I have heard a lot about the PACE program, but it was not until I actually saw a site a couple weeks ago that I fully understood what this long-term care community program is all about.
The PACE (Programs of All-Inclusive Care for the Elderly) site I visited was in Milwaukee. It was in a large building in an urban residential neighborhood. The name of the organization that provides PACE at this site is Community Care.
As soon as I walked in the door, I felt a liveliness about the place. A large group of older adults was sitting in a bright lobby area by the front doorway. Beyond the entryway was a dining area where workers, listening to R and B music, were getting ready for the lunch hour. It felt comfortable to be there.
I was met at the door by several smiling faces, including Natalie Lemke, communications specialist for Community Care, and Dr. Mary Gavinski, the medical director. They gave me a tour of the massive, 100,000-square-foot facility. Conference rooms, medical examining rooms, a therapy room, a workout room and a major storage area for durable medical equipment were among the stops on the tour that weaved through the building, which still looks new after opening in 2007.
It struck me how many healthcare services were available in one building. That, in a sense, is what PACE is all about.
“The philosophy is good preventive care, giving people what they need … is going to in the long-run for the whole program make sense,” said Gavinski, a gentle, petite woman, who has been with the program since it began with 49 members in the basement of a community health center more than 20 years ago.
The PACE program in Milwaukee, which has two large facilities, serves 850 seniors, who are known as members. About 75% live in the community and 10% live in group homes. Less than 5% live in nursing homes. Nearly all members are served PACE until they die, Gavinski said.
To enter the program, members must be Medicaid-eligible or have a cost-share with Medicaid, Gavinski said. The state also has to determine that they are nursing home-eligible.
When members enter PACE they receive a clinical assessment. The employees on staff determine what the members need—perhaps a housekeeper, home health aide or just visits to the center every three days. Then, as health events occur, the staff discusses possible interventions. Seniors may come to the center for meals and to socialize 3.5 days a week.
Many of the members PACE accepts have become isolated.
“They come into the center and they reconnect,” Gavinski said.
A team effort
The best part about PACE is that people on the team, which includes doctors, nurses, dieticians, social workers, physical therapists, home healthcare workers and housekeepers, get to know the members and can anticipate negative health situations before they occur.
“We get to know them like family almost,” explained Gavinski.
That could mean that if a member was not eating properly, the team could send in a home care worker to help make sure she was eating her meals and help with some daily tasks. A housekeeper also might be assigned to help do chores.
The staff gets to together to talk about members four to five times a week and make resource allocation decisions. The whole purpose of PACE is to prevent seniors from going into nursing homes and avoid unnecessary hospitalizations, Gavinski said.
That doesn’t mean that members don’t go to nursing homes, but the PACE program would prefer they stay at home as long as possible. Once members are in the program, PACE pays for care, including nursing home stays, for however long they stay in the program.
Of course, team members also must make fiscally responsible decisions. The program is funded with pooled Medicaid and Medicare dollars, so funds are not unlimited. But it works, said Gavinski, a geriatrician.
“We’ve proven time and time again … if you give people what they need in a cost-effective way, you’ll prevent high-cost things,” she said.
Just being able to go to a center and socialize also provides a dose of wellness for the seniors, who might be homebound otherwise, Gavinski said.
“It’s more powerful than the medicine I give them,” she said.
Better than home
One person is grateful for PACE is Mariea. The woman, who has a pretty, youthful face sits in a wheelchair as she talks to me. Her lower legs have been amputated.
“If I didn’t have the program, I’d be home by myself,” says Mariea, who is in her late 50s.
She comes to the center Mondays, Thursdays and Fridays. She eats breakfast and lunch there, plays bingo and does physical therapy.
“They put weights on my legs. I do sit-ups,” she explains.
Mariea, who lives with her daughter, says both of them love the program.
“I really make good use of my time,” she says.