Tag Archive for: PACE Education

PACE: Where You Belong – Part 3: Stories of Inspiration and Empowerment

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In the third and final installment of our “PACE: Where You Belong” series, we bring to you heartening stories of inspiration and empowerment from the participants and their caregivers of Neighborhood PACE and Cambridge Health Alliance(CHA) PACE. These narratives reflect the profound impact of PACE programs and illuminate its members’ life-changing experiences.

Kathleen Monteleone – Neighborhood PACE

Kathleen Monteleone’s encounter with a medical crisis in 2017 highlights the lifesaving intervention PACE can provide. Experiencing sudden numbness, a PACE nurse’s advice led her to urgent care, revealing a critical brain bleed:

“The PACE Rehab team gave me the tools to help me regain my mobility and independence – qualities I hold dear… I maintain constant communication with all of my Care Team – doctors, nurses, staff – all excellent and truly caring and professional and vital to my well-being. I don’t know where I would be without PACE……PACE has been a beacon of hope and support in my life.”

Her recovery journey, supported by the PACE Rehab team, emphasizes the program’s role in restoring independence and health.

Nilda Goodridge – CHA PACE

For Nilda Goodridge, PACE was a beacon of hope in addressing her mother Sheila’s declining health and social isolation. The program’s adult day services provided Sheila with an enriching social environment, creative stimulation, and medical care, reinvigorating her zest for life:

“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.”

Nilda’s relief in finding comprehensive support for her mother underscores the far-reaching impact of PACE on families.

Gerald Casey – Neighborhood PACE

Upon his return to East Boston, Gerald Casey’s discovery of PACE marked the beginning of a journey filled with personal growth and community engagement. From starting a book club to participating in health-focused programs, Gerald’s story is one of active involvement and holistic well-being:

“The most impressive thing about the PACE program is the people who are running the program. I truly believe they care about my health, and I like how they allowed me to have a say in my care… Getting into PACE and having a team support my overall health was life-changing. I started at 300 lbs, and now I am down to 230 lbs, and my blood pressure has stabilized. I can honestly say the PACE program saved my life and gave me a better quality of life.”

His health transformation, overcoming weight and blood pressure issues, is a testament to PACE’s integrated care approach.

Tomiko Matsuda – CHA PACE

One recipient of PACE housing assistance is Tomiko Matsuda. Shortly after she relocated to the United States from Brazil, her daughter passed away suddenly. Matsuda resided at the YWCA for a period. When PACE placed her in supportive housing with wraparound services, many of her medical conditions improved. She started participating in 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.”

These stories from Kathleen, Gerald, Sheila, and Tomika embody the spirit of PACE: Where You Belong. They narrate the provision of care and the fostering of empowerment, community, and a renewed sense of purpose. As we conclude our series, these tales of inspiration continue to affirm the vital role PACE plays in the lives of older adults and their families.

Let the Secret out by Expanding Older Adults Access to PACE

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This article was originally posted on Kevin MD. Read the full article here.

PACE, the Program of All-Inclusive Care for the Elderly, has long been considered the best-kept secret in the American health care system. It’s time to unveil this hidden gem. The health and well-being of older Americans – and the future of our health care system itself – may hinge on it.

Originating nearly half a century ago with the On Lok program in San Francisco’s Chinatown, the PACE model has since expanded to encompass 155 independent, locally-based PACE organizations. These organizations serve over seventy thousand older Americans across urban and rural communities in thirty-two states and the District of Columbia.

The growth of the PACE model has been methodical and deliberate, with a focus on maintaining its quality and integrity as new PACE providers enter the market. Multiple evaluations of the PACE model consistently demonstrate superior health, mood, functionality, survival rates, and utilization outcomes compared to alternative, unmanaged approaches. PACE not only benefits its patient population but also extends its advantages to families and caregivers.

However, as impressive and deliberate as the growth of PACE has been, the model currently serves only a fraction of the growing demographic in need. It is estimated that there are over ten million older Americans clinically eligible for PACE. To provide greater access to PACE, policy and statutory changes are required. The good news is that these changes are within reach.

I’ve been fortunate to work within the PACE model for over twenty-five years, assuming roles such as a front-line primary care provider, medical director, and national leader mentoring other PACE clinicians, and guiding the growth of the PACE model. For a geriatrician, PACE is akin to nirvana. I can’t envision practicing in any other setting.

