Meet the underdog of senior care

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Meet the underdog of senior care

Felicia Bitranta was struggling when, five years earlier, she enrolled in a PACE program run by Lutheran Senior Life in Jersey City, NJ.

Due to the stroke, he found it difficult to eat without choking. She used to fall frequently; His diabetes was out of control; He had lung disease and asthma. She may miss a medical appointment if she cannot afford or arrange a taxi. His family lived far away.

In short, she was a nursing home candidate. But such a move is exactly what PACE – the Program for All-Inclusive Care for the Elderly – was designed to prevent.

“The main goal is to place people in age,” said Maria Ivarone, executive director of the PACE program, which Ms Bitranta attended. “No one wants to leave their house. It’s where you’re most comfortable. It’s where you should be.”

Ms Biteranta now receives all of her health care through Pace, who supervises her along with 120 other seniors. Pace also provides the majority of her social life.

“Here, they schedule you for appointments,” said Ms Bitranta, 74, a retired nurse. “They send someone to pick you up and bring you home.”

Carpal tunnel syndrome in her wrists and arms makes personal care and household chores difficult, so Paes sends a colleague to her home 12 hours a week. “She cleans and does my laundry and shopping,” said Ms. Bitranta. “She knows the food I like.”

Paes provided the portable oxygen unit that freed him from dependence on the large oxygen tank he used at home. This arranged for cataract surgery and regularly took her to a podiatrist, a cardiologist, an endocrinologist, and other specialists. It provides many medicines at no charge, including asthma inhalers and diabetes-testing supplies. A staff social worker helped her apply for an apartment in a subsidized building for senior citizens and move.

As a Medicaid beneficiary, she pays nothing for this care—no co-pays, deductibles, or other out-of-pocket care expenses, and no cap on benefits. Whether it will require more home care hours or, eventually, a nursing home, PACE will cover those costs as well.

“It’s worry-free,” said Ms Bitranta, who was preparing to have lunch at the Pace Center, as she spoke. “They care for me.”

Yet both the state and central government save money. PACE programs receive a set amount monthly from Medicare and Medicaid, which provides almost everything for people over age 55 whose needs qualify them for a nursing home, but who enter a nursing home. don’t want to. This includes doctor visits, tests, procedures, physical, occupational and speech therapy, social workers, home care, transportation, medicine, dentistry and hearing aids. Participants typically visit a PACE center like in Jersey City several times a week for food and social activities as well as medical and health monitoring.

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The National Pace Association said monthly payments are on average 15 percent lower than Medicaid, which will primarily pay for care for low-income seniors.

Research has shown that PACE programs reduce hospitalizations, emergency room visits, and nursing home stays. Participants in less extensive programs live longer than similar patients. A study last year by the federal Department of Health and Human Services called the PACE program “consistently ‘high-performing’ as detracting from our analysis.”

Why, then, do so few PACE programs exist – and enroll so few older Americans? Nearly three decades after Medicare and Medicaid funded PACE programs—today, there are 144, with 272 centers operating in 30 states—the effort collectively serves less than 60,000 people, the National PACE Association reports.

The association estimates that 1.6 million Medicare beneficiaries may meet PACE eligibility requirements. As the list of current programs shows, however, 21 states have no PACE program, and 11 have just one.

Professionals with great care are fans. “Every geriatrician likes this model,” said Mark Latch, MD, co-chief of geriatrics and palliative medicine at Weill Cornell Medicine.

Experts like Dr. Latch have complained for years that traditional Medicare would cover expensive surgery to repair broken hips, but would not pay for installing inexpensive grab bars that could prevent falls. With PACE’s fixed payments, “the money may be short, but you spend it the way you want without coming over the phone for the insurance company’s approval,” Dr. Latch said.

For example, at the ArcCare PACE program in New York City, “if a person’s air-conditioner breaks during a heat wave, we replace it,” said Walid Michelen, the program’s chief medical officer. “If a blizzard comes and they need food, we send it.”

With coordinated care and close observation, “you survive a urinary tract infection before you get sepsis,” said Jay Luxenberg, former chief medical officer of the On Lok PACE program in San Francisco. “Or pneumonia when it can still be treated by antibiotics before you desperately need a hospital.”

Yet development has been slow. “We’ve had a lot of headwinds over the years,” said Sean Bloom, the association’s chief executive officer.

Persuading state legislators to expand PACE enrollment or authorize new programs has proven challenging; Such moves represent new expenditures, even though they ultimately reduce costs.

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For individuals, the enrollment process—which includes a state assessment to determine whether their medical condition, cognitive status, and functional limitations would warrant a nursing home—can take weeks. A family that needs great care may be unable to wait.

In addition, agreeing to receive all health care from PACE often means leaving it to their personal physician, and some patients hold on to that demand. Programs can avoid that hurdle by allowing PACE programs to work with community practitioners.

But potential patients may not be aware of PACE at all. “We’re trying to raise awareness, but we don’t have the ‘Mili Milk? Budget,'” Mr. Bloom said.

Still, the pandemic has intensified the desire of older Americans for alternative forms of long-term care. “If people didn’t want to be in nursing homes before Covid, they really don’t want to be there anymore,” Dr. Latch said. According to the association, COVID deaths among PACE participants accounted for nearly a third of nursing home residents.

So PACE continues to grow, with 45 new programs expected to begin enrollment over the next two years, partly due to higher federal incentives. In addition, for-profit companies are beginning to establish or acquire PACE programs, although skeptics worry that for-profit status will reduce quality.

Several bills introduced in Congress would remove barriers to development; one will partner with Veterans Affairs Hospitals to make Pace more accessible to veterans.

Another interesting possibility: encouraging middle-class patients, for whom the cost of even long-term care can be devastating, to enroll in PACE. Older adults who aren’t poor enough to qualify for Medicaid may already participate, but some do because their monthly premiums will be higher — in many states, $4,000 to $5,000 per month. Month.

But it’s still less than what’s paid for nursing homes or assisted living in many places. Policy analysts are looking at ways to reduce costs and expand PACE eligibility to the middle class.

In Jersey City, Ms. Bitranta is doing well, though she misses concerts, Zumba classes, birthday parties and other events at the PACE Center. Administrators curbed such activities during the pandemic, but expect them to be reinstated as COVID rates drop.

“Oh, my God, I’ll be so sad,” said Ms. Bitranta, without a pace. “It gives me a life.”

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