Elderly can benefit from PACE programPublished 5:35pm Monday, November 26, 2012
PACE stands for Program of All-Inclusive Care for the Elderly.
Launched in September as the fifth such program in Michigan and a partnership between Lakeland HealthCare, Area Agency on Aging and Hospice at Home, PACE, of St. Joseph, serves Berrien County, Dowagiac, Cassopolis and Edwardsburg in Cass County and Decatur, Hartford and Lawrence in Van Buren County.
A person qualifies for PACE if he or she is 55 or older, eligible for nursing-home-level care as determined by the State of Michigan and able to live safely in the community.
The agency provides all Medicaid and Medicare services the PACE team recommends and authorizes, which could include hospital care, transportation, nursing home care and therapy.
PACE of Southwest Michigan receives payments from Medicare/Medicaid, if applicable, to cover participants’ expenses.
Most people who have both Medicare and Medicaid pay nothing more for the program.
Once enrolled in PACE and Medicaid eligible, if you are admitted to a nursing facility, you may be liable for a patient pay amount as determined by the state.
A PACE participant may be fully liable for the cost of medical services from an out-of-network provider or without previous authorization (except for emergency services).
On average, participants attend the day center two to three days a week. However, many people attend one day per week, some every day. Day center attendance hinges on individual need. PACE provides transportation to and from the center, as well as to all other medical appointments authorized by the care team.
Even though PACE’s goal is to work with people lifelong, participants are able to “disenroll” and resume care in regular Medicare and Medicaid programs.
To enroll, call PACE at (269) 408-4322 and ask for intake coordinator Sarah McNees, a 2004 Buchanan graduate who attended Grand Valley State University and then the University of Michigan for her master’s degree. She previously worked in Grand Rapids and Detroit.
McNees arrived at Niles-Buchanan Rotary Club Monday noon at Riverfront Café from Cassopolis to talk about the program.
Nationally, the PACE model of helping clients stay in their homes as long as possible has been around for 30 years, she said.
“For older adults, it takes one bladder infection or one fall. Any little thing left unchecked can spiral a person’s condition and, suddenly, we’ve got a much bigger situation. We provide coordinated health care, including access to a physician more rapidly than in the traditional setting. They’re also coming for skilled physical therapy. The really exciting thing about this program is the model is a little bit different than our normal health care model.”
“We receive capitated, or lump-sum payments, from insurance companies,” McNees said. “We’re not fee-for-service, which means creativity and flexibility in how we spend our dollars. We focus on prevention.
“Even if someone is able to age in their own homes,” the social worker said, “older adults’ social sphere is dwindling. Their brothers and sisters are not with us anymore and they’re not seeing as many people to keep them engaged mentally and physically. They can go home and tell their son or daughter about their routine. The program also provides in-home chore service. We’re set up for long-term care. We can provide palliative care and hospice services, but we can come in a lot sooner than hospice.”
PACE has a capacity for 200 participants.
“We contract with two Lakeland physical therapists and local agencies that provide home care services,” McNees said. “We’ve created 17 jobs since opening in September. At our peak, in three years, we’ll have 53 fulltime jobs.”