PACE Awareness Archives

How PACE Avoids Institutional Bias To Keep People In Their Homes

October 15, 2025/in Articles/by masspace

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.

30 years of integrated care: How Element Care’s PACE program supports seniors

September 29, 2025/in Articles, In the News/by masspace

This article was originally published on McKnights HomeCare.

Imagine battling chronic illness, struggling to coordinate appointments, manage medications, and deciphering confusing insurance policies — all while feeling isolated and unsupported. These are not unique incidents but rather the harsh reality faced by many seniors as they navigate the daunting healthcare system alone.

In today’s fragmented healthcare landscape, the vision of a holistic approach to well-being remains elusive, particularly for seniors grappling with complex medical needs. As the population of seniors continues to grow, so do the challenges they encounter in accessing quality, coordinated healthcare. This is why it’s critical to raise awareness about the Program of All-Inclusive Care for the Elderly (PACE) as we celebrate National PACE Month this September. At Element Care PACE, we’re proud to celebrate three decades of commitment to seniors, and highlighting how PACE programs enable seniors to receive the care they need in the comfort of their own homes and communities for as long as possible, allowing them to be independent while receiving interdisciplinary care.

The growing need for integrated, coordinated senior care

As of 2023, 1.2 million Massachusetts residents were aged 65+, up 32.2% since 2010. As the Massachusetts population ages, the demand for high-quality, coordinated senior care is only intensifying. According to the National Council on Aging, about 93% of older adults have at least one chronic condition, and nearly 80% have two or more, often requiring complex management and coordination between multiple healthcare providers, yet 42% of older adults reported poor care coordination.

Without proper integrated, coordinated senior care, elderly individuals are put at a greater risk of preventable issues like medication dosage and timing errors, missed diagnoses from lack of adequate doctors’ appointments, unnecessary hospitalization, and overall gaps in care. The complexity of receiving quality care as people age can turn into a full-time job between appointments, follow-ups, sorting through insurance coverage, obtaining referrals, pursuing appeals — the list goes on. Fortunately, there is a solution for adults and caregivers contending with this situation, and that’s where all-inclusive programs like PACE come into play.

All-inclusive and all in one place

PACE programs streamline healthcare for older adults by bringing all medical care under one roof, including interdisciplinary care teams, an emphasized focus on preventive medicine, and a commitment to personalized attention. Built to bridge gaps in senior care, PACE provides a comprehensive, holistic model of care that helps reduce barriers and offers a proactive and person-centered approach, particularly for low-income seniors.

Element Care, which has been delivering PACE services for the past 30 years in Massachusetts, has seen this model evolve from a niche offering to a nationally recognized solution for aging populations. We’ve continued to evolve through partnerships with organizations such as 2Life to offer integrated housing models, enabling participants to maintain their independence, while having on-site access to medical care. This helps address the growing senior housing crisis and supports the needs of aging adults, improving health outcomes and providing connection and community.

Alleviating caregiver burdens for families and individuals

The growing burden on the ‘sandwich generation’ who are caring for both children and aging parents has surged to an estimated 11 million people in the U.S. PACE helps to alleviate burdens faced by this generation by providing peace of mind and assurance that their loved one is receiving comprehensive, coordinated care tailored to their needs.

Seniors reap the benefits of having their care consolidated through PACE — not only does it alleviate stress and take off the pressure of managing complex medical care, but there is also a cost benefit to the consolidated care model as well. Participants who qualify for PACE programs don’t pay for co-pays, glasses, transportation, therapy visits, procedures, or any other qualifying medical costs. When necessary, home health visits from nurses, dietitians, and physical therapy are also included. PACE empowers seniors to take control of their health and maintain a sense of independence.

Why the future of senior care depends on programs like PACE

As we face a surge in the aging population, the future of elder care must be proactive, not reactive. Now more than ever we must raise awareness among our communities that programs like PACE are an option for our loved seniors. Programs like PACE demonstrate how coordinated, person-centered care reduces hospitalizations, lowers costs, and improves quality of life. We’re working to expand our reach, enhance services, and remain a trusted partner in helping older adults age with independence. We’re continuing to expand our integrated senior housing models to offer affordable housing units for seniors.

