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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 home care.

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
  • Meals
  • Social services
  • Transportation
  • 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

  • Senior CommUnity 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. The National PACE Association has a toolkit for states with strategies for incorporating PACE into state integrated care initiatives and information to help communities develop their own PACE program.

Resources to Learn More

Evaluation of the Rural PACE Provider Grant Program
Document
This Report to Congress is a qualitative analysis on the initiation and early implementation of fourteen rural PACE pilot sites. The study includes information on starting new programs and discusses the challenges faced in rural settings.
Author(s): Anderson, K.
Organization(s): Centers for Medicare & Medicaid Services
Date: 2011

Expanding Rural Elder Care Options: Models That Work
Document
These workshop proceedings discuss model summaries and case studies of elder care options in rural communities.
Author(s): Fitzgerald, P., Coburn, A., & Dwyer, S.
Date: 11/2008

Integrated Care for Older Adults in Rural Communities
Document
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
Date: 5/2014

Quick Facts about Programs of All-Inclusive Care for the Elderly
Document
Overview about Programs of All-Inclusive Care for the Elderly (PACE), how it is financed, what it includes, and who is eligible to enroll.
Organization(s): Centers for Medicare & Medicaid Services
Date: 1/2011

Start a PACE Program
Website
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

Strategies for Incorporating PACE into State Integrated Care Initiatives
Document
This toolkit facilitates the incorporation of PACE into a state’s integrated care strategy.
Organization(s): National PACE Association
Date: 3/2014