PACE program: A More Humane Model for Eldercare in the U.S.

To help improve services for these patients, we analyzed the design and implementation of a national program called PACE: Program of All-Inclusive Care for the Elderly. We focused on this program because all PACE participants are vulnerable: They require nursing home–level care, and 90% are eligible for both Medicare and Medicaid. Few integrated-care programs serve this dual-eligible population, which now numbers 12.5 million Americans.

In-depth interviews with PACE staff and program participants conducted by two of us (Len Berry and Sunjay Letchuman); collaborations with PACE leaders, including two coauthors of this article (Mary Kummer Naber and Peter Fitzgerald); and our collective analysis of the features and daily operations of a PACE model in southeastern Michigan (led by Mary) reveal how PACE successfully delivers individualized, home-centered care to poor older adults while lowering overall costs. Given that PACE currently serves only about 60,000 of these patients, expanding the program has useful management and cost implications for health care systems nationally. Although nursing home and other institutionalized elder care clearly demand improvement, the United States also must invest in reimagining what elder care can be. PACE provides a roadmap.

More Comprehensive, Less Costly Care

The PACE program, first developed in San Francisco in 1973, is a comprehensive, integrated, community-based care model that lets older adults continue to live at home as long as possible. There are now 150 PACE programs in 32 states. The basic philosophy is that care should include what matters most to older poor people: all-inclusive care comprising nutrition, social interaction, transportation, and home upkeep, in addition to medical and related services. The goal is to treat patients with dignity as they safely live at home, rather than in an institution, and receive every needed service from one entity — all while lowering costs.