I am thinking of signing my elderly mother up for the PACE program in Southwest Florida as she needs more and more assistance now after having hip and knee surgeries. She lives alone and has very limited support as I do not live within driving distance of her. I was hoping to find someone that has gone through the process and can attest to how well the program works.
Thank you
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Fifty-five years of age or older, At risk of institutionalization, Live in the designated Program of All-inclusive Care for the Elderly service area. Able to live safely in the community, Person would also have to be under the income limit for Medicaid (from what I read)...Medicaid is really for very low income.
I also read that she would have to meet the criteria of meeting definition of needing nursing home care, So medical providers have to say there are certain daily living tasks she can no longer do for herself. I found many good reviews of the program. A few mentioned that you may not be able to use your regular doctors because they have providers that contract with them.
Probably worth applying to see if she meets the income limits and get them to send you info so you understand what she may have to give up or change in regard to drs who contract with them or other things that will be decided by pace because of contracts. Worst case scenario, she has too much income and they say she's not eligible. Won't hurt to try.
So designed to be billed with all participants to be “duals” which means on Medicare and Medicaid for health insurance AND your State comes in to have it be administered via your States Medicaid community based program. The community based Medicaid program is different than Medicaid as health insurance and it pays for costs associated with in-home health care, custodial care type of services that are not ever billable to health insurance. That PACE center will have a lot of billable custodial costs, likely set at a fixed per person rate day rate, that Medicaid pays the the Center. What elders and families very often do NOT realize is that if they go onto community Medicaid over age 55, this program - just like the State Medicaid NH LTC program - has the requirement to attempt to do a recovery of all costs paid by the State on all assets of the elder’s estate. Which for most elders means their home as Medicaid totally allows for them to keep their home as an exempt asset for their lifetime.
So the elderly still living in their home, who goes into a PACE, and is on PACE for whatever # of years is building up a bill every day associated with being on PACE that the State will attempt to recoup. Their Medicaid health insurance costs do not count for the recoup but all the community based Medicaid costs do. What is bad on all this is that Medicaid does not send out a statement of benefits / billing as far as I’m aware for any Medicaid program. Those on Medicaid blithely go along without really knowing what their Medicaid tally actually is. It’s only after they die that their family gets a bill for thousands or hundreds of thousands of dollars supposedly owed by their estate to State from the Medicaid program MERP division or its outside contractor.
And this imho is why that group of participants in the Westbank PACE in New Orleans went to court to have the Medicaid requirement struck down. And it was. You do NOT have to go onto Medicaid to enroll in their PACE program. All the info is on a document linked on their website. All you need is to be on Medicare and meet whatever medical “at need”. There is a copay for those not on Medicaid and it is $2,900 a mo. Not a small amount, kinda in the lower IL range. But I imagine for the demographic for this PACE area which is lots of oil & gas retiree couples (where only 1 needs PACE) & there are quite a few on FEHIB benefits (there is a federal base on the Westbank and it’s retirees), 3K a mo for a safe well run coordinating day program multiple days a week with transportation is not a problem.
If the PACE in your area has Medicaid enrollment as a hard & fast requirement, it’s on you to look at the fine print as to Medicaids recovery aspect.
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The PACE program in San Bernardino, CA. also has all the doctors and dentists at the main facility, as well as breakfasts, lunches, activities, movies, Bible studies, crafts, lots of stuff.
You can get information on PACE through your state’s website by typing the word “PACE” in their search section. You can call the phone number and speak directly to the facility that provides this service. .
PACE is a wonderful program which would cover the entire wellbeing of your mother if she qualifies. However, with regard to all government programs that have to pay out money to help people, these programs have income guidelines that must be followed.
To add to what others have said, it is truly all inclusive care. All needs will be met through the program. You will have a care team including doctors, nurses, social worker, nutritionists, physical therapists, activity coordinator, home care coordinator, chaplin...the list goes on. They coordinate everything. All costs are covered including prescription drugs, incontinence supplies, necessary equipment for the home-anything needed. The social aspect of attending the day care center and daily exposure to the care team is invaluable. Transportation and meals provided.
When the time came for placement, PACE coordinated all that, and remains responsible for oversight of her condition and continued care. We were even provided dedicated sitters 16hrs/day, 7 days/wk at the memory care facility.
I know I'm sharing our experience with this particular program, but the concept of PACE is sound and desperately needed, as navigating, coordinating, and managing this care is daunting at best.
As long as your mom can safely remain at home, PACE will become a partner in her care.
