The PACE program — which stands for Program of All-Inclusive Care for the Elderly — is a unique Medicare and Medicaid program that provides comprehensive medical and social services to frail older adults who need nursing home level care but want to remain living in their communities. PACE is designed to be a complete alternative to nursing home placement offering all of the care and services a person needs through a single coordinated program.
PACE is one of the most comprehensive long term care programs available in the United States but it is not available everywhere. Understanding what PACE offers, who qualifies, and how to find a program can help families consider it as an alternative to nursing home placement.
How the PACE program works
PACE provides all of a participant’s medical and social care needs through an interdisciplinary team of healthcare professionals working together at a PACE center. Participants typically attend the PACE center several days per week where they receive medical care, therapies, meals, social activities, and other services. Transportation to and from the center is provided.
The PACE team — which includes physicians, nurses, social workers, therapists, dietitians, and other specialists — develops and coordinates a personalized care plan for each participant. The team meets regularly to review each participant’s needs and adjust the care plan as necessary.
When participants need care that cannot be provided at the PACE center such as hospitalization or specialist care the PACE program arranges and coordinates that care as well. PACE assumes full financial and clinical responsibility for all of the participant’s Medicare and Medicaid covered services.
What PACE covers
PACE provides a comprehensive range of services including:
- Primary care including physician and nurse practitioner services
- Hospital care and specialist services
- Prescription drugs
- Nursing home care when needed
- Home care and personal care services
- Physical, occupational, and speech therapy
- Social work services and counseling
- Dental care
- Vision care
- Hearing services
- Nutrition counseling and meals
- Transportation to the PACE center and medical appointments
- Recreational and social activities
- Caregiver support and education
- Palliative care and hospice coordination
One of the most significant features of PACE is that it covers nursing home care when a participant’s needs temporarily or permanently exceed what can be managed at home. PACE participants can be admitted to a nursing home arranged by the program when necessary and can return to community living when their condition stabilizes.
Who is eligible for PACE
To be eligible for PACE a person must meet all of the following criteria:
- Be aged 55 or older
- Live in a PACE service area
- Need nursing home level care as certified by the state
- Be able to live safely in the community with the support of PACE services at the time of enrollment
PACE is available to both Medicare and Medicaid beneficiaries as well as people who have only Medicare or only Medicaid. People who are not enrolled in either program may be able to participate by paying privately though this is less common.
How PACE is paid for
The cost of PACE is covered through Medicare and Medicaid for eligible participants:
- Medicare beneficiaries — Medicare pays a monthly capitated rate to the PACE organization to cover all Medicare-covered services
- Medicaid beneficiaries — Medicaid pays a monthly capitated rate to the PACE organization to cover all Medicaid-covered services
- Dual eligible participants — people who qualify for both Medicare and Medicaid generally pay nothing out of pocket for PACE services
- Medicare only participants — may pay a monthly premium for the Medicaid portion of PACE services
- Private pay — people who are not eligible for Medicare or Medicaid may be able to enroll in PACE by paying privately
Benefits of PACE
PACE offers several significant benefits compared to traditional nursing home care or fragmented community-based services:
- Comprehensive coordinated care — all of a participant’s care needs are met through a single program eliminating the need to coordinate multiple providers and services
- Community living — PACE allows people who need nursing home level care to remain living at home or in a home-like setting
- Preventive focus — the interdisciplinary team approach and regular monitoring can prevent hospitalizations and health crises
- Family support — PACE provides significant support to family caregivers including respite care and education
- Person-centered care — care plans are individualized based on each participant’s needs, preferences, and goals
Limitations of PACE
PACE also has some limitations to consider:
- Limited availability — PACE programs operate in about 30 states and not all communities within those states have access to a program
- Center attendance required — participants are generally expected to attend the PACE center regularly which may not suit everyone’s preferences
- Exclusive care arrangement — PACE participants must receive all of their care through the PACE program. They generally cannot use non-PACE providers for Medicare or Medicaid covered services without prior authorization.
- Geographic restriction — participants must live within the PACE program’s service area
How to find a PACE program
PACE programs operate in approximately 30 states. Resources for finding a PACE program include:
- Medicare’s PACE information — medicare.gov provides information about PACE and a tool to find programs by location
- National PACE Association — npaonline.org maintains a directory of PACE programs organized by state
- Your local Area Agency on Aging — can provide information about PACE and other long term care options in your community
- Eldercare Locator — eldercare.acl.gov or 1-800-677-1116
Key terms to know
- PACE — Program of All-Inclusive Care for the Elderly, a comprehensive Medicare and Medicaid program for frail older adults
- Interdisciplinary team — the group of healthcare professionals who work together to provide PACE care
- Capitated rate — a fixed monthly payment made to the PACE organization to cover all of a participant’s care costs
- Nursing home level care — a level of care need that qualifies a person for PACE enrollment
- Dual eligible — a person who qualifies for both Medicare and Medicaid
- Service area — the geographic area within which a PACE program provides services
Sources
- National PACE Association — npaonline.org
- Medicare.gov — PACE
- Centers for Medicare and Medicaid Services
- Administration for Community Living
This article is for general informational purposes only and does not constitute legal or medical advice. PACE program availability varies by location. Contact your local Area Agency on Aging or visit medicare.gov for information specific to your area.