I recently read an interesting article about PACE. Here is more information about the program.

PACE is an All-inclusive Care Program for the Elderly . The model is centered around the belief that it is better for the well-being of seniors with chronic care needs and their families to be served in the community whenever possible.

According to the National PACE Association, there are 16,000 participants in PACE nationwide. The average client is 80 and takes eight prescription medications. Participants have to be 55 or older, certified by their state to need nursing home care and be able to live safely in the community.

Each PACE program receives a fixed amount per person from a patient’s state Medicaid program — usually 85% to 90% of estimated nursing home costs. Medicare funds come through a risk-adjusted formula in which the program receives more for sicker enrollees. PACE becomes both the patient’s insurer and care provider and is obliged to pay for all of the patient’s medical care from the point of enrollment forward.

Services include:

Delivering all needed medical and supportive services, the program is able to provide the entire continuum of care and services to seniors with chronic care needs while maintaining their independence in their homes for as long as possible. 

Care and services include:

• Adult day care that offers nursing; physical, occupational and recreational therapies; meals; nutritional counseling; social work and personal care
• Medical care provided by a PACE physician familiar with the history, needs and preferences of each participant
• Home health care and personal care
• All necessary prescription drugs
• Social services
• Medical specialists such as audiology, dentistry, optometry, podiatry, and speech therapy
• Respite care
• Hospital and nursing home care when necessary

The benefits of PACE are that participants are supported by a coordinated medical team that the federal government hopes will cut costs and improve life for the elderly.

As demand for hospice care has increased, so have the number of programs nationwide. Today, there are about 4,700 providers, up from about 3,300 five years ago, according to NHPCO. While the majority of providers are nonprofits, the for-profit sector is growing, accounting for 47.1 percent of hospice agencies last year.

Hospice is intended for any person who has a terminal illness and a prognosis of six months or less to live. Depending on the needs of each patient, care can include pain management, medications, medical supplies and equipment, and assistance with the emotional, psychological, and spiritual aspects of dying. A hospice team usually consists of nurses, home health aides, social workers, bereavement counselors, and clergy, as well as a hospice physician and the patient’s personal physician.

The benefit for Medicare and Medicaid patients is remarkably magnanimous. Medicare pays out $601 per patient per day for inpatient hospice care (and $789 per day for the typical patient who gets 24-hour home care), yet there are no copays, deductibles, or out-of-pocket expenses for the beneficiary. Private insurer hospice benefits offer a variety of hospice services, though they’re typically not as generous, according to the Hospice Association of America. To get Medicare or private insurance to cover hospice care, a patient needs only a physician’s referral. Hospice care is usually provided in the patient’s home. It can also be made available at a special hospice residence designed with a homelike atmosphere, or in assisted living or skilled nursing facilities.