By: Nancy Rice, Esq.
The federal Program of All-Inclusive Care for the Elderly (PACE) is a health care model aimed at allowing the elderly to age in place. PACE provides all-inclusive care for frail seniors so that they can remain in their homes, avoiding nursing home placement. There are currently 62 PACE programs in 30 states. Nationally, PACE is 90 percent successful at keeping individuals out of nursing homes.
PACE operates in specific areas so there is no competition between programs. New Jersey currently has two PACE programs known as Living Independently for Elders (“LIFE”) operated by Our Lady of Lourdes Hospital in Pennsauken (Camden County) and at St. Francis in Hamilton Township (Mercer County). The Pennsauken “LIFE at Lourdes” facility accepted its first participants on May 1, 2009 and the Hamilton Township “LIFE St. Francis” program welcomed its first participants on April 1, 2009. Additional New Jersey PACE programs are currently in the planning stages.
The goal of PACE is to provide seniors with all-inclusive care so that they can remain in their homes with the support of PACE professionals. PACE provides primary, acute and long-term care. The program focuses on preventive care and wellness; seeking to fix the root source of the problem so that it does not develop into additional problems. For example, if a person has bad teeth and is not eating as a result, he or she is at risk of malnutrition. Providing the person with dentures — a simple fix — to make eating easier can prevent a host of issues down the road. PACE covers all medically necessary care including; prescriptions, hospitalizations, day care and home health care. PACE will also cover items like dentures and procedures such as cataract surgery.
The PACE programs in New Jersey offer state-of-the-art day care services. Breakfast and lunch are provided to center attendees and meals may be sent home for dinner. PACE can also provide staff to assist participants in their home. Transportation to and from the center, as well as to all scheduled appointments, is provided.
Additionally, participants can obtain physical, occupational and recreation therapy at the center, and there are also social workers available. In addition, a care provider can be sent to a participant’s home on the weekend to help with cooking, cleaning, shopping and other tasks. All participants’ medications are monitored to ensure that they are taking medication properly. With electronic monitoring of medications, a family member or nurse will be called if there is a problem.
One unique feature of the program is that it will provide respite care to give a caregiver the opportunity to take a vacation or have time off for some other reason.
While the goal is to avoid institutional care, if such care is required, PACE will pay for the care.
Eligibility and Payment
To be eligible for PACE, individuals must be age 55 or older and be certified by the state to need nursing home level of care. In addition, they must be able to live in the community safely and live in an area served by PACE.
For individuals who are eligible for both Medicare and Medicaid, PACE is 100 percent covered and there are no out-of-pocket expenses. Elder Law Attorneys are trained to advise individuals about Medicaid eligibility, which has both asset and income limitations.
If a participant is only eligible for Medicare, there are co-pays that must be paid out of pocket, and this can be costly — into the thousands of dollars. Individuals who are not eligible for Medicare or Medicaid pay out of pocket.
PACE programs such as LIFE at Lourdes and LIFE St. Francis act as both medical provider and insurer. As such, PACE’s goals are aligned with the patient’s goals — to stay at home, in the community and avoid going to a nursing home.
For more information, including new PACE centers scheduled to be opened, call the New Jersey Division of Aging and Community Services toll-free at 1-800-792-8820 or contact the two PACE agencies currently in operation: