PACE programs shift senior health care to the home during COVID-19
As the COVID-19 pandemic has disproportionately hit nursing home residents it has drawn attention to the benefits of the nation’s PACE (Program of All-inclusive Care for the Elderly) programs, which allow frail seniors to “age in place” in their own home instead of a nursing home. Enrolled seniors are safer from infection because they are supported to thrive at home.
Janet joined PACE in August 2019 so she could continue living at her home in Seattle’s Greenwood area. She was delighted that her insurance covered the International Community Health Services (ICHS) PACE program and enjoyed the adult day services at ICHS Legacy House.
When COVID-19 began spreading in King County, “PACE made a series of quick and abrupt decisions,” said Dr. Kannie Chim, ICHS PACE medical director. After weeks of declining visits, on March 9, in the interest of patient safety, Legacy House closed group activities. “The team had to pivot to reaching people through other means.”
Staff made weekly phone calls to check on participants’ and share information. Knowing that many lacked safe transportation options, PACE staff began delivering food coordinated by PACE dietitians so participants could continue sheltering in place. The PACE team also increased home visits to ensure seniors received the care they needed to stay healthy.
“Doctors, physical therapists, nurses, almost everyone comes to your home to check on you,” said Janet. “I’ve had home safety checks and they are very careful.”
PACE staff also taught Janet how to connect to telehealth services. “Everyone in the program is motivated and responsive to patients,” she said. “I like it, especially during this difficult period.”
Dr. Kannie Chim | ICHS PACE medical director
You are living at home and can get around and still do your daily activities, but you are just getting by. We want to help participants not only survive, but thrive.
Healthy aging at home
PACE programs are individually designed for each participant and managed by a team. Care is interdisciplinary—a social needs analysis and investigation into individual health barriers are part of the program. Care is culturally competent, able to meet participant needs with respect to cultural traditions, language and preferences. The goal is to allow individuals to safely live in their community for as long as possible. When that is no longer feasible, PACE can coordinate transitions that keep the participant centered in his or her care.
“It’s team-based,” said Dr. Chim. “At PACE, we say ‘Let us take all of this and put it under one roof and take care of it. Let us help, we are going to coordinate this.’”
Mei and her husband live in the Chinatown-International District (C-ID) neighborhood of Seattle. Before the pandemic, PACE drivers would pick up Mei’s husband three times a week and take him to ICHS Legacy House for medical care, physical therapy and activities. The couple continue to live in their C-ID apartment while Mei’s husband receives the primary care he needs, staying connected to multiple services to help keep him healthy.
PACE team members include doctors, therapists, nutritionists, drivers, behavioral health specialists, social workers and administrative staff to coordinate an individualized care plan.
Many ICHS PACE participants take part in adult day services and social activities at ICHS Legacy House. They may also receive care within their own home that ranges from therapy and medical visits, to meal deliveries and home safety assessments.
To be eligible for PACE, participants must be 55 or older and in need of nursing home level of care as defined by Washington state.
Most participants “join the PACE program needing a little help,” explained Dr. Chim. “You are living at home and can get around and still do your daily activities, but you are just getting by. We want to help participants not only survive, but thrive.”
Setting the PACE ahead
During the pandemic, long-term care facilities have been especially vulnerable to outbreaks of COVID-19. Seniors face compounding challenges, including heightened risk of infection, transportation barriers, limited access to telehealth and other difficulties.
"Offering well-coordinated, community-based health care, socialization and living support is a priority throughout this pandemic and in the future," commented Teresita Batayola, ICHS President & CEO. "For us, PACE is the future."
ICHS, in partnership with Kin On Health Care Center (Kin On), is taking a bold step to create a better future for elders. Established in 2015, the partnership, called Aging in PACE Washington (AiPACE), will pioneer the nation’s first aging-in-place program for the Asian Pacific Islander community. A $20 million capital campaign is underway to create a 25,000-square-foot PACE center on the north lot of Pacific Tower on Beacon Hill.
AiPACE's facility will provide a home base for culturally-competent, in-language care for AAPI elders. It is also part of a collaborative development with affordable workforce housing by the Seattle Chinatown International District Preservation and Development Authority (SCIDpda) and childcare center operated by El Centro de la Raza.