Program of All-inclusive Care for the Elderly (PACE)

What is PACE?

PACE stands for Program of All-inclusive Care for the Elderly. It is an innovative Medicare program that provides frail individuals age 55 and older comprehensive medical and social services coordinated and provided by an interdisciplinary team of professionals in a community-based center and in their homes, helping program participants delay or avoid long-term nursing home care.

Each PACE participant receives customized care that is planned and delivered by a coordinated, interdisciplinary team of professionals working at the center. The team meets regularly with each participant and his or her representative in order to assess the participant’s needs. A participant’s care plan usually integrates some home care services from the team with several visits each week to the PACE center, which serves as the hub for medical care, rehabilitation, social activities and dining.

Who is eligible to participate in PACE?

To participate in PACE, an individual must be 55 years of age or older, require nursing home level of care but be able to live safely in the community at time of enrollment with the services of PACE, and reside in the service area of a PACE organization. PACE participants may disenroll from the program at any time and for any reason and those with Medicare or Medicaid who disenroll will be assisted in returning to their former health care coverage.

What services are provided through PACE?

PACE provides its participants with all services covered by Medicare and Medicaid, without the limitations normally imposed by these programs. It also provides any other services deemed necessary by the interdisciplinary team that would allow program participants to remain in the community.

Services provided by PACE include, but are not limited to, primary care (including doctor, dental and nursing services), prescription drugs, adult day health care, home and personal care services, nutrition services, and hospital and nursing home care if and when needed. Transportation to and from the center and all off-site medical appointments is also provided.

Who pays for PACE?

PACE agencies receive a set amount of Medicare and Medicaid funds each month to ensure participant care, whether services are provided in the home, community or in a nursing home setting. This capitated funding arrangement rewards providers who are flexible and creative in providing high quality care and gives them the ability to coordinate care across settings and medical disciplines. The program also accepts participants who pay privately.

When did PACE come to New Jersey?

Two PACE agencies began operating in New Jersey in 2009. PACE is currently offered in 65 markets nationally and has been in development in New Jersey since 2004, when the Department of Health and Senior Services (DHSS) received a grant from U.S. Centers for Medicare and Medicaid Services (CMS) and technical assistance from the National PACE Association to study bringing the program to the state. Besides funding feasibility studies to determine the best locations for PACE, the National PACE Association award provided education for state staff, and outreach to communities and potential providers. The PACE model was developed in San Francisco in the 1970s as ON LOK, the Chinese-American community’s alternative to nursing home placement. It was formally established by CMS as a permanent Medicare Advantage option in 1997.

Is PACE available in my community?

Two PACE agencies are currently operating in New Jersey and you must live in their coverage area to participate. Those centers are:

• LIFE (Living Independently For Elders) St. Francis, operated by St. Francis Medical Center. The center is located in Hamilton Township and has been approved by CMS to serve individuals who reside in Mercer County or in Bordentown, Florence, or Roebling in Burlington County. LIFE St. Francis was developed, in part, with a grant from the NJ Health Initiatives Program of the Robert Wood Johnson Foundation
  
  
• LIFE at Lourdes in Pennsauken, operated by Our Lady of Lourdes Medical Center. It serves individuals residing in most Camden County communities.

DHSS staff members are currently working with nonprofit and public healthcare administrators to establish additional PACE markets throughout the state.

How do I get more information on PACE?

Call the New Jersey Division of Aging and Community Services toll-free at 1-800-792-8820 or contact the two PACE agencies currently in operation:

• LIFE St. Francis: 609-599-5433
• LIFE at Lourdes: 856-675-3355

Additional information can also be found on the National PACE Association website at http://www.npaonline.org or the CMS website at http://www.cms.hhs.gov/pace.

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