Who Can Afford Healthcare?

Many people worry that the ongoing cost of various health issues will make aging in place impossible. However, a Medicare and Medicaid-funded program called “PACE” is slowly turning the tables on that long-held belief.

What is PACE?

The Program of All-Inclusive Care for the Elderly (PACE) is enabling some older adults to age in place successfully. The program is set up to serve older adults who need some nursing home type care, but could otherwise still live at home. It is a less expensive way of delivering comprehensive care than the alternative of full time living in nursing homes.   

PACE is based on the belief that the well-being of older adults with chronic care needs is better served in the local community whenever possible. The program services people 55 and older who are certified by their state to need nursing home care, who are able to live safely in the community at the time of enrollment, and who live in a PACE service area. When a person signs up with a local PACE provider, all of their Medicare/Medicaid benefits go through the PACE program.

Interestingly, 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 nursing homes. If a PACE enrollee needs nursing home care at some point after enrolling, the PACE program pays for it and continues to coordinate the enrollee’s care.

A Wrap-Around Services Approach to Care

PACE delivers all needed medical and supportive services, including the entire continuum of care and services a senior citizen with chronic care needs while maintaining some independence in their home for as long as possible. More information about PACE is available on the National PACE Association website.

As part of PACE, an interdisciplinary team of professionals — dietician, driver, home care liaison, nurse, personal care attendants, occupational and recreational therapists, social worker, and the person’s primary care physician — work together to provide care. Services covered by PACE include:

  • Adult day care
  • Dentistry
  • Emergency services
  • Home care
  • Hospital care
  • Laboratory/x-ray services
  • Meals
  • Medical specialty services
  • Nursing home care
  • Nutritional counseling
  • Occupational therapy
  • Physical therapy
  • Prescription drugs
  • Primary care (including doctor & nursing services)
  • Recreational therapy
  • Social services
  • Social work counseling
  • Transportation

Medicare-only PACE enrollees do pay monthly premiums, but no deductibles, coinsurance or other Medicare cost-sharing.

Limited Access to Affordable Comprehensive Care

Unfortunately, PACE is only available in 144 select areas in 30 states, even though it has been shown to benefit older adults and their families. That’s an average of only a little more than 4.8 programs in states with PACE programs. Additionally, if a person enrolled in a PACE program has to move into an area without PACE, they must leave the program. Often, this can mean going into a nursing home and/or increased costs to the individual.

The PACE program is managed via a partnership between Medicare/Medicaid and each state, and is implemented in local communities. Some states limit the number of people that can be enrolled in PACE. Other states limit the number of PACE programs that can operate. State policies often have to change to facilitate the growth of PACE programs.

The states without PACE programs include Alaska, Arizona, Connecticut, District of Columbia, Georgia, Hawaii, Idaho, Illinois, Kentucky, Maine, Minnesota, Mississippi, Missouri, Montana, Nevada, New Hampshire, South Dakota, Utah, Vermont, West Virginia, and Wyoming. More PACE programs are needed in all 50 U.S. states.

Bipartisan Senate Bill to Expand Something That Works!

Recently, a bipartisan effort led by Sen. Bob Casey (D-PA), chair of the Senate Special Committee on Aging, and Sen. Tim Scott (R-SC), Ranking Member, introduced the Program of All-Inclusive Care for the Elderly (PACE) Expanded Act of 2022 in the U.S. Senate this past February. The goal is to accelerate the capacity and reach of the existing PACE organizations and spur the establishment of new ones. The bill has been referred to the Committee on Finance.

To advocate for additional PACE programs in your state, contact your Congressional representatives.

Third Chapter Living is rooted in the idea that we are continuous learners; that there is no specific time of life that is best for learning; and that what we learn as we enter our “Third Chapter” — the 25 years after age 50 — can be more complex but ultimately more exciting and inspiring than anything else we’ve experienced to that point.

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  1. John Zeisel on June 27, 2022 at 10:52 am

    How can somoene advocate for a PACE program in a state that has none?
    How does a person get into a PACE program ina state that has one?

  2. Barb Powell on June 27, 2022 at 4:02 pm

    John, if you have no luck with your U.S. Congresspersons, try your state and regional representatives. Advocating for the need for them is the key. There may be older adult communities in your area that would be open to exploring applying for a PACE program. If you go to the National Pace website in the article — https://www.npaonline.org/ — you can learn more. Hope this helps!

  3. John Zeisel on June 27, 2022 at 4:22 pm

    Interesting that while “engagement in life” is so essential to all of our wellbeing, especially as we get older as we lose connections through work and family and professional associations, only one of the eighteen PACE services listed have any connection to “engagement” and even that only tangentially — “Recreational therapy”.

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