There is often a misconception that geriatric medicine should care for all older adults. However, this task demands the mobilization and support of a primary care workforce consisting of family physicians, internists, and nurse practitioners, a workforce currently under significant pressure. Geriatric medicine is designed to serve a specific but costly segment of the older population – those with medical and social complexity who require long-term care services and support. In other words, geriatric medicine, much like PACE, serves older adults who need assistance with their daily activities.

Older Americans overwhelmingly express a preference for having their long-term care needs met in their homes and communities rather than in institutional settings. Nonetheless, our health care system is designed to cater to the system’s needs rather than those of complex, disabled older patients. How else can we explain the fragmentation, the reliance on technology and high-cost utilization, and the expectation that family members shuttle their loved ones from one brief office-based appointment to another?

PACE flips this paradigm on its head by structuring care around the needs of patients, reallocating resources from excessive institutional utilization to social, functional, and nutritional determinants of health. PACE operates as a managed care model, receiving all-inclusive capitated financing from the Medicare and Medicaid programs and assuming responsibility for the delivery and costs of all care. Nothing is excluded. Nothing is carved out. PACE represents a shining example of managed care done right.

The PACE model revolves around two key operational features: the PACE center, which combines the features of a social day program and a full-service clinic, and the PACE interdisciplinary team. PACE teams comprise nurses, social workers, physical, occupational, and recreational therapists, registered dietitians, drivers, personal care and home care workers, center managers, chaplains, pharmacists, and primary care providers, with the older adult and their caregivers at the core.

As a geriatrician, I am a critical member of the PACE team, but I am not the team’s boss. The team functions as a non-hierarchical collective, conducting periodic and formal assessments, engaging in ongoing communication, collaboration, and problem-solving, and crafting and delivering finely calibrated, flexible, individualized care plans. Importantly, PACE is not a brokered model: every member of the PACE team not only participates in the care-planning process but also provides direct care.

The PACE model allows me to draw on my full range of training, skills, and experience as a geriatric generalist. I have a manageable panel of patients that I care for across the entire continuum of care, and at any moment, I can draw on the resources and expertise of my inter-professional colleagues on the PACE team. I am responsible for managing chronic medical conditions and episodic problems, and I have the time and support to address them, consulting my specialist colleagues only when I have a specific question or problem requiring their expertise.

I see my patients at the PACE Center, where our drivers transport them from home for a full day of social and physical activities. Our staff can pick up on subtle changes in function and behavior that are often the only signs of an emerging health crisis, which might otherwise lead patients to the emergency department. I also make house calls to patients who prefer the comfort of their own homes or who are nearing the end of life. I serve as the attending physician when my patients are hospitalized or admitted to a skilled nursing facility for a short stay. In summary, I operate a concierge practice for the most complex and high-needs older patients in our healthcare system.

To be eligible for PACE, one must be 55 years of age or older and meet clinical criteria for nursing home care. Nationally, over 87 percent of PACE enrollees are dually eligible, meeting criteria based on age or disability for Medicare and, due to financial constraints, for Medicaid. Of the remaining 13 percent, the majority qualify for Medicaid due to their financial status but are ineligible for Medicare for various reasons. Only a small number of current PACE enrollees solely have Medicare, with assets and income exceeding the Medicaid eligibility threshold. Nevertheless, this population is growing and urgently requires healthcare delivery solutions.

Broadly speaking, there are three strategies to expand access to PACE: scaling, spreading, and serving new populations. With the support of the National PACE Association’s 2.0 project, PACE plans are scaling up significantly, transitioning from boutique-sized programs to larger ones with approximately 1,000 members. These larger programs are better positioned to expand access and achieve sustainable economies of scale while preserving the intimacy that makes PACE successful. Concurrently, access to PACE is spreading. States like Kentucky and Ohio, which previously did not adopt PACE or restricted its growth, are now advocating for PACE as a statewide solution. In contrast, Michigan has enlisted provider organizations across the state, offering older adults in Michigan nearly universal access to PACE.

