This may be the most important senior care program that you’ve never heard of. Since 1973, one program — the Program of All-Inclusive Care for the Elderly (PACE) — has been quietly transforming our nation’s senior care system.
Spanning 30 states, PACE programs allow low-income citizens 55 and older to access services — from in-home care to transportation to socialization — that help them live as independently as possible. By allowing individuals to receive at-home assistance with daily tasks while receiving quality care and engaging with community members, the PACE model serves as a safety net for America’s seniors. And, the program generates significant cost savings for our healthcare system compared to other settings such as a hospital or nursing home.
Today — 59 years after its inception — the PACE model is well-positioned to meet the needs of an aging America, where senior care providers grapple with soaring demand for at-home care and seniors continue to report high rates of social isolation and loneliness. In fact, one in three older adults report infrequent contact (once a week or less) with people outside their home, up from 28 percent in 2018.
But to achieve its potential, congressional action is needed. It’s time to turbo-charge PACE.
Over the last few decades, and particularly post-pandemic, seniors (and their loved ones) have expressed a preference to receive healthcare services in their own homes rather than in an institutional setting like a nursing home, whenever possible. Yet, a large gap continues to exist between this demand and the care that is being provided to frail older adults with limited resources. Access to care has been particularly limited in America’s rural communities, with rural residents 78 percent less likely to receive home and community-based care than Americans in metropolitan counties.
As experts consider how to meet this demand, the PACE model is a promising way to expand home and community-based services, especially in rural areas, and reduce caregiver burnout. The PACE program not only provides in-home assistance, transportation, personal care, social contact and nursing care but, in some cases, PACE participants can receive help with daily tasks such as light housekeeping, meal preparation and laundry. An estimated 95 percent of PACE participants receive this care while remaining in their communities, allowing them to receive hands-on support services while staying in a comfortable, familiar environment.
PACE participants also have access to transportation services that pick them up at home and transport them to the PACE Day Center or to medical appointments.
These are “through the door” transportation services, meaning that instead of simply waiting outside to pick a participant up, PACE drivers may enter a participant’s home, help them get their shoes on, and collect their belongings before leaving. When returning, PACE drivers help participants back into their homes and ensure they are safe and situated before leaving. These services have proven to be particularly beneficial for rural participants who often face significant challenges in accessing medical care and transportation.
Through Medicare and Medicaid, PACE provides coverage for prescription drugs, physician care, home care, checkups, hospital visits, and even nursing home stays whenever necessary. As a result, PACE participants who are eligible pay nothing for their care — no co-pays, no deductibles, and no out-of-pocket care expenses.
Further, whether participants are at home or in the community-based Day Center, participants have 24/7 access to a dedicated skilled interdisciplinary team, which includes a primary care physician, home care coordinator, dietitian, social worker, or a physical or occupational therapist. The team works alongside the participant and the family to plan, coordinate and deliver holistic, personalized health services, whether it’s dental care, at-home prescription drug delivery, or the many other services PACE provides.
PACE is designed to meet these challenges and equip seniors with the resources they need to tackle the prevalent issue of social isolation among the elderly. Whether eating a meal with friends or engaging in an activity, the PACE program can help older adults foster meaningful connections. The program can not only meet participants’ social needs but can also offer mental health support through counseling and other psychological support services. In fact, evidence suggests that PACE participants experience measurable mental health benefits.
It’s clear that PACE is a proven model for improving the health of our nation’s seniors. The program’s frailty and income requirements only apply to a small slice of our nation’s seniors, meaning that PACE serves only 62,000 participants nationwide. Even with this small population, however, PACE has saved states thousands of dollars annually for each participant.
To address today’s challenges and lower healthcare spending, Congress must prioritize PACE through policy reforms and resource investment that increase access to and enrollment in the program. Thankfully, several bipartisan lawmakers in Washington have taken the first steps to make PACE more affordable through the PACE Part D Choice Act of 2023, which would expand access to affordable Part D plan options for Medicare-only PACE participants. In doing so, this legislation would enable many more Medicare-only seniors to enroll in the program and receive the care they need.
Growing older and seeking the right care in the right setting affects all of us at some point. It’s critical that lawmakers step up and ensure that seniors can access the comprehensive, home- and community-based care they want, need and deserve.
