Dr. Frank Landry, Medical Director for PACE Vermont and Clinical Associate Professor of Medicine at the UVM College of Medicine outlines how PACE delivers better long-term care to elderly Vermonters while saving the state money.
Q: In a nutshell, how does PACE work?
PACE, the Program of All-Inclusive Care for the Elderly, is a health care program that helps seniors (55+) who qualify for nursing home care remain in their homes.
Services are organized by a health team that includes a doctor, nurses, physical and occupational therapists, social worker, nutritionist, transportation coordinator, and more. The PACE Center includes a physician's office, therapy gym, and adult day program.
PACE caregivers help with household chores and personal care. PACE coordinates visits to medical specialists like podiatry, cardiology, and optometry. We work closely with clinical pharmacists and pay for all medications and even deliver medications right to the home.
PACE also arranges and pays for all in-patient services, including hospitalizations and nursing home stays for respite, rehabilitation, or long-term placement.
The program is paid for by a combination of Medicare and Long Term Care Medicaid. Families that do not qualify for Medicaid can pay privately (with or without a long term care insurance policy).
Q: What are some of the key benefits to the PACE approach for patients and for the health care system/government?
The main benefit in my view is the personal attention that each patient and family receives. The entire team of professionals gets to understand the important issues and works collaboratively with the individual and family to improve health and maintain function. Each patient has a plan of care designed just for them which includes input from the entire team as well as the patient and family. In addition, the health team can respond to new issues very quickly -- often the same day.
Family members report the biggest benefit is in the wrap-around services like transportation, medication delivery, and our on-call system. Families also report they are relieved to know their loved one has a safe place to go during the day. Many find that this program costs less than the services they had previously been using.
State and Federal government supports PACE because it is cost effective. The payment structure allows the government to anticipate how much a PACE enrollee will cost. This structure allows us to focus on care that makes the most sense for the patient in the most cost-effective manner. The PACE system is the ultimate "medical home" and is what most primary care physicians envision when they speak of health care reform. What is nice for me is that I can practice in this environment now!
Q: Do you consider the sites here and in Rutland to be successful and what comes next? Further expansion?
Absolutely! Early this year, Tara Meyer, a graduate student in UVM's Nurse Practitioner program, did a study that showed a significant reduction in emergency room visits, hospitalizations, and length of stay in the hospital among PACE enrollees. This is just one example.
We are just three years old, so our focus in the next 1-2 years will continue to be filling our two centers. Once full, we can look at expanding statewide.
As a member of the National PACE Association, we support the expansion of PACE throughout the US, especially in rural areas. There are currently 72 PACE programs in 31 states. Fifteen of these programs are in rural areas. We believe this model of care provides a viable solution to the challenge of providing and paying for the care of our elders, who deserve the very best care we can offer.
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