This National PACE Month join us in celebrating the progress we’ve made and our commitment to providing healthcare that meets the needs of our aging population. As we celebrate 30 years of Element Care PACE, we honor the seniors we serve, our committed team members who live out our mission every day, and the vision of a future where every senior has access to the compassionate, coordinated care they deserve.

Doug Thompson is CEO at Element Care PACE.

Health Care Groups Aim To Counter Growing ‘National Scandal’ of Elder Homelessness

September 25, 2025/in Articles/by masspace

This article was originally published on KFF Health News .

BRISTOL, R.I. — At age 82, Roberta Rabinovitz realized she had no place to go. A widow, she had lost both her daughters to cancer, after living with one and then the other, nursing them until their deaths. Then she moved in with her brother in Florida, until he also died.

And so last fall, while recovering from lung cancer, Rabinovitz ended up at her grandson’s home in Burrillville, Rhode Island, where she slept on the couch and struggled to navigate the steep staircase to the shower. That wasn’t sustainable, and with apartment rents out of reach, Rabinovitz joined the growing population of older Americans unsure of where to lay their heads at night.

But Rabinovitz was fortunate. She found a place to live, through what might seem an unlikely source — a health care nonprofit, the PACE Organization of Rhode Island. Around the country, arranging for housing is a relatively new and growing challenge for such PACE groups, which are funded through Medicaid and Medicare. PACE stands for a Program of All-Inclusive Care for the Elderly, and the organizations aim to keep frail, older people in their homes. But a patient can’t stay at home if they don’t have one.

As housing costs rise, organizations responsible for people’s medical care are realizing that to ensure their clients have a place to live, they must venture outside their lanes. Even hospitals — in Denver, New Orleans, New York City, and elsewhere — have started investing in housing, recognizing that health isn’t possible without it.

And among older adults, the need is especially growing. In the U.S., 1 in 5 people who were homeless in 2024 were 55 or older, with the total older homeless population up 6% from the previous year. Dennis Culhane, a University of Pennsylvania professor who specializes in homelessness and housing policy, calculated that the number of men older than 60 living in shelters roughly tripled from 2000 to 2020.

“It’s a national scandal, really, that the richest country in the world would have destitute elderly and disabled people,” Culhane said.

Over decades of research, Culhane has documented the plight of people born between 1955 and 1965 who came of age during recessions and never got an economic foothold. Many in this group endured intermittent homelessness throughout their lives, and now their troubles are compounded by aging.

But other homeless older adults are new to the experience. Many teeter on the edge of poverty, said Sandy Markwood, CEO of USAging, a national association representing what are known as area agencies on aging. A single incident can tip them into homelessness — the death of a spouse, job loss, a rent increase, an injury or illness. If cognitive decline starts, an older person may forget to pay their mortgage. Even those with paid-off houses often can’t afford rising property taxes and upkeep.

“No one imagines anybody living on the street at 75 or 80,” Markwood said. “But they are.”

President Donald Trump’s recent budget law, which makes substantial federal cuts to Medicaid, the public insurance program for those with low incomes or disabilities, will make matters worse for older people with limited incomes, said Yolanda Stevens, program and policy analyst with the National Alliance to End Homelessness. If people lose their health coverage or their local hospital closes, it will be harder for them to maintain their health and pay the rent.

“It’s a perfect storm,” Stevens said. “It’s an unfortunate, devastating storm for our older Americans.”

Adding to the challenges, the Labor Department recently halted a job training program intended to keep low-income older people in the workforce.

Those circumstances have sent PACE health plans throughout the country into uncharted waters, prompting them to set up shop within senior housing projects, partner with housing providers, or even join forces with nonprofit developers to build their own.

A 1997 federal law recognized PACE organizations as a provider type for Medicare and Medicaid. Today, some 185 operate in the U.S., each serving a defined geographic area, with a total of more than 83,000 participants.

They enroll people 55 and older who are sick enough for nursing home care, and then provide everything their patients need to stay home despite their frailty. They also run centers that function as medical clinics and adult day centers and provide transportation.

These organizations primarily serve impoverished people with complex medical conditions who are eligible for both Medicaid and Medicare. They pool money from both programs and operate within a set budget for each participant.

