CHATTANOOGA, Tenn. — George Raines, a gray-haired man wearing a red jersey and matching University of Alabama baseball cap, cracks jokes as physical therapist Brad Ellis leads him through a series of exercises to strengthen his legs. Ta.
Mr. Raines, 79, pretended to be in pain, but his smile belied his distressed tone. The men were in a therapy room at Ascension Living Alexian Pace in Chattanooga, Tennessee. There, elderly customers spend their days receiving medical and other services.
“Some patients are spicy,” said Reba Llewellyn, an occupational therapist at the center. During the Center’s “Crazy Hat Day” the week before, Raines wore a hat with fake pigtails that made her look like country singer Willie Nelson. It was said that there was.
PACE (Program of Comprehensive Care for the Elderly) Centers provide government-funded medical care to people age 55 and older whose complex medical needs require nursing home care, but who, with the right support, can live at home. Provide social services. . Most of his PACE clients are enrolled in both Medicaid and Medicare, but a few pay for the program through private insurance.
Nationally, PACE centers are owned by a variety of health care organizations, including nonprofit organizations, for-profit companies, large health systems, and religious organizations. If a state’s Medicaid program elects to cover her PACE care by law or policy change, the provider receives a fixed monthly payment from Medicare and Medicaid (rarely from private payers) for each enrolled customer. receive.
PACE has long gained national attention as an option for senior care. But recently, it has attracted the attention of lawmakers in states such as Georgia, Illinois and Ohio. That’s because it can keep people in their homes and may be less expensive than nursing home care.
I’m sure many of you were wondering, “Is a nursing home the only option?” They started looking around and realized that the PACE program made a lot of sense.
– Robert Greenwood, National PACE Association
Armed with capital and attracted by growing consumer and state interest, more large companies and health systems are opening PACE centers or acquiring existing centers from smaller nonprofits. . However, explosive growth also comes with challenges. Three years ago, California and Colorado investigated and subsequently sanctioned one of the nation’s largest for-profit PACE providers, finding that it was not providing targeted services. Additionally, several studies have shown mixed results regarding the effectiveness of the centers.
Many families are looking for an alternative to nursing homes. By 2030, one in five Americans will be over the age of 65, and most older adults say they will be. prefer to continue living at home as long as possible.
“One of the things about COVID-19 is that it really brought attention to long-term care because of the experience in nursing homes,” said Senior Vice President of Communications and Member Engagement for the National PACE Association, a professional network. said Robert Greenwood. PACE provider’s.
“I think a lot of people were wondering, ‘Is a nursing home the only option?’” They started looking around and realized the PACE program made a lot of sense. ”
Countries participate
The Alexian PACE center receives about half of its 300 customers each day. Starting at 6 a.m., the center’s bright purple buses pick up people like Raines from their homes in surrounding counties and bring them to the center for the same day.
On a rainy Tuesday in March, while Raines received physical therapy, dozens of other seniors sat at a small table in the cafeteria, eating lunch and working on jigsaw puzzles. In another hall, customers visited medical offices to get braces installed and prescriptions filled. The center offers dental and vision care, counseling, and testing services. Social workers help clients obtain necessary supplies, such as walkers and home wheelchair ramps.
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“I love this model,” said Vicki Guertin, CEO of the Alexian PACE Center. “I’m happy to be able to install an air conditioner.” [in clients’ homes] If necessary. We can buy people’s shoes. There are many things we can do that most health insurance plans could never do. ”
Late last year, Oregon We have started calling for bids. For the new PACE program. In January, New Jersey Democratic Governor Phil Murphy signed a bill that: Make it easier to register PACE people.Illinois State Begins 7 new PACE centers In June.Georgia bill awaiting Republican Gov. Brian Kemp’s signature We created a special carve-out State law allows PACE centers to open within the state. And Tennessee lawmakers are considering a bill that would direct TennCare, the state’s Medicaid program, to: Establish PACE throughout the state.
Ohio Republican Governor Mike DeWine announced Ohio’s PACE expansion is one of the largest currently underway, as the state launched new PACE programs in nine counties in December. The Ohio Legislature committed $50 million in federal funds to the effort.
“Momentum is definitely building,” said Greenwood of the PACE Association. “In recent years, there have been probably six or seven new PACE programs opening a year. In recent months, there have been about four new PACE programs opened each month. Over the next two years, 50 organizations are scheduled to participate. is.”
