The Program of All-Inclusive Care for the Elderly model is a viable and sustainable model of community-based long-term care, Tara A. Cortes, Ph.D., RN, FAAN, and Eileen M. Sullivan-Marx, Ph.D., RN, FAAN, write in the March issue of Journal of Gerontological Nursing.
Cortes is clinical professor of nursing and executive director of the Hartford Institute for Geriatric Nursing at the New York University College of Nursing. Sullivan-Marx is dean and the Erline Perkins McGriff Professor at the nursing college.
“PACE provides coordinated acute, chronic care and long-term services in an integrated, seamless approach to healthcare by an interdisciplinary team across the care continuum,” the nurse-leaders write. “This integrated and holistic, patient-centered approach, made possible using a capitated financing payment model, results in greater longevity, better health outcomes, and a better quality of life for patients and their caregivers enrolled in the program.”
Most importantly, Cortes and Sullivan-Marx say, PACE has demonstrated that it can delay admission to skilled nursing facilities for an average of two years. “The program offers fully integrated Medicare and Medicaid services for dually eligible adults 55 and older who meet the criteria for nursing home level of care but are able to live in the community at the time they are enrolled,” they say.
In November, President Barack Obama signed into law an expansion of PACE; the PACE Innovation Act allows the Centers for Medicare & Medicaid Services to develop pilot projects based on the PACE model.
“The PIA allows CMS to bring the PACE model to … seniors who do not yet meet the nursing home level of care standard, and others,” Cortes and Sullivan-Marx write. “The goal being to improve the quality of health and life for adults 55 and younger and to reduce healthcare costs by maintaining individuals in, or returning them to, the community.”
The act also “encourages CMS to allow operational flexibilities that would not only support adaptation of the PACE model for new populations but also promote PACE growth, efficiency and innovation,” they say. “CMS now needs to use this broad authority to create PACE demonstration programs to establish the ability of this program to improve outcomes, enhance patient experience and be cost-effective. This program offers new opportunities to existing PACE providers and other for-profit as well as non-profit providers to explore new ways of providing services to high-need, high-cost populations.”