PACE Aims to Keep Seniors in Their Homes
Providing all-inclusive care for frail seniors so that they can remain in their homes, avoiding nursing home placement. There are currently 62 PACE programs in 30 states.
July 23, 2009 /24-7PressRelease/ -- Article provided by Law Offices of Nancy M. Rice, please visit us at www.riceelderlaw.com
The federal Program of All-Inclusive Care for the Elderly (PACE) is a health care model aimed at allowing the elderly to age in place. PACE provides all-inclusive care for frail seniors so that they can remain in their homes, avoiding nursing home placement. There are currently 62 PACE programs in 30 states. Nationally, PACE is 90 percent successful at keeping individuals out of nursing homes.
PACE operates in specific areas so there is no competition between programs. New Jersey currently has two PACE programs known as Living Independently for Elders (LIFE) at Lourdes Hospital in Pennsauken and at St. Francis in Hamilton. The LIFE at Lourdes facility accepted its first participants on May 1, 2009 and the LIFE St. Francis program welcomed its first participants on April 1, 2009. Additional New Jersey PACE programs are currently in the planning stages.
Services Provided
The goal of PACE is to provide seniors with all-inclusive care so that they can remain in their homes with the support of PACE professionals. PACE provides primary, acute and long-term care. The program focuses on preventive care and wellness; seeking to fix the root source of the problem so that it does not develop into additional problems. For example, if a person has bad teeth and is not eating as a result, he or she is at risk of malnutrition. Providing the person with dentures -- a simple fix -- to make eating easier can prevent a host of issues down the road. PACE covers all medically necessary care including; prescriptions, hospitalizations, day care and home health care. PACE will also cover items like dentures and procedures such as cataract surgery.
The center of the LIFE program in New Jersey is the day care center. The center offers daily activities coordinated by the Recreational Therapist. Breakfast and lunch are provided to center attendees and meals may be sent home for dinner. LIFE can also provide staff to assist participants in their home if necessary. Transportation to and from the center as well as to all scheduled appointments is available through LIFE. Participants can obtain physical, occupational and recreation therapy at the center, and there are also social workers available. In addition, a care provider can be sent to a participant's home on the weekend to help with cooking, cleaning, shopping and other tasks.
One unique feature of the program is that it will provide respite care to cover a caregiver in assisted living situations. This allows the caregiver to take a vacation or have time off for some other reason. Another important service is that participants' medications are monitored to ensure that they are taking medication properly. With electronic monitoring of medications, a family member or nurse will be called if there is a problem.
While the goal is to keep PACE participants out of nursing home care, if such care is required, PACE will pay for the care.
Eligibility and Payment
To be eligible for PACE, individuals must be age 55 or older and be certified by the state to need nursing home care. In addition, they must be able to live in the community safely and live in an area served by PACE. Nationally, the average PACE participant is 80 years old and has 7.9 medical conditions. In addition, the average participant is limited in three daily living activities, and 49 percent of PACE participants have dementia.
For individuals who are dually eligible for Medicare and Medicaid, PACE is 100 percent covered and there are no out-of-pocket expenses. An elder law attorney can help individuals preserve assets while still becoming eligible for Medicaid by spending down assets, creating a Medicaid trust, gifting assets or other strategies.
If a participant is eligible for Medicaid only, the costs are also fully covered and there are no out-of-pocket expenses. If the person is only eligible for Medicare, there are co-pays that must be paid out of pocket, and this can be costly -- into the thousands of dollars. Individuals who are not eligible for Medicare or Medicaid pay out of pocket.
PACE programs, such as LIFE at Lourdes and LIFE St. Francis, act as both medical provider and insurer. As such, PACE's goals are aligned with the patient's goals -- to stay at home, in the community and avoid going to a nursing home. The programs are paid by Medicare and Medicaid, and because of the capitated financing, PACE providers can pay for things that participants need that would not be reimbursable under Medicaid or Medicare. This allows PACE to do more to allow people to remain independent and living in the community. For example, PACE could pay for an air conditioner for a person with emphysema who has trouble breathing in hot weather.
Conclusion
In New Jersey, seniors who have conditions that make them candidates for nursing care now have a way to stay in their homes with assistance from PACE and LIFE. These programs offer seniors comprehensive care that focuses on prevention so that they can live independently with assistance in their homes.
Source: Law Offices of Nancy M. Rice
Website: www.riceelderlaw.com
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