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Program of All‐inclusive Care for the Elderly (PACE): An Innovative Model of Integrated Geriatric Care and Financing
Author(s) -
Eng Catherine,
Pedulla James,
Eleazer G. Paul,
McCann Robert,
Fox Norris
Publication year - 1997
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.1997.tb04513.x
Subject(s) - pace , medicaid , medicine , family medicine , nursing , gerontology , health care , economic growth , economics , geodesy , geography
OBJECTIVES: The Program of All‐inclusive Care for the Elderly (PACE) is a long‐term care delivery and financing innovation. A major goal of PACE is prevention of unnecessary use of hospital and nursing home care. SETTING: PACE serves enrollees in day centers and clinics, their homes, hospitals and nursing homes. Beginning at On Lok in San Francisco, the PACE model has been successfully replicated across the country. In 1995, PACE was fully operational in 11 cities in nine states. PARTICIPANTS: To enroll in PACE, a person must be 55 years of age or older, be certified by the state as eligible for care in a nursing home and live in the program's defined geographical catchment area. PACE participants are ethnically diverse. In 1995, the average PACE enrollee was 80.0 years old and had an average of 7.8 medical conditions and 2.7 dependencies in Activities of Daily Living. A significant number have bladder incontinence (55%). Many enrollees (39%) live alone in the community, and 14% have no means of informal support. INTERVENTION: Medicare and Medicaid waivers allow delivery of services beyond the usual Medicare and Medicaid benefits. The PACE service delivery system is comprehensive, uses an interdisciplinary team for care management, and integrates primary and specialty medical care. PACE receives monthly capitation payments from Medicare and Medicaid. Patients ineligible for Medicaid pay privately. RESULTS: Outcomes of PACE programs have been positive. There has been steady census growth, good consumer satisfaction, reduction in use of institutional care, controlled utilization of medical services, and cost savings to public and private payers of care, including Medicare and Medicaid. CONCLUSION: The growing number of older people in the United States challenges healthcare providers and policy makers alike to provide high quality care in an environment of shrinking resources. The PACE model's comprehensiveness of health and social services, its cost‐effective coordinated system of care delivery, and its method of integrated financing have wide applicability and appeal.