However, to serve the Medicare-only, PACE-eligible population, statutory relief is essential. PACE plans offer comprehensive prescription drug benefits as Medicare Part D providers, submitting actuarially vetted bids to Medicare for annual approval. Nonetheless, because PACE serves a uniformly medically complex population with high pharmacy needs that require extensive support for medication safety and adherence, PACE Part D premiums tend to be considerably higher than what a Medicare beneficiary can acquire on the open market. Medicare-only beneficiaries eligible for PACE are already required to pay out-of-pocket premiums equal to the PACE Medicaid capitation. The additional PACE Part D premium often constitutes a prohibitive barrier to PACE enrollment. Fortunately, recent bipartisan and bicameral legislation introduced in Congress aims to lower this barrier. The PACE Part D Choice Act will allow Medicare-only beneficiaries to purchase prescription drug coverage on the open market if they wish, an option currently disallowed.

PACE isn’t suitable for everyone. It’s a voluntary program designed exclusively for disabled, vulnerable older adults with medical and social complexity. Not all those eligible for PACE will choose it. However, every older American eligible for PACE should have access to that opportunity. With a little push, PACE can be available in every neighborhood, county, and rural community. The health of older Americans may well depend on it. Let’s reveal this secret.

Adam Burrows is a geriatrician.

PACE: Where You Belong – Part 2: Stories of Resilience and Community

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In our continued journey through the PACE narrative, we dive into the second chapter of our three-part series. Focusing on the Program of All-Inclusive Care for the Elderly (PACE), we’re privileged to shed light on its transformative reach. As we embrace this month’s theme, “PACE: Where You Belong,” we illuminate the depth and breadth of PACE’s impact, highlighting its undying commitment to enhancing the holistic well-being of its elderly participants and their caregivers. Here are two touching tales that capture the heart of PACE.

Uphams PACE: Sarah’s Dream of Community Living Realized

Since joining Upham’s PACE in 2016, Sara (name altered for privacy) has faced a series of daunting challenges. With a past marked by homelessness, Sara was residing in a PACE-contracted Assisted Living Facility at the time of her registration. Unfortunately, a severe fall that led to hospitalization and subsequent nursing facility care rendered her ineligible to remain in her assisted living space. With limited family backing and the intricate nature of housing documentation, her dreams of community living remained unfulfilled. Sara’s only alternative was long-term residence in a nursing home, a setting she endured for six years.

However, Sara’s PACE Interdisciplinary Team (IDT) firmly believed a nursing home wasn’t the right fit for her. Committed to realizing Sara’s dream of community living, the IDT, despite facing hurdles like inadequate family support, regulatory constraints, and Sara’s health issues, tirelessly championed her cause. Their dedication bore fruit earlier this year when Sara transitioned to a PACE supportive housing apartment. Today, Sara relishes her daily visits to the PACE Center, receives diligent care from the PACE staff, and dances with a renewed spirit. Relieved to be out of institutional care, Sara is a testament to the collaborative, patient-centric approach of the PACE IDT and Supportive Housing teams.

Harbor Health PACE: Maria’s Heartfelt Testimony of Family and Care

Upon learning about the program through her daughter, Maria recalls with gratitude, “I called, and they accepted me – thank God.” Maria paints a poignant picture of loneliness many seniors feel, stating, “If I were at home, I’d have no one to talk to; my daughter would be working, everyone is busy.” However, PACE has given her a vibrant social environment that she cherishes deeply. “I feel like it’s my family,” she says, emphasizing the camaraderie she feels with everyone, from fellow members to the staff – even sharing that the lady who picks up the trash chats with her in Spanish.

Maria’s days at PACE are filled with joyful activities. She enthusiastically shares that from playing dominoes and bingo to dancing, “even though I am in a wheelchair, I still do the shimmy.” While her family in Puerto Rico often inquires about PACE, Maria proudly tells them about her fulfilling experiences and the diverse group of people she interacts with daily. Maria’s words of wisdom to her friends? “If you can join, you should.” One of the most touching aspects of her journey at PACE is her close bond with her aide, Sandia. To Maria, Sandia is more than just an aide; she’s like a daughter. They even share moments of joy, with Maria chatting to Sandia’s grandmother over FaceTime. Maria, who spent her entire life catering to her family, eloquently sums up her experience, “It’s so nice to be at this stage of life and be taken care of so well.”

As this chapter concludes, the tales of Sara and Maria underscore the significance of PACE and its unwavering dedication to its community. Stay with us for the final part of our inspiring series.

PACE: Where You Belong – Part 1: Transforming Lives Through Community-Centric Care for Older Adults

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This year, as we celebrate National PACE Month-themed “PACE: Where You Belong,” we begin our 3-part blog series to spotlight each of our eight PACE programs, whose goal is fostering community and connectivity—fundamental elements for individual well-being. For our first blog, we hear stories from three PACE programs; Serenity Care, Mercy LIFE, and Element Care that exemplify the PACE model’s ability to cultivate a compassionate, interconnected community.

