Long Term Care Solution? PACE Program

[Acechamp]

Hello, I came across this long-term care program. It appears to be all inclusive as the name implies (PACE - program for all inclusive care for the elderly) and is a one stop solution. It takes significant burden off of family and caretakers.

The program seems really interesting as a potentially viable solution to long-term care. it’s connected to Medicare and is also open to Medicaid members at no cost. Medicare participants pay roughly $4000-$5000 per month for in-home care and also includes medical care and prescriptions. they refer to the payments as premiums, but this is not a prepaid plan. The payments are made only while the participant is actively in the program.

The goal is to allow nursing home eligible patients to remain in their homes if possible until the end of life. there are about 30+ states participating in the program and each state determines its own criteria for what is nursing home eligible. It aims to manage all care and relieve caretakers of that huge responsibility, while still allowing them to participate in the care and decisions. Sounds almost too good to be true...

Has anyone else heard of it or had any experience with it? It would be great if we could gather input and comments here to validate if and when this may be a good solution, given the seriousness of our long-term care crisis. I’ve watched a handful of videos, here are a couple that were helpful. Thanks!

https://youtu.be/HHv5wmaEZY0?si=ATmCSdtgHUfAiOB0
https://youtu.be/Lyc_y1F5DPs?si=YWjMkx8ENWnWuF6t

[JBTX]

This is interesting. Worth noting if you enter the program you are exiting traditional Medicare and PACE provides all medical care, not your regular providers. You can leave the program and go back on Medicare, but I wonder if you get get back on Medicare supplement without going through underwriting - which I don’t think you can do if you choose Medicare advantage and wish to switch to traditional Medicaid.

[Ret2018]

Hello, I came across this long-term care program. It appears to be all inclusive as the name implies (PACE - program for all inclusive care for the elderly) and is a one stop solution. It takes significant burden off of family and caretakers.

PACE progams have been around for many years, and work very well for some Medicare and Medicaid beneficiaries. And as you note, it can provide some relief for families and caregivers, but typically only during the day. A couple of things to know about PACE:
-You do not "leave" Medicare or Medicaid when you enter a PACE program. You retain your original coverage. Healthcare services are "bundled" and paid differently, but you keep your Medicare/Medicaid. It is somewhat similar to a Kaiser type HMO, in which all care is provided by one system.
-PACE programs serve a specific geographic area. You can only participate in the program if you reside in that area.
-All the PACE progams I'm familiar with rely on a day program model, in which the participant is typically picked up by a van and transported to a center. None of the PACE progams I have looked at provide long term in-home services such as personal care assistants.
-PACE is primarily designed for Medicaid beneficiaries. You must meet nursing home level of care criteria (as assessed by a state--usually Medicaid--evaluator) to enroll. However, because of the reliance on the day program model, those who enroll typically are at the higher end of functioning (cognitively and physically) for nursing home residents.

And a warning--like everywhere else for-profit actors have entered the space. If you're considering a PACE program, I would only go with an established, non-profit provider. Honestly, the only way I can imagine making a profit on these programs (if relying solely on Medicaid/Medicare payments) is by cherry-picking clients and warehousing seniors. Some good providers have dropped PACE programs because of the increasing costs and complexities of elder care.