Program of All-inclusive Care for the Elderly in 2002

Abstract

This year is a pivotal time for the Program of All-inclusive Care for the Elderly (PACE) because the deadline for movement from demonstration project to permanent status is just around the corner for many sites. By late November, more than a dozen programs either will apply and be granted permanent provider designation or will cease to exist, once again altering the landscape of senior consumer options. After 3 decades of development, the PACE alternative has undeniably achieved success by both clinical and financial standards, but it does not lack some current and future challenges. HISTORY AND MODEL OVERVIEW PACE is an innovative, all-inclusive approach to caring for the frail elderly under a capitated reimbursement model. Originating in San Francisco in the early 1970s, the forerunner to today’s PACE model began in the ChineseAmerican community, wherein institutionalizing aging members in a nursing home was culturally unacceptable. On Lok (Cantonese for peaceful, happy abode) Senior Services developed a comprehensive, community-based approach to maintaining the frail elderly in their homes by applying multidisciplinary primary care within a structure that placed the adult day health center and related services (social, nutrition, recreational, medical, etc.) at its center and included home, acute, and extended care as relevant. By creatively applying the principles of health maintenance organizations (HMOs) to applicants deemed otherwise eligible for institutional care, On Lok has addressed the health care system issues affecting the elderly: fragmentation, expense, and lack of creativity in communitybased care. On Lok has maintained frail elders in their homes while enabling them to receive health care, recreation, and socialization through day centers and has managed risk through common sense preventive care. 1