part motivator. The two have become friends, discussing football between exercises.

“At first I needed help just to sit up in bed,” Radcliffe said. “Then I made it to the chair. Over the months I am finally doing some assisted walking.”

On Wednesday, the largest step was taken. Supported only by a belt that Fitzgerald grasped to help stabilize him, Radcliffe walked across the training room floor, much to the surprise and delight of Leedberg.

The timing of this momentous step is also quite serendipitous. September is National Spinal Cord Injury Awareness Month and Radcliffe ushered that in with his proud yet labored gait.

“People don’t understand how complicated SCI care is,” Leedberg said. There are several ancillary health effects including urinary tract infections, self-confidence damage and loss of hope. “He now has hope.”

“She has been a strong advocate for me,” Radcliffe said of Leedberg. “But she is also an advocate for PACE at Summit.”

Leedberg showed appreciation of the organization by being a featured speaker at the annual MassPACE Association Annual Conference in May. She also presented her extensive research paper, “Meeting the Needs of Caregivers to Decrease Burnout.”

Dinah Olanoff, a senior business consultant for Fallon’s PACE strategy, explained how the program works.

“We try to find support that is uniquely directed for each participant. We set up a model of care for every individual,” she said, including Radcliffe.

“He was very depressed when I first met him. Now he is living his best life,” Olanoff said.

But that “best life” will not be achieved by his standards until “I can walk out of here on my own,” Radcliffe said. “I plan to get back to working.”

Aging with Dignity in a Supportive Community

On June 2, 2022, 2Life Communities, Element Care, and partner organizations and funders launched the construction for the redevelopment of the J.J. Carroll BHA building that will have 142 additional affordable units for older adults in Brighton

It was a beautiful day on Chestnut Hill Avenue in Brighton, where old and new colleagues gathered around the construction site of the John J. Carroll apartments. The Boston Housing Authority, 2Life Communities, and its partners, including MassHousing, the City of Boston, and Element Care PACE gathered in celebration of the unveiling of the redevelopment of the property. The building was chosen for modernization and currently holds 64 units; the new construction plans will create 142 new units and an 11,000-square-foot PACE center.

Amy Schectman, 2Life’s President and CEO, led the ceremony and started the event by bringing to the stage the city’s new Mayor, Michelle Wu. As a longtime housing advocate, Mayor Wu celebrated the planning process, which was inclusive of its residents in the design process. She then applauded the team’s collaborative efforts, choosing to partner with Element Care to include a PACE center on-site, ensuring these residents can age in place with the services they need. She closed her speech by switching to Spanish to ensure everyone heard her message.

L-R: Jennifer Crampton, Wells Fargo; Mayor Michelle Wu, Secretary Marylou Sudders

Secretary Marylou Sudders of the MA Executive Office of Health and Human Services followed Mayor Wu, stressing the importance of upholding the value of respect. She described how we respect our older adults by ensuring they have affordable housing and long-term care in their community. She praised 2Life for its creativity and innovation and for making it a priority for residents to remain in their communities, stay active, be taken care of and thrive. Secretary Sudders, a supporter of the PACE model, described her vision of having more PACE/Housing partnerships: “We are taking this model across the State, we can do it in Boston, and we plan to do it across the Commonwealth.”

Undersecretary Jennifer Maddox of the MA Department of Housing and Community Development echoed Secretary Sudders’ praises for the PACE model of care for older adults, “a few retire in Florida, [but] most want to stay in the community with family and friends.” Amy Schectman described how PACE shares 2Life’s goal of focusing on “holistic and preventive care” and keeping residents in their units, adapting as they age, based on need.

At the Podium, Bob Wakefield of Element Care

MassPACE’s longest-serving Board Member and Executive Director of the Element Care PACE program, Bob Wakefield, closed the event with key takeaways – the importance of affordable housing, the strength of the PACE model, and collaborative efforts like the JJ Carroll renovation, that combine the two visions. Bob describes the JJ Carroll project as a particularly innovative partnership that he believes will “address the social determinants of health on a scale that has never been seen before.” With on-site amenities such as an urgent care center, Bob believes we are one step closer to eliminating the need for long-term care facilities.

The event’s energy was contagious. The group of people gathered at the event were those who worked day-in and day-out during the pandemic to ensure those they served avoided the deadly COVID-19 virus. Their tireless efforts allowed them to form and strengthen connections. Together, they are creating an inclusive and supportive environment that gives older adults the respect they deserve. 2Life’s board chair, Jeffery Sach, summarized the project ‘s mission: “to encourage aging with dignity in a supportive community.”

Urge Democratic Senators to Keep HCBS Funding at $400B in Reconciliation Bill

Negotiations continue among Senate Democrats on the contents of their partisan reconciliation package. NPA has learned that the amount of funding for HCBS, which includes PACE, has dropped from $400B to $150B.

