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

Martha Hostetter
Douglas McCarthy
Sarah Klein
Case Example
August 2016

The Program of All-Inclusive Care for the Elderly (PACE) is a model of care that fully integrates Medicare and Medicaid benefits and primarily serves dually eligible individuals eligible for a nursing facility level of care. This case study examines On Lok Senior Health Services, which 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. On Lok participants travel to day centers to socialize, eat, and exercise, and they also receive health care services and a wide range of support from an interdisciplinary team. 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.

The readmission rate within 30 days of hospital discharge for On Lok members is about half the average among other Medicare beneficiaries. PACE organizations receive monthly capitated payments from both Medicare and Medicaid, which allows them to pool the fixed monthly payments from each program to provide an array of services for members. Lessons from the PACE model may offer helpful lessons for policymakers and providers about how to serve high-need populations such as frail elders in community settings and to expand access to integrated care in the community.

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