PACE officials worry that, as federal funding for Medicaid programs shrinks, states will curtail support. But the PACE concept has always had bipartisan support, said Robert Greenwood, a senior vice president at the National PACE Association, because its services are significantly less expensive than nursing home care.

The financing structure gives PACE the flexibility to do what it takes to keep participants living on their own, even if it means buying an air conditioner or taking a patient’s dog to the vet. Taking on the housing crisis is another step toward the same goal.

In the Detroit area, PACE Southeast Michigan, which serves 2,200 participants, partners with the owners of senior housing. The landlords agree to keep the rent affordable, and PACE provides services to their tenants who are members. Housing providers “like to be full, they like their seniors cared for, and we do all of that,” said Mary Naber, president and CEO of PACE Southeast Michigan.

For participants who become too infirm to live on their own, the Michigan organization has leased a wing in an independent living center, where it provides round-the-clock supportive care. The organization also is partnering with a nonprofit developer to create a cluster of 21 shipping containers converted into little houses in Eastpointe, just outside Detroit. Still in the planning stages, Naber said, the refurbished containers will probably rent for about $1,000 to $1,100 a month.

In San Diego, the PACE program at St. Paul’s Senior Services cares for chronically homeless people as they move into housing, offering not just health services but the backup needed to keep tenants in their homes, such as guidance on paying bills on time and keeping their apartments clean. St. Paul’s also helps those already in housing but clinging to precarious living arrangements, said Carol Castillon, vice president of its PACE operations, by connecting them with community resources, helping fill out forms for housing assistance, and providing meals and household items to lower expenses.

At PACE Rhode Island, which serves nearly 500 people, about 10 to 15 participants each month become homeless or at risk of homelessness, a rare situation five or six years ago, CEO Joan Kwiatkowski said.

The organization contracts with assisted living facilities, but its participants are sometimes rejected because of prior criminal records, substance use, or health care needs that the facilities feel they can’t handle. And public housing providers often have no openings.

So PACE Rhode Island is planning to buy its own housing, Kwiatkowski said. PACE also has reserved four apartments at an assisted living facility in Bristol for its participants, paying rent when they’re unoccupied. Rabinovitz moved into one recently.

Rabinovitz had worked as a senior credit analyst for a health care company, but now her only income is her Social Security check. She keeps $120 from that check for personal supplies, and the rest goes to rent, which includes meals.

Once a week or so, Rabinovitz rides a PACE van to the organization’s center, where she gets medical care, including dental work, physical therapy, and medication — always, she said, from “incredibly loving people.” When she’s not feeling well enough to make the trek, PACE sends someone to her. Recently, a technician with a portable X-ray machine scanned her sore hip as she lay in her own bed in her new studio apartment.

“It’s tiny, but I love it,” she said of the apartment, which she’s decorated in purple, her favorite color.

Amid growing ‘scandal’ of elder homelessness, health care groups aim to help

August 16, 2025/in Articles, In the News/by masspace

This article was originally published on NPR.

BRISTOL, R.I. — At age 82, Roberta Rabinovitz realized she had no place to go. A widow, she had lost both her daughters to cancer, after living with one and then the other, nursing them until their deaths. Then she moved in with her brother in Florida, until he also died.

And so last fall, while recovering from lung cancer, Rabinovitz ended up at her grandson’s home in Burrillville, Rhode Island, where she slept on the couch and struggled to navigate the steep staircase to the shower. That wasn’t sustainable, and with apartment rents out of reach, Rabinovitz joined the growing population of older Americans unsure of where to lay their heads at night.

But Rabinovitz was fortunate. She found a place to live, through what might seem like an unlikely source — a health care nonprofit, the PACE Organization of Rhode Island. Around the country, arranging for housing is a relatively new and growing challenge for such PACE groups, which are funded through Medicaid and Medicare. PACE stands for Program of All-Inclusive Care for the Elderly, and the organizations aim to keep frail older people in their homes. But a patient can’t stay at home if they don’t have one.

More people 55 and over without homes

As housing costs rise, organizations responsible for people’s medical care are realizing that to ensure their clients have a place to live, they must venture outside their lanes. Even hospitals — in Denver, New Orleans, New York City, and elsewhere — have started investing in housing, recognizing that good health isn’t possible without it.