The Program of All-Inclusive Care for the Elderly (PACE®) is a comprehensive, fully integrated, provider based health plan for the frailest and costliest members of our society – those who require a nursing home level of care. The PACE philosophy is centered on the belief that it is better for frail individuals and their families to be served in the community whenever possible. Although all PACE participants are eligible for nursing home care, 95 percent continue to live at home.

According to the National PACE Association, PACE serves approximately 49,000 participants in 31 states. PACE serves individuals who are age 55 or over and certified by their state as needing a nursing home level of care. The average participant is 76 years old and has multiple, complex medical conditions, cognitive and/or functional impairments, and significant health and long term care needs. Approximately 90 percent are dually eligible for Medicare and Medicaid. PACE participants must live in a PACE service area and be able to live safely in the community with PACE services at the time of enrollment.

PACE organizations provide the entire continuum of medical care and long-term services and supports required by frail older adults. These include primary and specialty medical care; in-home services; prescription drugs; specialty care such as audiology, dentistry, optometry, podiatry and speech therapy; respite care; transportation; adult day services, including nursing, meals, nutritional counseling, social work, personal care, and physical, occupational and recreational therapies;and hospital and nursing home care, when necessary.In short, PACE covers all Medicare Parts A, B and D benefits, all Medicaid-covered benefits, and any other services or supports that are medically necessary to maintain or improve the health status of PACE program participants.

Day Center attendance is based on individual needs and can range from once a week, or every month, to several days a week, as needed.

Transportation is a key part of the PACE benefit and is provided between the home and the Day Health Center. In some circumstances, transportation can also be arranged to medical appointments outside the PACE Center.

A person qualifies if she or he: - Is 55 years of age or older - Lives in the service area - Is certified by the State of Indiana as meeting the need for the nursing home level of care as determined by the PACE eligibility team - Is able to live safely in the community with the help of PACE services when joining

Activities of Daily Living (ADLs) are those skills required to manage one’s basic physical needs including personal hygiene or grooming, dressing, toileting, transferring or ambulating, and eating.

If a person meets the income and assets limits to qualify for Medicaid, the program pays for a portion of the monthly PACE premium. Medicare pays for the rest. If a person does not qualify for Medicaid, he or she is responsible for the portion of the monthly premium Medicaid would pay. PACE staff can help determine a person's Medicaid eligibility.

PACE organizations receive fixed monthly payments from Medicare, Medicaid and private payers (for program participants who are not dually-eligible). These funds are pooled, and care is provided following a comprehensive assessment of a participant’s needs. This bundled payment provides a strong incentive to avoid duplicative or unnecessary services and encourages the use of appropriate community-based alternatives to hospital and nursing home care.

PACE organizations often are part of larger health care systems or organizations, including hospital systems, medical groups, federally qualified health centers, area agencies on aging, hospice organizations, and collaborations among several different entities. Some PACE programs operate as stand-alone entities. PACE of Northeast Indiana is a collaborative effort between Indiana's Area III Area Agency on Aging, Aging & In-Home Services of Northeast Indiana, and Parkview Health.

According to the National PACE Association, the average age of PACE participants is 76 years old. Seventy-five percent of participants are female.

A recent study by the National PACE Association found that the top diagnoses among PACE participants are vascular disease, diabetes with chronic complications, congestive heart failure, and chronic obstructive pulmonary disease, and major depressive, bipolar and paranoid disorders. Nearly 47% of PACE enrollees have dementia.

All prescription and non-prescription drugs deemed necessary by the PACE interdisciplinary care team are paid for by the PACE program.

When a person enrolls in PACE, he or she is assigned a primary care physician who is part of an IDTeam skilled in treating the problems of the aging. This primary care physician works with other members of the team to coordinate all services a member receives. In some circumstances, participants may be able to visit a former primary care physician when approved by the PACE IDTeam. Additionally, participants may continue to receive care from their speciality providers if deemed necessary by the IDTeam.

The goal of PACE is to keep participants out of a nursing home as long as possible. If at some point it is in the best interest of the participant to receive care in a nursing home, PACE will pay for the care, and medical oversight by the interdisciplinary team will continue.

Consult the National PACE Program Locator on the National PACE Association website to determine if PACE is available in the area in which you reside. Contact PACE plan so they can schedule a home visit with you and your caregiver to tell you more about their plan. Attend a tour of the PACE site with your family/caregiver(s). The PACE plan will then schedule a complete medical and social assessment for you by their interdisciplinary team.

You can only enroll in one Medicare health plan. PACE health plans are both Medicare providers and long-term care providers. By enrolling in a PACE health plan you will be automatically disenrolled from your current Medicare/HMO.

Focusing on a single aspect of care does not provide the participant with the best chance of remaining independent in the community. Upon enrolling in PACE, the Interdisciplinary Team develops an individualized plan of care to provide the participant with a comprehensive health and wellness plan, integrating a variety of services.

A PACE participant is free to disenroll from PACE and resume their benefits in the traditional Medicare and Medicaid programs at any time.