PACE Programs: Just the FAQs

What is a PACE program?

A PACE program is a healthcare option that allows the elderly to stay in their homes, even if they are frail. The program is built on the belief that seniors — even those with chronic care needs — are better served when they can live in the community.

PACE programs offer medical and social services in an adult daycare setting in their own facilities. These services are supplemented by in-home and referral services, depending on participant needs.

What is the goal of PACE?

The goal of a PACE program is to allow every participant to achieve and maintain the highest functional level possible. PACE organizations focus on helping the frail and elderly live in the community for as long as possible, and to meet this goal, PACE organizations focus on preventive care. PACE programs seek to manage chronic conditions effectively, and reduce the number of hospitalizations.

Who is eligible to participate in a PACE program?

At the time of enrollment, participants must be 55 years of age or older, require nursing home level of care and must be able to live safely in the community. Participants must live in the PACE service area as well.

Why should I choose a PACE program?

PACE programs allow their participants to get the care and supervision they need during the day, while enjoying the comforts of home and family, rather than moving into a facility. PACE programs allow caregivers the freedom they need to live regular lives while caring for an elderly loved one.

How do I enroll in a PACE program?

Enrollment is voluntary, and based on eligibility. A comprehensive assessment is performed, and a care plan is presented to the participant.

Can I be denied enrollment?

Enrollment is dependent on the participants ability to live safely in the community.

What services are provided at a PACE center?

PACE centers provide participants with a broad continuum of care. Services include nursing and personal care, as well as physical, occupational and recreational therapy.

Meals and nutritional counseling promote wellness.

Social services are provided to help participants and their families.

Other services include the following:

  • Primary Care
  • Hospital Care
  • Medical Specialty Services
  • Prescription Drugs
  • Nursing Home Care
  • Emergency Services
  • Home Care
  • Physical therapy
  • Occupational therapy
  • Adult Day Care
  • Recreational therapy
  • Meals
  • Dentistry
  • Nutritional Counseling
  • Social Services
  • Laboratory / X-ray Services
  • Social Work Counseling
  • Transportation

 

Are doctors available at the center?

Each PACE program has a group of physicians on staff, providing medical care as needed. This group is typically composed of a medical director who guides the program and oversees other physicians.

PACE physicians become familiar with the history, needs and preferences of each participant.

Medical specialties, such as audiology, dentistry, optometry, podiatry and speech therapy are usually present.

What if I need to see a specialist?

PACE programs provide transportation to appointments in the community. PACE organizations also provide all medically-necessary transportation to the PACE center for activities or medical appointments.

What if I need more care?

If a PACE enrollee needs nursing home care, the PACE program pays for it, while continuing to coordinate the enrollee’s care. While all PACE members must be certified to need nursing home care, only about 7 percent of PACE participants nationally reside in a nursing home.

What happens if I find that the PACE program is not for me?

PACE participants may dis-enroll from the program at any time and for any reason. Those with Medicare or Medicaid will be assisted in returning to their former health care coverage.

A participant’s enrollment continues as long as they wish, regardless of change in health status, until expiration or voluntary or involuntary dis-enrollment.

How much does PACE cost, and who pays for it?

Medicare and Medicaid are the largest contributors to PACE programs, though there are other options.

Medicare
The participant can have Medicare as the only source of insurance with either part A or part B separately or combined. There is an out-of-pocket cost for long-term care insurance.

Medicaid
Some participants have only Medicaid coverage and no other.

Dual Eligible
Some participants are covered by both Medicare and Medicaid.

Private Insurance
Some participants have long-term care or other insurance that pays, either in whole or in part, the long-term care premium.

Private Pay
Some participants pay both the Medicare and Medicaid capitation amounts privately, out-of-pocket.

If you qualify for Medicare, all covered services are paid for by Medicare.

If you also qualify for your State’s Medicaid program, you may have a small monthly payment for long-term care insurance. Some Medicaid participants do not need to pay at all.

If a participant not qualify for Medicaid, they will be charged a monthly premium to cover the long-term care portion of the PACE benefit as well as a premium for Medicare Part D drugs.

PACE programs never have a deductible or copayment for any drug, service, or care approved by the PACE team.

Beacon of LIFE, in Oceanport, NJ, is a government-approved PACE program created to provide seniors, their family, caregivers and professional health care providers the flexibility to meet their health care needs while continuing to live in their community.

Beacon of LIFE maintains an interdisciplinary team of professionals who give each client the coordinated care they need. Our staff specialize in working with older people, and work with each client and their family to develop the most effective plan of care.

Our care and services allow people who would otherwise need to live in a nursing home to live where they want — in their own communities, in their own homes.

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