This enthusiasm tends to be bipartisan, with Tennessee state Rep. Caleb Hemmer, a Democrat who represents Nashville, and Republican state Sen. Bo Watson, representing Hamilton County (which includes Chattanooga), promoting PACE statewide. We are co-sponsoring a bill to expand the
Last fall, Hemmer organized a bipartisan group of lawmakers to tour Tennessee’s only Alexian PACE Center. The facility is owned by Ascension, one of the largest nonprofit Catholic health systems in the country.
“Even I was surprised when I visited,” Hemmer told Stateline. “When you walk in, it’s nice and clean, smells good, and has activities for people. It’s a place you want to send your loved ones.”
How to use
In the early 1970s, community leaders in San Francisco’s Chinatown and North Beach neighborhoods were looking for a way to care for the elderly, who had immigrated primarily from China, Italy, and the Philippines. They decided that nursing homes were cost-prohibitive and culturally inappropriate in their communities, so they formed a nonprofit organization to provide long-term elderly care. They named it Onlok, which means “peaceful and happy abode” in Cantonese.
On Lok Adult Day Center eventually became the first PACE Center.
Currently, more than 160 PACE centers operate in 32 states and the District of Columbia, which is far fewer than the more than 15,000 nursing homes nationwide. There are approximately 72,000 people registered with PACE, but more than 1 million people live in nursing homes.
Medicaid and Medicare do not require states to provide PACE centers. However, in states that have adopted Medicaid, approximately 90% of enrollees are eligible for both Medicaid and Medicare, including some of the nation’s most medically complex populations. Medicaid is a federal-state insurance program for low-income people, and Medicare is a federal program for people over age 65. Both programs target people with some disabilities.
Greenwood said Medicaid and Medicare’s fixed per-customer payments (which vary by state) encourage PACE providers to focus on preventive medicine and other supportive services that reduce hospitalizations and keep participants as healthy as possible. He said yes.
In 2022, researchers at the University of Arizona Few studies have been published When the results of PACE were compared to those of other elderly care programs, the results were mixed. In a 2014 study, PACE enrollees experienced a decline in hospitalization rates; However, the study’s authors note that there is “significant” variation between different PACE programs.
Jasmine Travers, assistant professor of nursing at New York University, said: Her 2020 PACE Enrollment Survey The health disparities she was used to seeing among black and Hispanic older adults in nursing homes were less pronounced among minority PACE users, she said.
“Many things influence disparities in health care access, such as transportation costs, co-pays, and meals. Things like this are not always considered in the external environment. [health care] It’s a setting,” Travers told Stateline. “PACE takes those into account.”
Audits, sanctions and litigation
For decades, PACE has been a strictly nonprofit-driven model. About a decade ago, Congress, which oversees Medicare and Medicaid, allowed for-profit companies to open PACE centers.
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In 2016, a private equity-backed company called InnovAge was founded. Became the first for-profit PACE organization in Japan.. Over the next several years, he acquired his non-profit PACE program in multiple states, increasing enrollment and revenue.
But in 2021, the Colorado Department of Health Policy and Financing… All new registrations have been temporarily suspended InnovAge’s six Colorado PACE centers resume operations after state audit finds InnovAge Colorado “substantially failed” to provide covered medically necessary items and services to participants it was done. Meanwhile, the folks at the Centers for Medicare and Medicaid Services (CMS) conducting independent research, reached similar findings. Colorado Attorney General Phil Weiser (Democratic) started an investigation Too.
Around the same time, CMS Registration stopped At Innovage’s PACE Center in Sacramento, California. InnovAge shareholders filed a lawsuit alleging that the company violated federal securities laws by lying to investors about its finances and operations.
“At first glance, PACE seems like a way for people to get everything in one place,” said Julie Goldsmith Reiser, a lawyer for the plaintiffs and a partner at the Washington, D.C.-based firm Cohen Milstein Sellers & Toll. “It looks like a great way to receive quality care.” “But what’s happening with some of these commercial models is that people are waiting longer to see a doctor, and there aren’t enough doctors willing to participate, so people are falling through the cracks. , the outcome is worse than not participating. Not at all.”
Last year, C.M.S. lifted up Sanctions against InnovAge. The company continues to operate his PACE centers and calls itself the largest provider of his PACE in the country based on participants served.
“At InnovAge, on behalf of all of our employees, we are at the beginning of a continuous journey of improvement and operational excellence,” said InnovAge CEO Patrick Blair. public statement Last year, they announced the lifting of sanctions. “We will continue to focus on these elements as we fulfill our long-term mission of expanding access to community-based care for more seniors.”
