MIAMI – February 9th, 2015 – Want to stay in your own home as you age? More seniors will have that chance through a little-known program that’s expanding in South Florida.
The Program of All-Inclusive Care for the Elderly, or PACE, uses Medicare and Medicaid dollars for services and care management designed to keep older people at home and out of nursing homes.
MorseLife, a senior care nonprofit with a PACE center at its West Palm Beach campus, is doubling its capacity to 250 people this year. It also plans to open a second center at Temple Sinai of Palm Beach County in Delray Beach by the middle of 2015, MorseLife officials said. The new location would accommodate up to 200 people.
Meanwhile, Broward County would get its first PACE site by early 2016. This new PACE center in Miramar would have room for 125 seniors and be run by Miami Jewish Health Systems, which already has three centers in Miami-Dade County.
“Every day that someone is in PACE instead of being in an institution is a success,” said Alan Sadowsky, MorseLife’s senior vice president of community-based services. “We know that, by and large, people prefer to age in their communities. And they can get much better care in PACE.”
How it works: PACE offers centralized services intended to address a variety of needs, from comprehensive medical care and transportation to meals to social activities.
Once enrolled, PACE seniors are assigned a geriatrician who oversees their medical care. The physicians also are part of a care team that includes nurses, therapists and social workers, who regularly meet with participants and their caregivers. The program also provides home health workers and sends contractors to make a participant’s home safer and more accessible.
PACE started in 1973 as a trial program at an adult day center in Chinatown-North Beach community of San Francisco. Today, the PACE network includes 106 programs in 31 states.
In Florida, it’s jointly coordinated by the state’sDepartment of Elder Affairs and Agency for Health Care Administration.
Each of Florida’s PACE programs is managed by a geriatric care nonprofit and is licensed as an adult day center. Besides those in South Florida, there are two PACE programs that serve Pinellas County and three southwest Florida counties.
PACE programs, and the number of people they can serve, must be approved by state legislators. The upcoming expansions are the result of legislators during the last session authorizing funds for a total of 600 new slots to be divided among existing programs, according to the Florida Department of Elder Affairs.
To enter PACE, participants must be age 55 or older and be certified by the state as being at-risk for being placed in a nursing home — meaning they usually have severe chronic medical conditions and are unable to do tasks like prepare meals or bathe themselves.
“They are a difficult population to care for … Our goal is to keep them as healthy as we can,” said Cliff Bauer, senior vice president and COO of Miami Jewish Health, which started Florida’s first PACE program in 2003.
The majority of people in Florida’s PACE programs are on Medicare and Medicaid, the state and federal health care program for the poor, which pay MorseLife and Miami Jewish Health a per capita rate to cover care expenses. Seniors on Medicare alone can sign up for PACE but must pay some costs on their own, about $2,300 to $2,700 monthly in South Florida.
While PACE can place someone in a nursing home if their health deteriorates, only three out of 454 participants in the Miami Jewish Health program and one out of 121 in the MorseLife program now are living in a skilled care facility. The majority live at home.
One of them is Celia Williams, 67. Formerly a nurse, she spent much of her career helping others who could not walk or care for themselves. Now she is in a wheelchair, disabled by a spinal condition and living in her brother’s house in a rural western Palm Beach County subdivision, surrounded by fruit trees.
Three days a week, she rides the MorseLife van to the program’s West Palm Beach PACE center, where she has been going since 2013. Williams said she has made friends there, taken computer classes, studied Italian and joined a book club.
The physical therapists at the center also created an exercise program that increased her upper body strength, Williams said, so she can get herself in and out of bed, or into the bathroom — critical skills for staying independent. Rosemarie Goffe, a certified home health aide with PACE, stops by to help bathe her and with housekeeping tasks.
Without PACE, Williams said she would be in a nursing home. “If it had to be, I would endure, but I prefer to stay here at home,” she said. “It shows that I am competent.”
Despite PACE’s reputation, MorseLife and Miami Jewish Health officials say enrollment is not as high as it could be because many seniors don’t know about the program.
Experts say PACE faces other potential barriers: Participants have to give up their primary care physician and use a PACE doctor. Those who are not on Medicaid may face high out-of-pocket costs. Also, depending on where they live, seniors might have to travel far to get to a PACE center.
Bauer said he would like to find ways to expand PACE, and make it affordable for those who aren’t low-income and on Medicaid. “PACE is the most exciting medical delivery system I have been involved with during my 40 years in the health care business,” he said.
A 2013 report by the Claude Pepper Center at Florida State University said research shows PACE”enables people to receive quality care while they live where they want to live and die where they want to die.” The report said studies found PACE participants were 30 percent less likely to be hospitalized than other elders receiving services at home.
Other research cited in the Pepper Center report has shown PACE seniors were more likely to say they had a good quality of life and less likely to be depressed. The reviews were mixed, the report said, on if it was less expensive to receive care through PACE vs. traditional long-term care options with no central coordinator.
Larry Polivka, the Claude Pepper Center’s executive director, said he considers PACE the nation’s most successful model for quality long-term care. When his father was dying last year, going back and forth between his nursing home and the hospital, “I wished there would have been a PACE program [nearby] for him,” Polivka said.
“It would have been nice to have a program that is really focused on quality, integrated patient care.”
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