Innovative PACE program aims to keep seniors out of nursing homes

Staff Photo by Dan Henry / The Chattanooga Times Free Press- 11/5/15. Martha Sims works out as Sandra Gaston supervises her adult daycare client while at the Alexian Brothers Community Services facility off of Cumberland Street in downtown Chattanooga on Wednesday, November 4, 2015.

Who are the Alexian Brothers?

The Congregation of Alexian Brothers is an 800-year-old Catholic lay organization, all male, that has as its mission “caring for the sick, the poor and the dying and promoting the physical, mental, spiritual and social health and well-being of all individuals we serve.” In Tennessee, they focus on care for seniors, although in other states they have hospices for AIDS patients, medical facilities for women and children, or mental health facilities, managed through the Alexian Brothers Health System. In 2012, the Alexian Brothers Health System merged with St. Louis-based Ascension Health, the largest nonprofit and Catholic health system in the U.S. In Chattanooga, Alexian Brothers operates PACE; Alexian Village, a campus on Signal Mountain that offers independent living, assisted living and rehabilitation; the Alexian Grove apartments for independent living; and the Alexian Brothers Valley Residence for patients with dementia.

The Boomer Bubble

Between 2012 and 2050, the population of the U.S. is projected to grow from 314 million to 400 million, a rise of some 27 percent.The percentage of residents 65 years old or older will rise to 20 percent in 2050, compared to 13 percent in 2012 and only 9.8 percent in 1970.Source: U.S. Census Bureau

Debbie Dawson didn't know how she was going to care for her mother, who has dementia, after the older woman had a debilitating stroke several years ago.

"I am the only family member able to care for her," said Dawson, who teaches school in Sequatchie County. She and her husband both work, and their only alternative seemed to be to put Debbie's mom in a nursing home.

But then she heard about PACE, an innovative form of senior care offered in Chattanooga by the Alexian Brothers, a Catholic organization that in Tennessee specializes in senior care.

"PACE is the only way I could keep her at home because we both work full time," Dawson said.

Her dilemma is one faced by many families. As people live longer, more seniors are unable to care for themselves. The problem will only get worse as the huge Baby Boom generation retires.

"I don't think we really have a grasp on this huge surge in population who are going to need huge amounts of services," said Vickie Niederhauser, dean of the School of Nursing at UT-Knoxville.

Alexian's Program of All-Inclusive Care for the Elderly is just one of several programs trying to address that problem by keeping disabled seniors in their homes, a solution that geriatric care specialists say is good for patients, families - and even taxpayers.

"Being able to have their dignity and the independence they want in the home - that really is an important thing as people age," Niederhauser said.

But staying at home is not easy. Some seniors have mental problems - they get disoriented, can't manage their medications, forget to turn off the stove or faucet. They may have difficulty walking because of medical conditions, or break a hip in a fall. When that happens, family members have to step in and find a way to provide care.

The options are limited: home care, nursing homes or something in between.

Trying to care for disabled seniors at home can be a nightmare, from juggling family schedules to dealing with multiple doctors and medical issues without expertise or assistance.

"Some people get so tired and worn out that they stop going to church; they stop seeing friends," said Colleen Combs, marketing coordinator at PACE. "They want to be the primary and sole caregiver to be sure it is done right. And they wear themselves out and can become ill."

Nursing homes are expensive, with an average cost in Tennessee of about $55,000 per year, according to 2015 data from Genworth Financial. That can rapidly exhaust even a moderately well-funded retirement plan. Medicaid provides free coverage, but only for seniors who have extremely limited assets.

PACE takes an alternative approach that allows seniors to remain in their homes, but provides medical care and activities during the daytime. It appears to be gaining momentum nationally. The program began as a demonstration project in San Francisco's Chinese community in the 1970s, but later became part of Medicare. It has now grown to more than 100 plans nationally.

All-in-one approach

Chattanooga has the only PACE program in Tennessee.

Some 30 white PACE vans, all equipped with lifts, roam Hamilton County beginning at 6 a.m. to bring about 180 seniors every day to the PACE facilities on Third Street, about four blocks east of Erlanger hospital.

PACE's comprehensive medical care - including a pharmacy, dental services and help with eyeglasses, hearing aids and footwear - is one key to its appeal. Since everything is provided at one location, family members don't have to worry about making multiple trips to various medical facilities.

"I call in [my mother's] prescription when the bottles are near empty, and they come home on the bus with her. They pick her up in the morning, her doctor is there on site, she sees the same seniors all day long," Dawson said. "They know immediately if anything is amiss with them and take care of it."

Plans can be customized to meet a patient's needs. "Each family's plan of care is different," Combs said.

On a recent Tuesday afternoon, about 50 elderly patients sit, most in wheelchairs, in a large pleasant room, playing a card game. A list of the week's activities is posted on a bulletin board (a copy is mailed to patients' families every week). One woman is getting her hair done by the staff hairdresser.

A duplicate facility offering the same services is on the other end of the large, single-story PACE building and there is a separate, secure facility for some 30 patients with dementia problems such as Alzheimer's. In back, two huge metal awnings stretch over the two loading areas where patients enter and leave the facility.

PACE currently has no waiting list, but getting in is not easy. Each state sets its own eligibility standards for nursing care, and Tennessee's standards are strict. Each prospective patient must be evaluated by a PACE nurse, and then the state reviews the applications and has the final say. The rules are not specific, but basically patients are evaluated as to whether they can feed themselves, go to the bathroom, move from a wheelchair to a chair or bed, manage their medicines and have sufficient mental capacity. Combs summarizes the requirement as "if someone needs hands-on assistance for daily living, every single day."

Almost all of PACE's patients are covered by Medicaid. To qualify for Medicaid, a patient can have no more than $2,000 in assets, and earn no more than $2,199 per month from pensions or Social Security, although they are allowed to keep their home and an automobile.

Where Medicaid patients in nursing homes must turn over almost all of their monthly Social Security check, PACE patients keep the check, Combs said, under the assumption that they need money to continue living at home.

A handful of PACE patients are paying privately, and Combs said she hopes more people will consider that option. The monthly fee for private patients is $3,627, which is much less than a nursing home, Combs said. In Chattanooga, nursing home fees averaged $160 per day in 2015, or $4,800 monthly, according to a survey by Genworth Financial.

Comfort and savings

PACE and similar programs that keep seniors out of nursing homes as long as possible also appeal to state and federal lawmakers and health officials trying to restrain the growth in medical spending.

"There are a lot of these in-between options that are growing rapidly," said Vanderbilt University health economist Matt Harris.

Tennessee offers alternatives to PACE. The state's CHOICES program provides home care and adult day care for patients who qualify for nursing home care under the same criteria used by PACE, but it does not offer medical care or transportation.

Many private firms offer home care, where workers will visit a home for a few hours every day or every week to help with bathing or cooking chores. But they offer no medical treatment.

Some nurse practitioners have begun offering home care, according to UT's Niederhauser, where they can provide medical treatment. But those visits don't free up caregivers to go to work full time.

PACE is not without its problems. Only the most frail patients are accepted, and they must have exhausted their savings or have the ability to pay more than $3,600 per month.

But for those who qualify, PACE can be a lifesaver. Dawson said it has made a huge difference for her mother.

"The doctor and clinical staff are very attentive to her and always aware of her needs," Dawson said. "All of this complete care comes at no cost to Mom, leaving her Social Security benefits to be spent on her extras and making her life the best it can be in her twilight years."

Contact staff reporter Steve Johnson at sjohnson, at 423-757-6673, on Twitter @stevejohnsonTFP or on Facebook at stevejohnson TFP.