The Program of All-Inclusive Care for the Elderly (PACE) enables older people to remain active members of their community who would otherwise need to reside in a nursing home. To be considered eligible for PACE, patients must be age 55 or older and certified by the state in which they reside, to have a chronic illness, disability, or be in need of physical or medical assistance.
PACE developed in the Chinatown section of San Francisco CA in 1971. At the time, this community consisted of many families whose elders had immigrated from Italy, China, and the Philippines. The option of nursing home care for the elderly was culturally unacceptable for many living in this community. Based on consultant work by Marie-Louise Ansak and a federal grant, On-Lok (Cantonese for “peaceful happy abode”) was founded. The first On Lok Center provided adult day care with medical, rehabilitation, respite, ...view middle of the document...
Enrollees are typically eligible for Medicare, Medicaid or both. If an individual does not have Medicaid but they do have Medicare, they will be charged a monthly fee for the long-term care portion of PACE and a premium for the Medicare Part D drug coverage. Members that do not qualify for either can still receive services if they pay a monthly premium based on their financial status. PACE provides services based on individual patient needs and include: dentistry, emergency services, home and hospital care, meals and nutritional counseling, occupational therapy, physical therapy, and prescription drug coverage offered through Medicare Part D. PACE also supports family and other caregivers with training, support groups, and respite care. Services are provided by a team that is selected based on the participant’s individual needs and generally include: physicians, nurses, social workers, therapists, nutritionists and transportation workers that are contracted in the community through the PACE organization. Staff employed by PACE meets state and federal safety requirements. In 2013, The National PACE Association reported 98 programs were operational in 31 states.
Elders living in rural areas are faced with greater difficulty receiving needed care and assistance. Rural areas tend to be of a higher proportion of people ages 65 and older, have higher rates of nursing home utilization, and have limited healthcare providers. This need was recognized and congress passed legislation in 2005 to encourage PACE growth in such areas, resulting in 14 rural PACE programs opening in 13 states by 2008. As noted in The Western Journal of Medicine (Coburn 2001).
I believe ethical challenges will always exist in the medical field whether it be of the social, economic, or moral type. PACE differs from managed care organizations in that it is a non-profit organization which alleviates financially driven choices in relation to optimal patient care. However, physicians or other employees working under PACE, may still face challenges such as denying one patient a service or procedure in the best interest of the other participants in the program.