PACE, the Program for All-Inclusive Care for the Elderly, is a national comprehensive health care program that enables eligible seniors to continue living at home as long as possible. This program provides valuable community based care and services to seniors who otherwise need nursing home level of care. Services can be provided at home, an adult day health center, and/or inpatient facilities. An interdisciplinary team of doctors, nurses and other health care professionals assess the participant’s needs, develop care plans and deliver all necessary services which are integrated for a total health care plan.
PACE provides all the care and services covered by Medicare and Medicaid. The program also offers additional medically-necessary care and services not covered by Medicare and Medicaid based upon the various medical, social and rehabilitative needs of the participant. The individualized care plans customized by the PACE program are designed to preserve or restore the participant’s independence, remain in his or her home and community and to maintain his or her quality of life.
In order to be eligible for PACE, applicants must be at least 55 years of age, live in a PACE service area, must be certified as eligible for nursing home care by the state (must require help with two “activities of daily living” and at least one “skilled nursing” need), and must have the ability to safely remain in the community with the additional medical and support services offered by PACE. For eligible individuals, the PACE program becomes the sole source of health care services for eligible enrollees.
Interdisciplinary teams of doctors, nurses, social workers, therapists, nutritionists, personal care attendants, and other medical staff work together to provide all needed medical and supportive services to maximize a participant’s ability to remain in his or her home for as long as possible. Care and services include: primary medical care, home health care, adult day health, rehabilitation services, nursing services, hospital care, restorative therapies, personal care and supportive services, nutritional counseling, recreational therapy, meals, transportation, medications, podiatry, optometry, dental, social services, and anything else the program determines is medically necessary to improve and maintain the participant’s overall health. Services are available 24 hours a day, 7 days a week, 365 days a year. Generally, the majority of PACE services are provided at an adult day center, but these services may be provided in the home when appropriate. If the time comes when nursing home placement is necessary, PACE would pay for the nursing home costs and would continue to supervise the member’s care, so long as the member resides in a PACE facility.
PACE providers receive monthly Medicare and Medicaid capitation payments for each eligible participant. Medicaid presently pays $3,497 per member per month, with the Medicare rate dependent on the diagnosis codes of each member.
If the participant meets the financial eligibility requirements for Long–Term Care Medicaid, the program pays for a portion of the monthly PACE premium. For married couples, only the income and assets of the participant are countable. Participants cannot have more than $2,000 in countable assets. The income limit is three times the federal SSI benefit amount. In 2010, the federal SSI benefit amount is $674 per month. Thus, for participants with monthly income of $2,022 or less, there is no monthly spend-down and the participant can keep the entire $2,022. For participants whose income exceeds $2,022 per month, there is a monthly spend-down to $542 to establish eligibility. Participants with monthly income over $4,039 would pay privately, while participants with income below $4,039 would apply for Medicaid in order to keep the $542 monthly. Private pay participants are only charged the monthly premium Medicaid would pay, or $3,497 per month.
In the PACE program there is never a deductible or co-payment for any drug, service or care approved by the PACE team. PACE providers assume full financial risk for participants’ care without limits on amount, duration, or scope of services a participant may need.
LIST OF PACE PROGRAMS IN MASSACHUSETTS
PACE is not available in all cities and towns. Currently, there are only six PACE programs in Massachusetts, each covering a different geographic area.
- Elder Service Plan of the Cambridge Health Alliance
270 Green Street
Cambridge, MA 02139
Web site: Elder Service Plan of the Cambridge Health Alliance
Allston, Chelsea, Arlington, Everett, Brighton, Malden, Cambridge, Medford, Charlestown, Somerville
- Elder Service Plan of the East Boston Neighborhood Health Center
10 Gove Street
East Boston, MA 02128
Web site: Elder Service Plan of the East Boston Neighborhood Health Center
East Boston, Revere, Winthrop
- Elder Service Plan of Harbor Health Services
2216 Dorchester Avenue
Dorchester, MA 02124
Web site: Harbor Health Elder Service Plan
Avon, Brookline, Hyde Park, Norwood, Sharon, S. Boston, Canton, Kenmore, Quincy,
Stoughton, Braintree, Dedham, Mattapan, Randolph, West Roxbury, Brighton,
Dorchester, Milton, Roslindale, Weymouth
- Summit ElderCare of the Fallon Community Health Plan
10 Chestnut Street
Worcester, MA 01608
800-698-7566 (TTY: 800-439-2370)
Web site: SummitElderCare
All towns in Worcester County, Hudson, Marlboro
- Elder Service Plan of the North Shore
37 Friend Street
Lynn, MA 01902
Web site: Elder Service Plan of the North Shore
Beverly, Ipswich, Marblehead, Salem, Wakefield, Danvers, Lynn, Middleton, Saugus, Wenham, Essex, Lynnfield, Nahant, South Hamilton, Gloucester, Magnolia, Peabody, Swampscott, Hamilton, Manchester, Rockport, Topsfield
- Upham’s Elder Service Plan
1140 Dorchester Avenue
Boston, MA 02125
Web site: Upham’s Elder Service Plan / PACE
Boston (area codes 02108, 02109, 02110, 02111, 02114, 02115, 02116, 02210), S. Boston, Brookline, Dorchester (area codes 02121, 02122, 02124, 02125), Hyde Park, Jamaica Plain, Mattapan, Roslindale, Roxbury
WHY CONSIDER PACE?
PACE is often an ideal solution for seniors and families who want an alternative to nursing home care, but who need skilled and experienced care services to stay at home. The primary goal of the PACE program is to provide each participant with the medical, social and rehabilitative supports needed to remain in the community and out of an institution for as long as possible.
Another benefit of the PACE program is that it is covered by Community Medicaid rather than Long-Term Care Medicaid. This means that transfers of assets are presently not penalized. For those who have not done prior planning and are suddenly faced with the need for long-term care services, PACE may offer a valuable option. In addition, the application process for Community Medicaid/PACE is significantly less cumbersome and tedious than the long-term care Medicaid application.
A PACE participant is free to disenroll from PACE and resume their benefits in the traditional Medicare and Medicaid programs at any time.
This article is only a brief overview of the PACE program. Additional information can be found on the PACE website at www.npaonline.org. Before making any decisions with regard to long term care, it is best to speak with a qualified elder law attorney to help navigate you through the various options.