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Upcoming Event: PACE Policy, Expansion, Research, and Innovation: The Call to Action

When: July 14 | 2:00–4:00pm EDT

This two-hour seminar will bring together Program of All-Inclusive Care for the Elderly (PACE) leaders and experts, policymakers, and advocates to provide an in-depth look at the PACE program and its ability to meet the needs of a growing Medicare population. We will explore topics ranging from policy solutions that are being considered to address the Medicare Part D dilemma to the ways in which PACE programs have adapted during Covid-19. View agenda highlights below or see our most up-to-date list of participants.

Agenda Highlights:

  • Hear from Senator Bob Casey of Pennsylvania and US Representative Debbie Dingell of Michigan’s 12th Congressional District on how PACE can potentially change the way aging occurs in the US
  • A panel of leading PACE innovators share what they are doing before, during, and after Covid-19
  • Key state and federal policymakers cover the major challenges, barriers, and opportunities to PACE expansion today
  • Leading advocates and policy experts provide a glimpse into the future through their broader vision for PACE 10 years from now

Register Here Learn More

COVID-19 Exposed the Faults in America’s Elder Care System. This Is Our Best Shot to Fix Them

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For the American public, one of the first signs of the COVID-19 pandemic to come was a tragedy at a nursing home near Seattle. On Feb. 29, 2020, officials from the U.S. Centers for Disease Control and Prevention (CDC) and Washington State announced the U.S. had its first outbreak of the novel coronavirus. Three people in the area had tested positive the day before; two of them were associated with Life Care Center of Kirkland, and officials expected more to follow soon. When asked what steps the nursing home could take to control the spread, Dr. Jeff Duchin, health officer for Seattle and King County, said he was working with the CDC to provide guidance, “but,” he acknowledged, “it is a very challenging environment, particularly with so many vulnerable patients, to manage an outbreak.”

It turned out the virus had already been circulating among Life Care’s residents for weeks by the time administrators took action, and soon it was tearing through the facility. By March 5, at least nine residents had already died of COVID-19, and a group of families whose loved ones were still inside held a desperate press conference. “Our families are dying. We don’t know what to do. Our calls for help aren’t working,” Kevin Connolly, whose father-in-law lived in the facility, told reporters. “We have limited resources to battle this disease, and I think somebody somewhere decided that this population of people wasn’t worth wasting resources on.”

Many long-term-care experts would say Connolly was right. The pace at which that first U.S. coronavirus outbreak spread through Life Care, killing dozens of residents in weeks, shocked the public. But for those familiar with long-term care, it wasn’t surprising. “We really failed in a lot of ways, historically but also during this pandemic, to value older adults,” says David Grabowski, a professor at Harvard Medical School and an expert on long-term care. That is to say, the U.S. health care system basically left its nursing-home residents as sitting ducks for a viral pandemic like COVID-19.

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PACE Providers Shift Services Toward the Home Amid Nation’s Long-Term Care Overhaul

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The COVID-19 pandemic has revealed a dire need to rethink how and where Americans age, most long-term care experts agree.

Investing in small-home senior living and “nursing homes without walls” are among the several innovative ideas that have been floated over the past year. Alternatively, some aging services stakeholders have simply called for a sweeping redirection of government funds away from facilities toward in-home care, something President Joe Biden is backing in his newly proposed “American Jobs Plan.”

There’s another way to reimagine long-term care in the U.S. that isn’t being talked about nearly enough, however: Programs of All-Inclusive Care for Elderly (PACE).

“I think we’re now in a situation across the country, as well as in Massachusetts, where PACE is being recognized as a significantly improved opportunity and alternative for health care delivery,” Dr. Rob Schreiber, vice president and medical director of Fallon Health’s Summit ElderCare, told Home Health Care News. “Specifically for those who are nursing home eligible and want to maintain their lives in the community.”

As of March 30, there were at least 138 PACE organizations operating 272 PACE centers in 30 states, serving roughly 55,000 participants combined, according to the National PACE Association.

Dr. Schreiber helps run Summit ElderCare, one of the largest programs of that bunch. Launched in 1995 as a subsidiary of the Worcester, Massachusetts-based health plan Fallon, Summit cares for nearly 1,200 PACE participants across five sites in the Bay State, plus one location in Buffalo, New York.

“PACE has been around for almost 50 years,” Schreiber said. “It’s still here, and it is one of the only validated models of care that has really been shown to improve quality, lower costs, improve quality of life and boost person-centered satisfaction. It checks all the boxes.”

Not every PACE operation is the same, but most work by melding center-based services with comprehensive in-home care. Summit, for example, coordinates services from social workers, nurses, rehab specialities and eight other disciplines.

“The key, the secret sauce to PACE is the interdisciplinary team,” Schreiber explained.


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