Impoverished, frail and elderly, the widow struggled to cope with her multiple health problems. Dementia slowly eroded her ability to comprehend her circumstances. Younger family members could no longer cope with her needs.
A team of health care professionals entered her life, providing a coordinated range of services. Her comfort and safety were assured. Five days each week, a van transports her to a health center where she enjoys breakfast and lunch, attention to her medical needs and guided socialization with other seniors. A staff of physicians, nurses, rehabilitation specialists, dietitians and pharmacists oversees her care. She spends her evenings at home where family members assist her. Caregivers are on call for any acute issues.
Since opening in 1998, Chattanooga's Program of All-Inclusive Care for the Elderly (PACE), has provided comprehensive health care to some of Hamilton County's most vulnerable residents. PACE began in San Francisco and 12 other sites in the 1970s as a demonstration project sponsored by Medicare. The challenge: To provide comprehensive health care within a fixed budget to poor, frail, elderly persons in their homes under the guidance of qualified caregivers.
The initial sites succeeded and the concept spread. Currently, 95 PACE centers operate across the country. With 325 enrollees, Chattanooga's PACE is one of the nation's largest and the only Tennessee program to integrate Medicare and Medicaid services.
PACE receives a fixed, monthly payment for each enrollee. The program provides all health services for about 15 percent less than standard Medicare and Medicaid programs, which provide considerably less care.
Recently, I spent a morning at PACE to understand how it succeeds. An interdisciplinary team evaluates patients continually, determines needs for a full range of health services and authorizes payments. The team meeting that I attended included a physician, nurse practitioners, medical social workers, certified nursing assistants, van driver, dietitian and various therapists. New problems were assessed. The care of all patients is regularly reviewed.
The driver had pertinent observations regarding a patient's changing behavior. The dietitian recommended home dietary supplements for another patient whose appetite was declining. A sitter was authorized for two hours each evening so a primary caregiver within the family could see to personal needs. A nighttime sitter was arranged for another patient to observe and to evaluate problems with falls and oxygen usage.
The care team can authorize dental, eye and foot care, which can be delivered within the PACE facility. A panel of specialists is available for consultations for complex problems. A small medical ward within the facility permits administration of IV fluids, blood transfusions and other acute therapy that might be needed. An on-site pharmacy provides and oversees all medications.
PACE members spend an average of 1.6 days per year in hospital, that's half the rate for typical Medicare enrollees. PACE members see an average of 1.5 specialists each year, contrasting with five different specialists at four different clinic locations for the general Medicare population.
A diverse program of physical and mental activities engages the PACE members in a large area that resembles a living room. Television is not available; it lulls clients into inactivity. A separate unit for patients with advanced dementia is somewhat quieter. These men and women are nonetheless engaged by their caregivers in individual and small-group activities.
Surveys document a high degree of satisfaction among patients, their families and staff members. One lady summed up her experience at PACE: "This is my church now."
As I moved among the PACE members in their various activities, I felt as if I were visiting cherished grandparents whose sunset years were sustained with dignity and compassion.
Last year, TennCare tightened eligibility standards for long-term care. Fewer disabled, impoverished seniors will qualify. This creates uncertainty for the future of PACE in our community.
Quality, access to care and cost-containment can be attained through careful planning. The PACE model must be sustained and expanded.
Contact Clif Cleaveland at firstname.lastname@example.org.