Program for All-Inclusive Care for the Elderly (PACE)
Integration of physical and behavioral health services can help older adults living in rural areas to access
needed healthcare services. The Program
of All-Inclusive Care for the Elderly (PACE) model is designed to integrate care for frail older adults
who are eligible for both Medicaid and Medicare (dual-eligibles). This population of dual-eligible individuals
is more likely to have physical, mental, and cognitive conditions, and therefore, benefit from integrated care.
Some PACE programs are targeted toward all older adults who meet the minimal acuity levels required for nursing
PACE services are provided by interdisciplinary teams, which are responsible for coordination of 24-hour care
delivery. PACE provides all Medicare and Medicaid benefits, which include:
- Adult day care
- Social services
- Primary care
- Nursing home care
- Home care
This integrated model of
care aims to improve the quality of life of older adults with chronic care needs by providing services in the
community when possible. In rural communities, PACE programs are located either in a larger healthcare system
or in a local agency or organization.
Examples of Rural PACE Programs
Care is a PACE program that serves older adults in rural Delta and Montrose counties in Colorado.
Senior CommUnity Care addresses all medical and social needs of enrolled patients, including transportation
services, meals, and nursing, dental, and mental healthcare, among many other services.
Northland PACE, which serves older adults in Dickinson
and Bismarck, North Dakota, coordinates healthcare and home care services for enrolled patients through care
teams. This team includes a range of providers, including physicians, nurses, social workers, licensed
therapy professionals, and home care attendants.
Considerations for Implementation
The high start-up costs for designing and implementing PACE means rural health networks may need to look for
additional funds. As PACE programs typically enroll patients based on service area, rural PACE programs may find
it difficult to maintain sufficient enrollment. In addition, rural communities should be aware that program
enrollees may only see physicians that participate in PACE. PACE program leaders should communicate with
enrollees about their choices within the PACE program to ensure that patients still feel in control of their
healthcare management. Program leaders can also consider applying for a CMS waiver to allow enrollees to use
community physicians in addition to PACE providers.
Resources to Learn More
Elder Care Options: Models That Work
These workshop proceedings discuss model summaries and case studies of elder care options in rural
Author(s): Fitzgerald, P., Coburn, A., & Dwyer, S.
for Older Adults in Rural Communities
This research brief assesses population-based and target models of care integration in rural communities and
provides examples of effective models.
Author(s): Griffin, E. & Coburn, A.
Organization(s): Maine Rural Health Research Center
Start a PACE Program
This webpage on the National PACE Association website provides information about the PACE program as well as
steps and information for registering and developing a PACE program.
Organization(s): National PACE Association