An Overview of PACE and How the Genesis of This Critical Solution For Seniors was Inspired by a Local Community Effort in San Francisco Over 40-years Ago

By ciminocare


The Program of All-inclusive Care for the Elderly, otherwise known as PACE, is a Medicare and Medicaid (in California called Medi-Cal) state option that provides community-based, comprehensive medical and social care for individuals age 55 and older who would otherwise need a nursing home level of care. 

The PACE model allows eligible individuals to remain independent and in their homes or home-like settings, such as assisted living, for as long as possible.

What is PACE

The PACE programs are facilitated by health care providers who directly employ an extensive range of health care specialists, including physicians, nurses, physical therapists, and more. 

PACE Programs allow elderly individuals to maintain their independence through access to comprehensive medical and social services, which in turn helps members stay out of long term institutional care. This care can include primary and specialty medical care, nursing, social services, therapies, pharmaceuticals, home care, health-related transportation, and anything else the program determines is medically necessary to maximize a member’s health. The program is then reimbursed on a fixed per member, per month rate or capitation payment.

Services provided by PACE programs take place in a “PACE Center.” These centers often have physicians’ offices, nursing, Day Health Centers, rehabilitation services, social services, and more, all in one site. Care planning is done with the member and their care team. Members can attend the center anywhere from once every so often to daily. 

History and Background 

The PACE program has been around for approximately 40 years, but in recent times the pace of PACE growth (no pun intended) has picked up dramatically. This is due to the need to control the rising costs of caring for seniors in need of physical and cognitive support.  PACE does this by being proactive in case management, care, and support of our seniors living with chronic physical challenges or dementia.

The PACE Model of Care can be traced to the early 1970s, when the Chinatown-North Beach community of San Francisco saw the pressing needs for long-term care services by families whose elders had immigrated from Italy, China and the Philippines. 

On Lok Senior Health Services, a nonprofit corporation, created a community-based system of care to answer these needs. With research and demonstration funding from the U.S. Administration on Aging, On Lok opened one of the nation’s first adult day health center in 1973 based on the British day hospital model. By 1974 they had already begun to receive reimbursement for their adult day health services.

In,1975 On Lok added a social daycare center and included in-home care, home-delivered meals and housing assistance in its program.

In 1979, they received a four-year grant from the Department of Health and Human Services to develop a consolidated model of delivering care to persons with long-term care needs.

By 1983, On Lok was allowed to test a new financing system that paid the program a fixed amount each month for each person in the program.

In 1985, Congress extended On Lok’s waivers indefinitely and in 1986, provided waivers for the replication of the model at 10 sites. This support enabled On Lok to provide technical assistance to help new sites develop and to create a cross-site database to track performance. 

In 1990, the model was finally named “Program of All-inclusive Care for the Elderly” or PACE, and received receive Medicare and Medicaid waivers to operate.

The Balanced Budget Act of 1997 (P.L. 105-33, Section 4801-4804) established PACE as a permanent recognized provider type under both the Medicare and Medicaid programs. 

Existing PACE demonstration programs became permanent PACE providers by 2003. The Deficit Reduction Act (DRA) of 2005 authorized a Rural PACE initiative and in 2006 the Centers for Medicare and Medicaid Services (CMS) announced 15 rural PACE grantees.

As of September 2018, there are 134 PACE programs operating in 31 states. The largest of these has more than 2,500 frail elderly enrollees, but most serve a few hundred on average.

Anyone working in the field of Senior Care should know about and have a basic understanding of PACE. At CiminoCare, we consider it to be our duty to spread the word about important programs such as PACE to our community. 

Please stay tuned for Part II of this series where we will explore how the PACE organizations have interfaced with Senior Assisted Living Communities and CiminoCare’s experience with the program. 

For more information on PACE please visit: 

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