Medicare PACE and LIFE Programs: All Inclusive Elderly Care
"For many low to middle income seniors, Medicare PACE programs are the best long term care option, balancing quality of life with quality care and affordability."
Medicare PACE is not a source of funds for paying for senior care; rather it is an optional program that covers all of a participating senior’s medical needs as well as some personal care. The program is open to both Medicare and Medicaid beneficiaries and provides comprehensive medical and social services at home, adult day health centers and inpatient facilities as an alternative for those who would otherwise require nursing home care.
All of a patient’s medical needs are determined and provided by a set group of medical service providers. This includes medications and medically-necessary transportation.
This model of care is sometimes referred to as Managed Care at Home and in certain states PACE Programs are called LIFE Programs. PACE is an acronym for Programs of All-inclusive Care for the Elderly and LIFE is an acronym for Living Independence for the Elderly.
Pros & Cons
PACE programs are intended for families that wish to have the care recipient live at home instead of instead of in a skilled nursing home / facility. Participating families are expected to provide some personal care themselves and not rely entirely on the program for 24-hour care. However, if a PACE program can no longer safely support the care of an enrolled participant at home or in adult day care, the program will pay for care in a skilled nursing home.
PACE programs are a very good option for families that are able to provide some level of care. Unfortunately, as of March 2016, PACE programs were not available nationwide. Currently there are PACE / LIFE Programs at 137 locations spread through 36 states. Another drawback to this program is that seniors must give up their primary care physician to enroll in the program. Finally, in some areas it can take many months to apply and have the application processed prior to enrollment.
Qualifications for PACE Programs
- Age - participants must be at least 55 years old.
- Disabilities / Health- participants must require the level of care typically provided in nursing homes. During the screening process, they will be certified as such by a team of doctors, therapists and nurses. A diagnosis of Alzheimer's, Parkinson’s or dementia does not automatically ensure the applicant will be medically qualified. For these conditions, the progression of disease is important.
- Family - the participant's marital status has no impact on their eligibility. However, the participant's family, a spouse or otherwise, must be able to provide a certain level of care in the home.
- Financial - the programs in and of themselves do not have financial eligibility requirements, however participating seniors must be enrolled in Medicare or Medicaid. Therefore, they must meet the Medicare requirements or the Medicaid requirements.
- Veteran Status - Medicare PACE / LIFE programs are available to both Veteran and non-Veterans.
- Geographic - currently PACE programs are not available nationwide. Participants must reside or be willing to reside in a Medicare PACE or LIFE Program eligibility area.
States with PACE
Follows is a list of states with PACE / LIFE programs. While each of these states has at least one PACE / LIFE program, there may not be programs available statewide.
|States with PACE / LIFE Programs||States without PACE / LIFE Programs|
Benefits and Services
PACE Programs are designed to provide all of a participating senior's medicinal and care needs.
PACE benefits come only in the form of medical and care services. Seniors do not receive cash payments. Benefits are determined on a case by case basis are provided by a dedicated team of health care professional and can include any of the following.
- Adult Day Care
- Emergency Services
- Home Care
- Hospital Care
- Laboratory/X-ray Services
- Medical Transportation
- Nursing Home Care
- Nutritional Counseling
- Personal Care
- Physical Therapy
- Prescription Drugs / Medications
- Primary Care
- Recreational Therapy
- Social Services
- Social Work Counseling
PACE Programs and Assisted Living
PACE programs do not pay for assisted living in a traditional sense but persons residing in assisted living communities and still receive care services paid for by PACE. To clarify, a PACE program would treat an individual residing in an assisted living community the same as a person living at home. PACE would arrange daytime transportation to take the individual to and from an adult day care center. This could greatly reduce the amount of care services provide by the assisted living community (and therefore their fees). However, PACE will not pay for the room and board in assisted living.
PACE Programs are possibly the most cost effective form of long term care available in the US.
PACE / LIFE programs receive monthly payments from Medicare or Medicaid. Participating seniors do not make payments to the PACE program. If a participant qualifies for Medicaid, there is no monthly premium for long term care. Seniors that are not Medicaid eligible, but have Medicare, will pay a monthly premium but do not have deductibles or co-payments.
How to Apply for PACE / LIFE Programs
Persons can apply for PACE or LIFE Program with the individual, regional PACE providers. Click here for a list. For more information about PACE Policy, please visit the National PACE Association website.
While there are many positives to these programs, an unfortunate reality is the application process can require patience and perseverance. For some programs in certain areas, the application and approval process can take as long as 9 months. This is by no means the case everywhere, but applicants and their families should be aware of this possibility.