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David Harrison

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FEBRUARY 2, 2021 WASHINGTON, DC -- -- The COVID-19 pandemic has demonstrated that Programs of All Inclusive Care for the Elderly (PACE), with their focus on keeping participants at home and in the community, are safer than nursing home care.

According to the National PACE Association (NPA), the rate of PACE residents that have died from COVID is one third of the rate for nursing home residents.  The rate of cases among PACE participants was also one third of the rate for  nursing home residents.  
 

During the pandemic, the PACE model has demonstrated resiliency and increased potential into the future by continuing to provide all the care and services necessary keep their participants safe in the community. In response to COVID-19, PACE programs have substantially and swiftly transformed to continue to meet all participants care and services needs:

• Maintained existing home-based services for participants and shifted provision of most of their center-based services into participants’ homes to minimize the risk of infection and protect their extremely vulnerable participants from COVID-19 complications.
• Expanded Use of Telehealth
• Redeployment of center-based staff
• Use of Mobile Health Vans
• Social supports/socialization
• Repurposing of PACE Centers for overnight care and respite care

What is PACE?

PACE is a wholly integrated, coordinated, person centered, provider led, capitated and fully risk bearing model of care. Driven by objective of maintaining the independence of program participants in their homes and communities for as long as possible; PACE programs are the lifelines that enable frail older Americans to live at home instead of in a nursing facility; 95% of participants live safely in the community.

A total of 139 organizations operate PACE programs in 31 states across the United States. More than 55,000 people are enrolled in PACE. Enrollees are age 55 and over and meet their state definition of needing nursing home care. 

PACE organizations serve approximately 1 in 10 of those that could benefit from their care in their communities. Of the 2.2M lower-income older adults estimated to need long-term services and support (LTSS), PACE organizations serve just 2.5% approximately. 

PACE was proven safer and more cost-effective even prior to the pandemic: 
 

·       PACE employs strong financial incentives for PACE organizations to avoid duplicative or unnecessary services while encouraging the use of appropriate community-based alternatives to hospital and nursing home care. Care decisions are provider-led through the care team in consultation with the participant and his or her family. This construct empowers the PACE model of care to achieve better care, improved patient experience, and lower costs. 

·       Lower out-of-pocket costs for participants with no Medicare or Medicaid deductibles or copayment. 

·       Better care leads to lower costs:

o    13% lower cost for state Medicaid programs, comparable Medicare costs 

^o     Reduced hospital admission: 24% lower hospitalization rate than dually eligible beneficiaries who receive Medicaid nursing home services ^I,II

o   Decreased rehospitalization: 16% less than the national rehospitalization rate of 22.9% for dually eligible beneficiaries age 65 and over^III

^o     Reduced ER visits: less than one emergency room visit per member per year than similar individuals living in the community ^{IV, V}

^o     Fewer nursing home admissions: despite being at nursing home level of care than those with similar care needs ^VI

o   PACE participants have fewer unmet needs and receive better preventive care, specifically with respect to hearing and vision screenings than seniors in the community. ^VII

·       PACE incorporates many of the reforms the Medicare program seeks to promote, including person-centered care, delivered and coordinated by a provider based, comprehensive system, with financial incentives aligned to promote quality and cost-effectiveness through capitated financing. 

·       PACE provides care to older Americans in their preferred environment— home; 86 percent of those 65 and older surveyed either strongly or somewhat agreed that they want to remain in their current home for as long as they can according to AARP. 

·       PACE and other alternatives to nursing homes will be in great demand to meet the needs of Medicare and Medicaid beneficiaries and others in the coming years 

The National PACE Association (NPA) works to advance the efforts of PACE programs, which coordinate and provide preventive, primary, acute and long-term care services so older individuals can continue living in the community. The PACE model of care is centered on 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. For more information, visit www.NPAonline.org and follow @TweetNPA.

1. NPA Analysis of PACE Upper Payment Limits and Capitation Rates, March 2017.

 

1. Mathematica Policy Research. (2014). _e E_ect of PACE on Costs, Nursing Home Admissions and Mortality: 2006-2011. Evaluation prepared for U.S.

Department of Health and Human Services, O_ce of the Assistant Secretary for Planning and Evaluation, O_ce of Disability, Aging and Long-Term Care Policy.
 

1. Segelman, M., Szydlowski, J., Kinosian, B., et al. (2014). Hospitalizations in the Program of All-Inclusive Care for the Elderly. Journal of the American

Geriatrics Society, 62: 320-24.
 

1. Division of Health Care Finance and Policy, Executive O_ce of Elder A_airs. (2005). PACE Evaluation Summary. Accessed online on May 25, 2011.
    
2. Kane, R.L., Homyak, P., Bershadsky, B., et al. (2006). Variations on a theme called PACE. Journal of Gerontology Series A, 61 (7): 689-93.
    
3. Friedman, S., Steinwachs, D., Rathouz, P., et al. (2005). Characteristics predicting nursing home admission in the Program of All-Inclusive Care for Elderly

People. Gerontologist (2009). 45 (2): 157-66.

4. Leavitt, M. (2009). Interim report to Congress. _e quality and cost of the Program of All-Inclusive Care for the Elderly. Mathematica Policy Research

Evaluation prepared for the Secretary of the U.S. Department of Health and Human Services for submission to Congress.