Caring for Older Adults with Complex Needs in the COVID-19 Pandemic: Lessons from PACE Innovations

June 2020

The Program of All-Inclusive Care for the Elderly (PACE) is an evidence-based model of care for older adults who meet a nursing-home level of care, but live in community settings. Across the country, nearly 54,000 individuals are served by 133 organizations in 31 states. PACE organizations blend funding from Medicare and Medicaid to integrate preventive, acute, and long-term care as well as services to address social needs. While many services are provided in PACE day centers, PACE organizations adapted the delivery of services to meet the needs of their patient population during the COVID-19 pandemic.

This webinar, coordinated by the Better Care Playbook and the National PACE Association and made possible through support from the Seven Foundation Collaborative and West Health Policy Center, highlighted innovations adopted by PACE organizations during the pandemic to provide care for older adults with complex needs. Leaders from PACE organizations across the country described their experiences implementing new approaches for addressing social determinants of health, chronic care management, functional supports, and the delivery of care across settings, including the home, PACE center, hospital, and nursing home. Lessons are broadly applicable to organizations serving vulnerable older adults in other settings during the pandemic as well, particularly through integrated health plan approaches. Additionally, presenters from the National PACE Association highlighted state policy considerations to address the long-term needs of older adults requiring a nursing home level of care.

Speakers reflected on the implications of these activities for national efforts to improve care for high-need populations. After the speakers concluded, all webinar participants had the opportunity to share questions for webinar presenters to respond to.





I. Welcome and Introduction

Speaker: Logan Kelly, MPH, Senior Program Officer, Center for Health Care Strategies (CHCS)

L. Kelly welcomed participants, provided a brief overview of the Better Care Playbook, and introduced the PACE model of care, including the evidence base and growth of PACE organizations.

II. Overview of PACE Program and Enrollee Needs During the COVID-19 Pandemic

Speakers: Mia Phifer, MSJ, Vice President of Quality; and Chris van Reenen, PhD, MPP, Vice President of Regulatory Affairs, National PACE Association

M. Phifer and C. van Reenen provided a brief overview of the PACE program and addressed the impact of the COVID-19 pandemic on individuals served by the program.

III. Lessons from PACE Innovations

Speakers: Marianne Ratcliffe, MHA, Executive Director, Piedmont Health SeniorCare, North Carolina; Samantha Black, LCSW, Executive Director, TRU PACE, Colorado; Robert Schreiber, MD, Vice President and Medical Director, Summit ElderCare, Massachusetts

Speakers provided case studies of how their PACE organizations are adapting to the needs and challenges of the COVID-19 pandemic to support the individuals they serve. Case studies addressed innovations in the areas of social determinants of health, chronic care management, functional supports, and repurposing the PACE day center setting.

IV. Policy Considerations

Speaker: Peter Fitzgerald, MSc, Executive Vice President for Policy and Strategy, National PACE Association

P. Fitzgerald drew from the PACE organizations’ response to the COVID-19 pandemic to highlight policy considerations for supporting access to community-based options for older adults with complex care and functional support needs.

V. Implications for Health Care Stakeholders Responding to Older Adults’ Needs in the Pandemic

Reactor: Anne Tumlinson, ATI Advisory

A. Tumlinson reflected on the implications of these innovations for other stakeholders working to improve care for older adults with complex needs.

VI. Moderated Q&A 

Moderator: Logan Kelly, Senior Program Officer, CHCS


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