April 2, 2020

Medical Update Spring 2019

Support for Seniors at Home
How PACE programs are helping families care for loved ones


As the population continues to age and millions more Americans suffer from dementia each year, the health care system is feeling the strain of caring for older adults. One solution is a 40-year-old federally- and state-regulated program called Program of All-Inclusive Care for the Elderly (PACE).

“Assuming they aren’t going to cure dementia anytime soon, something has got to give,” says Dr. Kate Robichaud, a family medicine physician and Medical Director of the Sentara PACE program. “If we could expand PACE or the concepts of PACE out to the larger community, that would be a good step toward solving this problem.”

What is PACE?
PACE provides comprehensive support to help seniors stay in their homes instead of moving into nursing facilities. These programs serve as both health care provider and payor for the participants enrolled and offer numerous services through their adult day care centers, which are staffed by PACE physicians, social workers, therapists, nurses and more.

“It’s the entire system coordinated in one place,” Dr. Robichaud says. “It allows us to really wrap our care around a person, while acknowledging and respecting his or her age and disabilities.”

PACE programs provide transportation to and from day centers, where participants can receive medical services that may include:

• Dental care

• Nutritional counseling

• Durable medical equipment 

• Exercise programs

• Hearing services

• Lab tests, X-rays, and other tests

• Pharmacy services

• Physical, occupational, and speech therapy

• Primary care office visits

• Psychiatric care and counseling

• Social work services

• Vision care

Additionally, participants are given a meal and snacks and are able to socialize and engage in recreational activities. If a participant needs specialty care, PACE staff can arrange and provide transportation to those appointments.

“The primary goal is to provide the services for families to keep their loved ones at home,” says Dr. Robichaud. “But it’s not just about keeping them at home; it’s about balancing the quality of the life for the family and the participant themselves.”

Hampton Roads is home to two PACE programs. The Sentara PACE program, run by the Sentara Life Care Corporation, has day centers in Norfolk and Portsmouth. InnovAge, a nationwide PACE provider, has a center in Newport News. Combined, these two programs serve almost the entirety of Hampton Roads.

Eligibility for PACE Programs
Qualifications for the PACE program are set by the Centers for Medicare & Medicaid Services. Participants must be:

• Aged 55 or older

• Able to live safely in the community

• Living in a service area currently served by a PACE program

• Qualified for nursing facility level of care as certified by Virginia’s Department of Medical Assistance Services (DMAS)

Kate Robichaud, MD

Dr. Robichaud says over half of the participants in Sentara PACE have dementia. The program also serves patients with a mental illness such as schizophrenia, or an intellectual disability such as Down syndrome.

The Benefits of PACE Programs
The coordinated, comprehensive care that PACE programs provide allow more seniors to stay at home, while decreasing fall rates and improving vaccination rates. 

The programs also represent a cost-savings for both families and the healthcare system. Nationwide, InnovAge’s PACE participants have an average of less than one emergency room visit per year, and a hospital readmission rate of just 16 percent. By staying at home, these patients also spend less on care than they would in nursing facilities.

For primary care physicians in the community, PACE also provides an opportunity to ensure some of the most complex patients receive the right care for them. PACE provides far more coordination than a primary care physician can offer alone.

“Having been a primary care physician in the community for 15 years, I remember having patients that I just felt weren’t getting the services they needed, because logistically it was too overwhelming for them to coordinate,” Dr. Robichaud says. “These patients need a whole lot more than just my medicine and oversight; they need socialization and dignity in taking care of their day-to-day needs. It’s a relief to families and the community that PACE can provide that.”

The Future of PACE Programs
Though PACE programs have existed for 40 years, rollout of these programs has, until recently, been slow. While programs exist in 31 states, they only care for about 45,000 seniors.

In an effort to fuel program expansion, Congress recently updated some PACE regulations. For instance, nurse practitioners now can serve as primary care providers, and PACE participants have the option to see a community physician as their PCP.

“We are governed by CMS, DMAS, and local community boards that oversee day centers,” says Dr. Robichaud. “There are a lot of regulations we have to adhere to, so improving flexibility is going to be key to expansion.”

Population density also presents limitations. While rural communities may be home to seniors who qualify, arranging transportation to a day center can be too difficult. However, PACE programs are even seeing expansion in these sparse areas. Recently, Sentara PACE began serving residents in Surry, Franklin and Isle of Wight County. 

InnovAge, meanwhile, has grown nationally. Since 2017, the company has expanded into Virginia and now operates four PACE centers in the state; it also offers programs in four other states. As the nation’s largest PACE provider, InnovAge understands how to develop programs within regulation requirements, which can be one of the most challenging aspects of opening a new center.

PACE is just one piece of the larger senior care puzzle, but with proper nationwide expansion, it could help provide the relief that participants, families and the healthcare system need.