Aging Gracefully: The PACE Approach to Caring for Frail Elders in the Community

Martha Hostetter
Douglas McCarthy
Sarah Klein
Case Study
August 2016

This resource is a case study of the Program of All-Inclusive Care for the Elderly (PACE), focusing on On Lok, the original program.

  • On Lok Senior Health Services was founded in 1971 in the San Francisco Bay Area of California with the intention of enabling older adults to “age in place” in their communities.
  • Participants receive a wide range of support from an interdisciplinary team, both at day centers and in their homes.
  • Participants come to the day centers to socialize, eat, play games, and exercise. They also see their health care providers there.
  • On days when participants do not come to the centers, they may have meals delivered and receive help with dressing, bathing, and other tasks in their homes.
  • With 700 full- and part-time staff, On Lok serves more than 1,400 people in the San Francisco Bay Area. About 90 percent are dually eligible beneficiaries of Medicaid and Medicare.
  • PACE enrollees appear to have fewer hospitalizations than older adults served through fee-for-service Medicare. The readmission rate within 30 days of hospital discharge for On Lok members is about half the average among other Medicare beneficiaries.
  • There are nearly 120 independent PACE organizations across the US. They operate as managed care plans, pooling the fixed monthly payments they get from Medicare and Medicaid to purchase an array of services for members.
Posted to The Playbook on
Population Addressed
Frail Older Adults
People with Behavioral Health and Social Needs
Key Questions Answered
  • What is the PACE approach? How has it been implemented?
  • What are the elements of an effective approach to supporting frail elders in the community?
  • What are the results to date for the PACE approach?
Level of Evidence
What does this mean?