In early November I was invited to tour the Sacramento, California PACE operation. PACE is an acronym that stands for Program of All-inclusive Care for the Elderly. I had heard of PACE and had even toured a PACE operation in San Diego during an aging services conference back in 2017. Its comprehensiveness had impressed me at that time so I was eager to see a different PACE center in a location not far from my home in northern California.
What triggered my interest this time around was an offer to connect with InnovAge, a company whose entire mission is to launch and manage PACE programs. After speaking by phone with representatives of the company, I was heartily impressed by the InnovAge mission and anxious to see their operation nearest to me, which turned out to be Sacramento.
What is PACE and Who does PACE serve?
In the words of Patrick Blair, InnovAge CEO, “Our mission is to empower seniors to age safely with dignity and autonomy. PACE goes beyond delivering care; it’s about addressing the full spectrum of participants’ needs, from providing medical care and activities at our day centers to in-home assistance. Through a dedicated interdisciplinary team and a holistic approach, we support our aging population’s ability to thrive at home and within their communities.”
PACE provides comprehensive medical and social services to frail, older adults in the community. Most participants are eligible for Medicaid and/or Medicare benefits. The program enables these individuals to remain in their homes in the community rather than receive care in a nursing home.
InnovAge often helps eligible seniors apply for long-term care Medicaid. Many participants have been poor all their lives, others may have spent down all of their assets. They also must be able to live independently and have stable housing of some kind, which could be an apartment of their own, shared housing, or a bedroom in a relative’s home.
How PACE operates
PACE started in the 1980s as an adult day program through On Lok in San Francisco. For over 40 years PACE has supported thousands of low-income seniors across the country, helping them remain independent at home.
PACE Eligibility
Individuals who qualify on the basis of income can join PACE if they meet certain conditions:
● Age 55 or older
● Live in the service area of a PACE facility
● Be able to live safely and independently in the surrounding community
PACE and InnovAge in Sacramento
The first thing I saw when I got out of my car in Sacramento was a fleet of buses, waiting to shuttle PACE members from their homes in the service area to the PACE facility on the southwest side of Sacramento. Those buses also serve to transport participants to appointments with specialists outside the PACE community. They are equipped with wheelchair lifts and offer all standard safety features of mass transport vehicles.
At the PACE center in Sacramento, which opened in 2020, I witnessed a high-functioning upbeat operation. InnovAge has provided a beautiful building, perfectly adapted to the needs of the PACE users as well as the staff. The day I visited, I would estimate there were between 60-75 people receiving services of one kind or another. Every PACE program includes a balanced hot breakfast and lunch for participants.
InnovAge had beautifully repurposed an existing building to include a meandering central hallway with handrails along all of the walls, and no square corners. This unique adaptation was in the interest of keeping clients with early stages of dementia from getting confused, which happens more often in building interiors with lots of corners to navigate.
I toured four large and very different day rooms: one used as a game room, with pool and Ping-Pong tables as well as other gaming equipment, another was being used as an entertainment and information center, and another had large round tables set up for activities guided by physical and occupational therapists. I was there in mid-morning and there were 40-50 participants chatting and working at crafts and other fine motor skill activities. The fourth activity room was hosting a bible study group.
As we wandered counterclockwise through the flowing hallways of the circular interior of the building, we stopped to look in on a dental clinic, a physical therapy studio, a small gym, a medical clinic, and a variety of counseling offices and meeting rooms. Social workers make themselves available to participants to help with administrative tasks that they find too confusing or cumbersome to tackle alone (e.g. tax forms, medical forms, statements of income).
The government charter for PACE requires every program to have a “participant’s advisory committee,” consisting of a president, vice president, secretary and treasurer. Participants are nominated by fellow members and voted on by the PACE participants themselves. InnovAge has facilitated that process and helps with the annual election and voting process.
InnovAge
InnovAge began in 1989 as a not-for-profit organization. They are now a public corporation whose mission is to allow seniors to live life on their own terms – by aging in place, in their own homes and communities, for as long as safely possible. The primary way they do that is through their PACE communities. InnovAge has committed their efforts to expand PACE to serve more seniors in more communities. They currently have 20 PACE communities. Every year InnovAge has to demonstrate to the federal and state regulators that they are meeting all requirements to run each of their PACE programs.
InnovAge hires a team of a minimum of eleven healthcare professionals to serve each participant in their programs. These professionals focus on providing the connected care the participants need to remain independent and stay out of nursing homes. These professionals assess the health needs of everyone in the program. They subsequently prepare a personalized care plan that may include primary care, social support, physical and occupational therapy, dietary support and more. The average PACE participant receives around $100,000 per year in services, which InnovAge bills to Medicare and Medicaid.
“PACE allows us to provide care that is tailored to each individual, addressing not just their medical needs but also their social and emotional well-being,” said InnovAge Chief Medical Officer Dr. Richard Feifer. “The results are clear that by combining proactive care with a personalized approach, we can significantly improve seniors’ overall well-being and help them maintain independence longer.”
Why aren’t PACE programs everywhere?
Seeing such a successful program in operation, I couldn’t help but wonder why PACE seems to be the best kept secret in aging services. I learned that the biggest impediment is getting the individual states to adopt it. Without state support (Medicaid dollars are administered by each state independently), PACE is not viable.
State support is not the only impediment to starting a PACE program. Lots of up-front capital is required to put together the infrastructure and maintain it until critical mass is reached and the operation is self-sustaining. Sign-ups can be slow at first, one patient at a time, and each enrollee has to be qualified through the state’s approval process. All of it takes time.
InnovAge operates PACE programs in California, Colorado, Florida, New Mexico, Pennsylvania, and Virginia. Some were started by InnovAge, others were acquired. Each PACE center has a specific service area and an applicant must live within the service area to qualify for the services.
Another challenge for InnovAge and other entities that run PACE programs is that they do not and cannot support the homeless in their service areas. The charter for PACE programs is that they are strictly for those who have a stable living environment. For that reason, many PACE programs have partnered with organizations that provide housing for low-income individuals. InnovAge has gone beyond that in Colorado, where they own a senior living facility. These facilities are not formally affiliated with InnovAge PACE, but that doesn’t prevent them from partnering in cases where individuals qualify for PACE services.
The PACE program, particularly as implemented by InnovAge, represents a vital service for seniors, allowing them to receive necessary care while remaining in their communities. The model prioritizes independence and offers a comprehensive approach to health and social services, which is essential for many low-income older adults. The success of such programs highlights the need for broader adoption and support at the state level to ensure more seniors can benefit from these services.
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