The one by us, Benson Center, stays busy. Was former Catholic Church, now Fully renovated, state of the art senior day center with kitchens, arts n crafts room, mini health clinic, portaXray van. It’s pretty sweet. Has preset population as draws from existing HUD 202 congregate & independent living housing that is also run by Catholic Charities (Christopher Homes, Christopher Inns, what can I say, they are the health care mafia for south Louisiana). They have buses & vans that pick up folks on schedules 2-4 days a week depending on assessment and they bring them to the Benson for almost full day of meals, health screening & activities then take them back to their apts with a hot meal before it gets dark. If they need an actual hospital or clinic appointment, PACE schedules it and takes them to it with an aide. It also has seniors that live in their homes, which vans pick them up from and bring to the center & return home. For all, they are assessed & MUST show to be “at need” for NH level of care but able to continue to live in their community safely (so they have family or others nearby or live with them that enable this to happen & I do think there’s a lot flexibility as to what this means).
All their health care gets co-ordinated through PACE. It has to be the new network for all, including drugs. I think they’re all Tulane or LSU health care system so they have to switch over to care providers to be in PACE system & at LSU/ Tulane. FWIW imo that is likely to be what happens for any PACE anywhere as they are going to need to go “in-network of providers” for care as it’s a way to do cost containment and show some degree of a streamlining of & continuum on services. The nurses & PAs & therapist’s at the PaCE are going to be your moms new entry points; they are going to do the referral to within whatever health science center that PACE center in FL is affiliated with. If your mom does any traveling, being enrolled in PACE could be problematic….. clearly ask on this as it likely runs like MediCARE Advantage does so very narrow network for care providers. Any care outside of the PACE network will be out of network not covered by insurance so $$$$.
For LA PACE once they get beyond centers capabilities, they do referrals to to get a LTC Medicaid bed. That’s the system now in So LA. It’s this or they get into a NH via a post hospitalization rehabilitation admission then stay and file for LTC Medicaid bed. It’s dreadfully hard to get a Medicaid NH bed otherwise.
New network may be an issue for y’all. My mom was real “I wAnT my DoCTor!”, we had MDs in the family, she was used to concierge service before that was even a term. It may take some come to Jesus talks with your mom to get her aboard this type of care if she is unused to it.
The PACE centers in my area reflect their service area. The westbank PACE is more retirees where 1 is at need for a NH. Apparently couple of folks successfully challenged requirement to have to enroll in LA Medicaid. That in fact, all you need is to be assessed to be NH eligible & on Original Medicare, HOWEVER, if not on Medicaid, you have to pay a surcharge of $2,900 a month, required to be paid in full beginning of the month & enrolled in a Medicare Part D program whose formulary used by the health care network at the PACE center.
I like the concept. But it’s not 24/7 oversight. If she needs that & family + paid caregivers realistically cannot provide; then she needs a facility.
The advantage for an assessment is she can get placed in a situation appropriate for her. You do not want to find yourself placing her in a program/facility, spend 2 weeks in FL getting this done, breathe a sign of relief then get a letter 90 days from now that “we love your mom but cannot meet her level of care” and have to come back to FL in the middle of Hurricane season 2023.
In theory on assessments, the PACE should do one, a good AL would do one, ditto for a NH. Really any facility would want one done BEFORE any participation as they want to ensure they can meet the level of care needed. Often that is NOT what happens as they need to make their #’s & make their $$$. But you on your own can get one done & seriously this is what I would recommend. The Area (Council) on Aging for your moms region should have info on Social Workers who have a private practice & do assessments. They are usually a duo of RN & SW and it takes abt 1-2 hrs in person in the elders home. Less opportunity for mom to “show dog” as they will ask her to do an ADL in her home, like “Mrs NoMansLand can you fix us a cup of tea?” And they grade her capabilities. If you are there, you will be asked to be outside so no coaching. As your moms POA you will need to sign off a document to allow this and to allow for them to look at your moms RXs and look at her medicine cabinet. They may want to review her health history as well with you ahead of time (like details as to her hospital stays and surgery)
When I moved my mom years ago from her IL apt to her 1st NH (bypassed AL phase, no rehab phase) she did not get an assessment but her gerontologist was medical director of the NH so her chart was detailed for ICD codes. But when I moved her from NH #1 to NH #2, #2 sent out their in-house assessment duo to moms NH bedside to do onsite assessment to make sure they could meet level of care needed…. like degree to which she could transition from bed to potty, her medication management (she had a compounded RX), etc. They called me from her bedside and I could tell from the sounds of their voices they were 100% happy with having her become a resident, she was an easy care / minimal issues type of resident; and I faxed over a bed hold request that afternoon. Moved her right after the beginning of the next month (to dovetail on Medicaid copays). NH#2 had a care plan ready to go for the day she moved in based on the assessment. It’s stuff like this that makes having an assessment priceless & efficient.
If she lives in a bigger city that has Jewish Family Services, they tend to have a larger Senior program that has assessment services available to anyone in the community with fees based on sliding scale.
Call your local Office of Aging to see what info they have.