The Serenity PACE Approach: Human-Centered Care and Connection

“Who could have ever thought that my ‘golden’ years would turn out to be the happiest period of my life?”

These heartfelt words came from an extraordinary participant who became part of the Serenity Care PACE community four years ago. Initially, she faced the intimidating option of moving into a nursing home, a proposal made even more daunting by language barriers, unfamiliar foods, and her aversion to institutional settings stemming from past experiences.

Then came her serendipitous discovery of Serenity Care PACE. Today, she leads a life of independence and community involvement, especially within her faith group. Her daughter lives in Los Angeles and has witnessed her mother’s metamorphosis:

“Before PACE, every call with my mom left me in tears. She was lonely and anxious, and getting clear information about her health was a struggle. The guilt was overwhelming. Now, she’s cheerful, shares stories about her days at the center, and, most importantly, I’m kept in the loop about her health and medications. Our lives have improved dramatically. We’re so grateful.”

A Lifeline for Independence: The Mercy LIFE PACE Story

In November 2019, Mercy LIFE came into contact with a younger, older adult living with his mother, his lifelong primary caregiver. Born with a brain injury, his life took a turn when his elderly mother could no longer provide the level of care he needed, contemplating a move to long-term care facilities as a last resort.

The man, known for socializing at the neighborhood corner store, often could not return home, resulting in numerous falls from his wheelchair. Faced with this predicament, his sister began exploring alternatives, eventually stumbling upon the PACE program at Mercy LIFE.

After an initial meeting with the family, it was evident that his 86-year-old mother was at her breaking point. Taking a chance on PACE, they enrolled him in the day center, where he now receives personal care and undergoes physical therapy. Now, not only can he use his walker for short distances, but he’s also become a cheerful part of the community, participating in activities and socializing enthusiastically. Thanks to Mercy LIFE PACE, he can age in place, right in the comfort of his home.

A Personal Perspective: Carol Pallazolla and Element Care PACE

Carol Pallazolla, a resident of Gloucester, serves as the Education and Outreach Coordinator for Element Care PACE. After witnessing her mother, Mary, face health challenges, she encouraged her to join Element Care PACE.

“When I joined PACE, I met so many nice people. My nurse, Emma, and my Physical Therapist Grace, to name a few. I have had shoulder pain for so long, and for the first time in a long time…I am pain-free,” said Mary.

Before joining the program, Mary was saddled with a $45 co-pay for each physical therapy session and struggled with medication costs. Now, she not only receives her medications but also gets prescribed Eliquis, which she couldn’t afford previously. Additionally, Mary got a free Grandpad tablet, through which she participates in virtual exercise classes, plays games, and even finds a lifeline during a power outage to connect with her daughter.

Mary sums it up best:
‘I feel pampered…..When you get older, and things start happening to you, it is hard to accept help, but since PACE, the best word I can say is “pampered.” I feel pampered, I feel looked after.’

As we continue to navigate the complexities of healthcare and aging, especially in these isolating times, the stories above illustrate why PACE isn’t just a program—it’s a community where older adults genuinely belong.

Podcast: Keep up with PACE: Episode 08 Adam Burrows

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This podcast was originally posted on Carevention. Listen to the podcast here.

Join us for this podcast series, hosted by Ankur Patel, MD, MBA, FAAFP, Chief Medical Officer at Tabula Rasa HealthCare. The podcast focuses on strategies to grow Programs of All-Inclusive Care for the Elderly (PACE) as one of the best models of care for the frail elderly. Each episode features interviews with expert PACE professionals.

PACE program assists with care, transportation

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To view and download a PDF version of this article, written by Melissa Erickson, click here.

Free program supports Massachusetts seniors living at home

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This was originally posted on WCVB.com. Read the full post and watch the video here.

COVID-19 has dramatically impacted older adults, through illness or the isolation often needed to keep them healthy. In Massachusetts, a free program is supporting those able to stay in their homes by partnering with families as the pandemic continues to take its toll.

Gloria Williams has always been independent. As she got older and her medical needs increased, she was determined to stay at her home in Dorchester.

“Just to leave my home and to a nursing home, I’m not ready for that yet,” Williams said.

