What Is PACE?


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.

Programs of All-Inclusive Care for the Elderly (PACE®) serve individuals who are age 55 or older, certified by their state to need nursing home care, able to live safely in the community at the time of enrollment, and live in a PACE service area. While all PACE participants must be certified to need nursing home care to enroll in PACE, only about 5 percent of PACE participants nationally reside in a nursing home. If a PACE enrollee needs nursing home care, the PACE program pays for it and continues to coordinate the enrollee's care.


Delivering all needed medical and supportive services, a PACE program provides the entire continuum of care and services to seniors with chronic care needs while maintaining their independence in their home for as long as possible.

Services include the following:

  • 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 specialties, such as audiology, dentistry, optometry, podiatry and speech therapy;
  • respite care; and
  • hospital and nursing home care when necessary.


The PACE Model of Care can be traced to the early 1970s, when the Chinatown-North Beach community of San Francisco saw the pressing needs for long-term care services by families whose elders had immigrated from Italy, China and the Philippines. William Gee, DDS, a public health dentist, headed the committee that hired Marie-Louise Ansak in 1971 to investigate solutions. Along with other community leaders, they formed a nonprofit corporation called On Lok Senior Health Services to create a community-based system of care. On Lok is Cantonese for "peaceful, happy abode."

 1971 William Gee, DDS, and two others execute articles of incorporation for the nonprofit Chinatown-North Beach Health Care Planning and Development Corporation (later renamed On Lok Senior Health Services) and retain Marie-Louise Ansak to study the feasibility of building a nursing home in the community. She finds a nursing home would be financially infeasible and culturally inappropriate. Instead, she obtains funding to train health care workers in cooperation with the University of California San Francisco. She also outlines a comprehensive system of care combining housing and all necessary medical and social services based on the British day hospital model.
 1973 On Lok opens one of the nation’s first adult day centers in San Francisco.
 1974 On Lok begins receiving Medicaid reimbursement for adult day health services.
 1975 On Lok adds a social day care center and includes in-home care, home-delivered meals and housing assistance in its program.

The On Lok model of care expands to include complete medical care and social support of nursing home-eligible older individuals.

 1979 On Lok receives a four-year grant from the Department of Health and Human Services to develop a consolidated model of delivering care to persons with long-term care needs.
 1983 On Lok is allowed to test a new financing system that pays the program a fixed amount each month for each person in the program.
 1986 Federal legislation extends the new financing system and allows 10 additional organizations to replicate the On Lok service delivery and funding model in other parts of the country.
 1987 The Robert Wood Johnson Foundation, the John A. Hartford Foundation and the Retirement Research Foundation provide funding to On Lok and the first replication sites to support their efforts.
 1990 The first Programs of All-Inclusive Care for the Elderly (PACE) receive Medicare and Medicaid waivers to operate.
 1994 With the support of On Lok, the National PACE Association (NPA) is formed.
11 PACE organizations are operational in nine states.
 1996 21 PACE programs are operational in 15 states.
 1997 The Balanced Budget Act of 1997 establishes the PACE model as a permanently recognized provider type under both the Medicare and Medicaid programs.
 1999 Interim Regulation is published in November.
30 PACE programs are operational in 19 states.
 2000 The Robert Wood Johnson Foundation and the John A. Hartford Foundation fund the PACE Expansion Initiative to assist NPA in expanding the benefits of the PACE model of care to more families in need.
 2001 Alexian Brothers Community Services in St. Louis becomes the first PACE provider to become a full, permanently recognized part of the Medicare and Medicaid programs.
 2006 Final Regulation is published in November.
Congress awards grants of $500,000 to 15 organizations for rural PACE expansion.
 2007 42 PACE programs are operational in 22 states.
 2008 61 PACE programs are operational in 29 states.
 2009 72 PACE programs are operational in 30 states.
 2010 75 PACE programs are operational in 29 states.
 2011 82 PACE programs are operational in 29 states.
 2012 88 PACE programs are operational in 29 states.
 2013 98 PACE programs are operational in 31 states.
 2014 106 PACE programs are operational in 31 states.
 2017 122 PACE programs are operational in 31 states.
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