PACE

AlzWife2023

Please share your experiences with the PACE program. I've just initiated contact with them. I'll post here once I get more info.

If your loved one is receiving PACE services, please share details and tips, hours, ADL requirements, and whether you act as the PCA or bring someone in.

Thank you.

What is the Program of All-Inclusive Care for the Elderly (PACE)?

PACE provides comprehensive medical and social services to certain frail, elderly people (participants) still living in the community. Most of the participants who are in PACE are dually eligible for both Medicare and Medicaid.

https://www.cms.gov/medicaid-chip/medicare-coordination/qualified-beneficiary-program/program-all-inclusive-care-elderly-pace

AlzWife2023

You can also pay into PACE if you’re not Medicaid eligible (I’m pretty sure). We’ll worth looking into!

M1

Yes, there was a thread about this recently. there are 32 states with a PACE program; it is jointly funded by Medicare and Medicaid. Those who are not Medicaid eligible but want the services have to pay extra Medicare premiums to receive the services. For those who are Medicaid eligible, it is an estate recovery program (estate may be charged a certain percentage of the care costs after death), but the states vary in how aggressively they pursue this.

I believe you said in another thread that you had your DH qualified for Medicaid? So it should be fairly straightforward to have him evaluated. One important question you should ask is about a waiting list. Many, many places are still struggling with staffing issues--more people eligible for services than there are providers to furnish.

AlzWife2023

Yes, DH has Medicaid and Medicare so he qualifies.

PACE is an all-inclusive program so they provide you with a team and you switch to their doctors who will make house calls.

Now, we just need to see how many PCA hours he can get. I don't think that he can get PCA services and the Foster Care service, but I know he can get the Foster Care service and attend a day program.

On my initial phone call today I learned that the main PACE day program is an hour away. On Wednesday someone who knows more about day programs and if there is a closer day program will call me. A day program would be a good thing for both of us, in some ways, but not if it's so far away. I don't think he'd like to go every day either.

DH was evaluated by the foster care program as needing Level II care which is help with 2+ ADLS and behavioral issues (wandering, resistance to care) which I think should qualify him for a good number of PCA hours. We'll see. I would rather get paid as his F/T (40 hour) PCA than send him to a day program and try to find outside work. That would be much more exhausting for both of us.

If this program does not seem like a good fit, there is something in Massachusetts called Navicare SCO (Senior Care Options) which is also a Medicaid add on. Not really sure about the difference between the programs, but the SCO guy I spoke to on the phone said he thought the PACE program was more appropriate so he referred me.

I guess SCO is better if you want to keep your current doctors and PACE may be better for day program placement.

It seems like they are pushing the day program. It is probably cheaper for them than paying for F/T PCAs. They provide meals, exercise classes, games and crafts and they do the doctor visits on site so it's good that way, too.

In terms of the staffing shortage, the woman I spoke to sounded excited when I said I'd be interested in being his 40 hour/week PCA.

I'll update when I learn more.

FTDCaregiver1

Hi AlzWife2023 - thanks for starting this thread, PACE being relatively new on the scene and not offered in all states, even some geographic areas within states as well, its great your sharing info about how to know more about this program. Currently enrolled in PACE to care for DW since 2021, overall, very positive! On some of the items in this thread a few comments as to what I've experienced thus far.

Since PACE administers Medicaid (along other revenue sources), I employed a CELA, their pricing covered Annual Medicaid Redeterminations, so DW continues to qualify for Medicaid and protecting assets against Medicaid estate recovery. Yes, talk to a CELA. Suffice it to say, after seeing the work my CELA did on establishing the trust, and continues to do on annual Medicaid Redeterminations, I feel in good shape at this point.

On waitlists, yes there are, I got lucky though as while I was still working on DW's SSDI claim, I had also been in contact with a social worker from PACE for some time who knew her background and we're in the wings willing to assess her once her SSDI came through, fortunately they just expanded their enrollment numbers so she was assessed/enrolled the same month her SSDI came through.

Pace's day programming - If your fortunate enough to have one close by, I'd encourage you to visit. DW and I visited ours this afternoon. They might offer bus pickup if you live close enough. Ours offers a lunch, facilities to assist with showering, toileting, supplies, exercise room and cognitive work with clients. While I was there today, a small group of clients were being lead in a group exercise on word recollection. Its a day program, visit it and see if its a good fit for you.

concerned_sister

Thanks for this info. I can do a little leg work for folks interested in South Orange County, California. I've confirmed the program is available here. I've contacted my insurance agent to see if she has access to the premium contribution figures for someone not qualified for Medi-cal.

RickM

I stumbled upon the PACE program here in Seattle when I was looking into a daycare program in my neighborhood. You had to be enrolled in PACE for the daycare. I was impressed with the two people I talked with about the program. If we qualified for Medicaid I’d be looking pretty hard at PACE. I did ask about paying out of pocket. I was told it would be around $5500. I was told that could include assisted living/memory care if unable to keep LO at home (which was becoming difficult due to her waning mobility).

I was in the process of looking at a variety of alternatives and after a respite stay at a private pay MC walking distance from my house. I decided to move my DW there.

AlzWife2023

https://alzconnected.org/discussion/comment/203424#Comment_203424

Thanks for your input @RickM

I will ask the PACE people here in Massachusetts about assisted living/memory care. It would be wonderful if they have those placements available.

LindaLouise

I have looked into the PACE program in Washington State east of Seattle, and found that if you are not qualified for Medicaid, there is a pretty significant out of pocket pay AND you have to pay a much higher premium (over $1000 month) for prescription drugs. The PACE program is/was (not sure where this bill is currently) working with Congress on a bill to change the high cost of PACE prescription drugs so those not qualified for Medicaid don't pay quite as much out of pocket. I've done a lot of reading, but still can't figure out when/how PACE decides your LO needs placement in a MCF, or if PACE only supports in home care and day care. I was told by the PACE program I contacted, that is available in my zip code, that day care is only available twice a week, if available, so it seems expensive ($+5000) for that?

AlzWife2023

https://alzconnected.org/discussion/comment/203447#Comment_203447

Good info. Thanks.