So about 10 years ago, she joined MassPACE: Programs of All-inclusive Care for the Elderly. It’s a federally and state-funded program, an alternative to nursing home care that keeps seniors living at home.

“In general, older adults prefer to age in place at home if they can,” said Dr. Adam Burrows, medical director for the Upham’s Corner Health Center PACE program in Dorchester.

He said participants are 55 years and older, with medical and social needs that would qualify them for a nursing home. Instead, they’re trying to live at home and that’s where PACE teams come in.

“Made up of primary care providers, social workers, nurses, occupational and physical therapists, registered nurses, dietitians who together assess our participants, decide on a finely calibrated individualized care plans,” Burrows said.

Pre-COVID, much of this work had been done at the PACE centers — the clinical care as well social events — but the coronavirus changed that.

“So we relied on daily telephonic outreach. We relied on video technology. We relied upon staff going into homes,” Burrows said.

They also relied on family like Williams’ granddaughter, TaMarsha Williams. PACE hired and trained her to be Gloria’s personal care worker.

“It was all new to me, but I know I can give her the best care. When we were younger, she took care of me and my siblings and now it’s reversed. Me taking care of her, just trying to pay her back,” TaMarsha Williams said.

Burrows said that sense of community is exactly what PACE is about.

“When we think of taking care of these very vulnerable older adults, we’re also thinking about how do we create healthier households and healthier communities.”

There are 130 PACE programs across the country, eight of them in Massachusetts. Nationally, they’re seeing an increased interest in the program as families and older adults look for options.

A Safe Alternative to Nursing Homes

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In a 2018 blog post, the Institute for Healthcare Improvement (IHI) describes PACE as “safe alternative to nursing homes.” While posted in 2018, this post is more relevant than ever in light of the COVID-19 crisis.

More than 1.8 million seniors over the age of 65 in the United States live in supportive care facilities, but many would choose to remain at home if they could. The following excerpt from IHI’s No Place Like Home: Advancing the Safety of Care in the Home report presents a program that provides nursing home-level care to patients in their own homes.

To optimize the care of nursing home-eligible individuals receiving care at home or in a community-based setting, in 1990 the federal government began offering states Medicaid waivers to enable experimentation with value-based service models. The Program of All-Inclusive Care for the Elderly (PACE), an initiative originally developed by San Francisco’s On Lok Senior Health Services, was among the first programs. PACE aims to avoid nursing home placement by providing a broad range of care services to Medicare and Medicaid beneficiaries who clinically require a nursing home level of care. The program provides flexibility for caregivers; offers tailored services that manage the complex medical, functional, and social needs of frail elders; and promotes adherence to home safety standards.

Congress authorized 10 PACE replication sites in 1986 and codified PACE as a permanent Medicare program in the Balanced Budget Act of 1997. To date, 31 states offer PACE options to frail elders; 90 percent of PACE enrollees are eligible for both Medicare and Medicaid.

Description of the Program

For individuals who are deemed eligible for a nursing home level of care by their state’s administering agency, PACE offers an alternative option: living in their homes and communities while receiving coordinated, highly tailored health care services spanning the care continuum. Eligible seniors are assigned to a specific PACE organization that includes an interdisciplinary team comprising clinicians and support service providers. The interdisciplinary team is responsible for conducting initial and periodic participant assessments, performing care planning, and coordinating 24-hour care delivery.

The program includes these components:

  • Initial and ongoing assessments by the interdisciplinary team
  • PACE center services (such as adult day and social programs, primary and preventive care, restorative therapy, nutrition services and meals, pharmacy, social services)
  • Transportation for participants
  • Mental health care services
  • Care coordination
  • Assistance with activities of daily living
  • Prescription medications
  • Emergency services

How the Program Works

PACE organizations provide a wide range of services, including adult day programs, primary and preventive care, nutritional support, pharmacy services, social services, transportation, and other support services. Members of the interdisciplinary team coordinate services, based on a comprehensive baseline needs assessment. Within 30 days of enrollment, beneficiaries receive in-person assessments conducted by the interdisciplinary team, including an in-home assessment by a team member. Additional assessments are conducted at least every six months thereafter. Care is provided at PACE centers, at home, or in the community through contracts with other community-based providers. PACE center safety standards, outlined in federal regulations, address wheelchair accessibility, handrails, safe water temperatures, housekeeping chemical storage, cleanliness, and infection control protocols.

