PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) - AN INNOVATIVE MODEL OF INTEGRATED GERIATRIC CARE AND FINANCING

OBJECTIVES: The Program of All-inclusive Care for the Elderly (PACE) i s a long-term care delivery and financing innovation. A major goal of PACE is prevention of unnecessary use of hospital and nursing home car e. SETTING: PACE serves enrollees in day centers and clinics, their ho mes, hospitals and nursing homes. Beginning at On Lok in San Francisco , the PACE model has been successfully replicated across the country. In 1995, PACE was fully operational in 11 cities in nine states. PARTI CIPANTS: To enroll in PACE, a person must be 55 years of age or older, be certified by the state as eligible for care in a nursing home and live in the program's defined geographical catchment area. PACE partic ipants are ethnically diverse. In 1995, the average PACE enrollee was 80.0 years old and had an average of 7.8 medical conditions and 2.7 de pendencies in Activities of Daily Living. A significant number have bl adder incontinence (55%). Many enrollees (39%) live alone in the commu nity, and 14% have no means of informal support. INTERVENTION: Medicar e and Medicaid waivers allow delivery of services beyond the usual Med icare and Medicaid benefits. The PACE service delivery system is compr ehensive, uses an interdisciplinary team for care management, and inte grates primary and specialty medical care. PACE receives monthly capit ation payments from Medicare and Medicaid. Patients ineligible for Med icaid pay privately. RESULTS: Outcomes of PACE programs have been posi tive. There has been steady census growth, good consumer satisfaction, reduction in use of institutional care, controlled utilization of med ical services, and cost savings to public and private payers of care, including Medicare and Medicaid. However, starting up a PACE program r equires substantial time and capital, and the model has not yet attrac ted large numbers of older middle income adults. CONCLUSION: The growi ng number of older people in the United States challenges healthcare p roviders and policy makers alike to provide high quality care in an en vironment of shrinking resources. The PACE model's comprehensiveness o f health and social services, its cost-effective coordinated system of care delivery, and its method of integrated financing have wide appli cability and appeal.