PACE Interdisciplinary Team Members of the PACE Interdisciplinary Team

At a minimum, the assessments address the following health and safety concerns:

  • The home environment, including the ability to safely enter and leave the home
  • Physical and cognitive function
  • Medication use
  • Participant and caregiver preferences for care, including advance care planning and participant goals of care (person-directed care)
  • Socialization and availability of family support
  • Current health status and treatment needs
  • Nutritional status
  • Participant behavior
  • Psychosocial status
  • Medical and dental status
  • Participant language and cultural needs
  • Based on the assessment findings, the interdisciplinary team creates a tailored care plan with a strong prevention component. If the participant is hospitalized or enters a skilled nursing facility, the interdisciplinary team often participates in clinical rounds that involve the participant.

The program is funded by a combination of sources, including Medicare, Medicaid, and private payers. Reimbursement is a fixed per member per month fee that covers the entire spectrum of participant-tailored services that care for the whole person. Because PACE assumes the full risk of the participant, the organization may find it cost-effective to provide interventions that are not traditionally covered by Medicare or Medicaid. For example, if the interdisciplinary team determines that a participant needs to have an air conditioner installed in his or her apartment perhaps because of a pulmonary condition, the program could cover that expense.

Program Results

  • A 2014 federally supported evidence review suggested that PACE is cost-neutral relative to traditional Medicare. It also noted that PACE enrollees experience fewer hospitalizations than their counterparts in fee-for-service Medicare. Of the studies included in the review, the one with the strongest evidence rating found that PACE enrollees were nearly 30 percent less likely to be hospitalized than a matched comparison group.
  • A 2016 Commonwealth Fund report suggested that the original (On Lok) PACE program’s 30-day readmissions rate was half that of other Medicare beneficiaries.
  • A 2015 study found that PACE enrollees had a 31 percent lower risk of long-term nursing home admission than enrollees of Medicaid home- and community-based waiver programs, suggesting that PACE may help reduce long-term nursing home utilization.
    Approximately 93 percent of PACE participants report that they would recommend the program to a friend or relative.

Program Results

  • A 2014 federally supported evidence review suggested that PACE is cost-neutral relative to traditional Medicare. It also noted that PACE enrollees experience fewer hospitalizations than their counterparts in fee-for-service Medicare. Of the studies included in the review, the one with the strongest evidence rating found that PACE enrollees were nearly 30 percent less likely to be hospitalized than a matched comparison group.
  • A 2016 Commonwealth Fund report suggested that the original (On Lok) PACE program’s 30-day readmissions rate was half that of other Medicare beneficiaries.
  • A 2015 study found that PACE enrollees had a 31 percent lower risk of long-term nursing home admission than enrollees of Medicaid home- and community-based waiver programs, suggesting that PACE may help reduce long-term nursing home utilization.
  • Approximately 93 percent of PACE participants report that they would recommend the program to a friend or relative.
    To read other case studies and learn more about improving patient safety in the home, please download the No Place Like Home: Advancing the Safety of Care in the Home report.

This post was initially published by the IHI Multimedia Team on 10/4/2018. 

Picking up the PACE for Elder Care

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This was originally posted in CommonWealth Magazine. Read the full post here.

JAMES WOODBERRY, wheelchair bound and severely depressed, struggled to find hope. Overwhelmed by his condition and a complex health system, the 80-year-old Boston resident and his family faced a grim future. It was only after several failed attempts that he came across a program equipped to handle his needs — the Program of All Inclusive Care for the Elderly, or PACE.

PACE’s vision is simple, allowing seniors who qualify for nursing home level of care to age in place, at home. The program started as a federal demonstration project in 10 locations across the US in the late 1980s. By 1990, it became a permanent provider for individuals covered under both Medicare and Medicaid, the so-called “dual eligibles.” Structured as an adult day center, members have access to medications, primary care providers, social services and more, every day of the week.

This year, East Boston Neighborhood Health Center, one of the 10 pilot centers, celebrates 30 years of partnership with PACE. Called “Neighborhood PACE,” the East Boston health center’s program is Massachusetts’ longest running. Noteworthy is the housing component unique to Neighborhood PACE. The health center is a long-time partner of the East Boston Community Development Corporation. Together, they converted a former East Boston school into the first PACE center in Massachusetts to offer housing in 2007.
Despite the program’s long history, PACE operates under the radar. Manny Lopes, president and CEO of the East Boston health center and chairman of the board of Boston’s Public Health Commission, wants this to change.

PACE providers deliver integrated, patient-centered care that values personal choice. Dr. James Pedulla, medical director of East Boston’s PACE since its inception, knows that the care and time he devotes to patients is uncommon in most health care settings today. For him, a rewarding feature of the program is direct access to an interdisciplinary network. At PACE, everyone from drivers to clinical providers are part of the team.

Woodberry, a member of Neighborhood PACE for over 10 years, is one of the program’s biggest champions. For him, the program is a blessing. “I thank God I am in a place that I get the kind of care I get, the kind of caring that I get,” he said.

A former professional football player, Woodberry found his inability to walk a constant source of anguish. With the support of his PACE team, Woodberry regained his ability to walk and met his personal goal to play 18 holes of golf – twice.

A typical day for Woodberry starts with waking up in his own apartment and going down to the PACE center, which operates in the same building, for breakfast and conversation with other PACE enrollees. Woodberry gets his medications dispensed on site by one of the staff members, is able to participate in center activities, and meet with his primary care provider or another member of the clinical team.
For Woodberry, the adult day center model, which is unique to PACE, has been particularly influential. The decline in his physical health led him down a path of deep depression. He started to withdraw from his family and friends, feeling hopeless and defeated. Daily access to a space that facilitates social interaction and relationship building provided the strength and support he needed to recover. When asked what life would be like without PACE, Woodberry said matter-of-factly, “I’d be dead. What you see today is a helluva different person.”

The significant improvement in Woodberry’s mental and physical health is not lost on his family. Before discovering PACE, Woodberry’s daughter was prepared to uproot her life from New York City to Boston. Enrolling her father in PACE afforded her the choice to stay in New York while remaining involved in his care. In fact, once Woodberry attained the independence he was yearning for, it became easier for him to accept his daughter’s help. With direct access to the site nutritionist, Woodberry’s daughter can send him home cooked meals that comply with his recommended diet.
Family members of enrollees are invited to visit the facilities, communicate directly with the clinical care team, and attend regularly scheduled team meetings. Highlighting the impact that PACE has on family members, Lopes says, “We reduce some of their stress… allow them to go back to work or feel like they can go back to work without worrying about leaving mom or dad home alone.”

So why don’t more PACE programs exist? And why aren’t more seniors enrolled in PACE?

Assessing PACE’s success has been challenging due to its nature and population. Susan Ciccariello, director of coordinated care for the state’s Executive Office of Health and Human Services, has spent several years overseeing the PACE program. She acknowledges that the data on its effects are limited. The program’s impact on quality of life, mortality rates, and costs remains unclear. What is unequivocal however, is the growing interest in PACE both by state officials and seniors.

Currently, 129 PACE programs exist across 31 states, 8 in Massachusetts. The state saw a 5 percent increase in PACE enrollees in 2018. Nationwide, enrollment has increased 120 percent since 2011, now covering 45,000 enrollees. More recently, the federal government is allowing, for the first time, for-profit companies to become PACE providers.
Across the state, there has been a general trend towards coordinated health care models with the emergence of Senior Care Organizations, One Care plans (i.e., Medicare-Medicaid plans), and Accountable Care Organizations. These programs vary in eligibility, benefits, and funding source but share a similar goal to PACE — to provide comprehensive, integrated care that improves quality of life years for a growing number of seniors.

Despite existing for much longer, enrollment in PACE has lagged behind its counterparts. According to Ciccariello, a major reason for this large difference is access and awareness. Qualifying seniors are often not aware of the program or do not live in close proximity to a PACE site.

Recognizing these barriers, the Baker administration has established goals for streamlining the program and eliminating “PACE deserts.” The administration’s plans for the 2019-2020 calendar year include a review of costs and programming at each site, standardization of eligibility, enhancing awareness and access for qualifying residents, and establishing a more reliable system to collect data and create transparency among different program sites.

While no one size fits all solutions, stories like Woodberry’s are a good reminder that PACE has the potential to thrive, and scaling up the program is worthwhile. For Manny Lopes, the East Boston health center director, PACE is a symbol of what US health care should look like. He sees the expansion of PACE and models like it as an encouraging sign of a health care system that values the “voice and choice” of the people it serves.

Monica Vohra is a community health physician and advocate in Boston.