Veterans life insurance

Meet the Elder Care Underdog

Felicia Biteranta was struggling when, five years ago, she enrolled in a PACE program run by Lutheran Senior Life in Jersey City, NJ

Victim of a stroke, she had trouble eating without choking. She fell frequently; his diabetes was out of control; she had lung disease and asthma. She might miss a medical appointment if she couldn’t arrange or pay for a taxi. His family lived far away.

She was, in short, a candidate for a nursing home. But such a decision is what PACE – the All-inclusive senior care program — was designed to prevent.

“The main goal is to let people age in place,” said Maria Iavarone, executive director of the PACE program in which Ms. Biteranta participates. “No one wants to abandon their home. This is where you are most comfortable. This is where you should stay.

Ms Biteranta now receives all of her health care through PACE, which meticulously monitors her and 120 other elderly people. PACE also provides much of its social life.

“Here they set up appointments for you,” said Ms Biteranta, 74, a retired nurse. “They send someone to pick you up and bring you home.”

Carpal tunnel syndrome in her wrists and arms makes self-care and household chores difficult, so PACE sends home help 12 hours a week. “She cleans and does my laundry and shopping,” Ms Biteranta said. “She knows the food I like.”

PACE provided the portable oxygen unit that freed her from reliance on the larger oxygen tanks she uses at home. He has arranged cataract surgery and regularly takes him to a podiatrist, cardiologist, endocrinologist and other specialists. It provides a host of free medications, including asthma inhalers and diabetes screening supplies. A staff social worker helped her apply and move into an apartment in a subsidized building for the elderly.

As a Medicaid beneficiary, she pays nothing for that care — no co-pays, deductibles or other out-of-pocket care expenses, and no caps on benefits. If she needs more hours of home care or possibly a nursing home, PACE will cover those costs as well.

“It’s no worries,” said Ms. Biteranta, who was preparing for lunch at the PACE Center as she spoke. “They worry about me.”

Yet the state and federal government are also saving money. PACE programs receive a fixed monthly amount from Medicare and Medicaid to provide almost everything to people over age 55 whose needs qualify them for a nursing home but who don’t want to enter it. This includes doctor visits, tests, procedures, physical therapy, occupational and speech therapy, social workers, home care, transportation, medications, dentistry, and hearing aids. Participants typically visit a PACE center like the one in Jersey City several times a week for meals and social activities as well as therapy and health monitoring.

This monthly payment is 15% less, on average, than what Medicaid would normally pay to care for low-income seniors, the National PACE Association said.

Research has shown that PACE programs reduce hospitalizations, emergency room visits and stays in nursing homes. Participants survived longer than similar patients in less comprehensive programs. A study carried out last year by the Federal Department of Health and Human Services noted that the PACE program “stands out in our analysis as consistently ‘high performing’.”

Why, then, are there so few PACE programs — and enrolling so few older Americans? Nearly three decades after Medicare and Medicaid began funding PACE programs — today there are 144, operating 272 centers in 30 states — the effort collectively serves fewer than 60,000 people, the National PACE Association reports. .

The association estimates that 1.6 million Medicare beneficiaries could meet the PACE eligibility criteria. As shown in a list of current programshowever, 21 states do not have a PACE program and 11 have only one.

Aged care professionals tend to be fans. “Every geriatrician loves this model,” said Mark Lachs, co-chief of geriatrics and palliative medicine at Weill Cornell Medicine.

Specialists like Dr. Lachs have complained for years that mainstream health insurance will cover expensive surgeries to fix broken hips, but won’t pay to install inexpensive grab bars that could prevent falls. With PACE’s fixed payments, “there may be less money, but you spend it the way you want, without calling for insurance company approval,” Dr. Lachs said.

At the ArchCare PACE program in New York, for example, “if a person’s air conditioner breaks down during a heat wave, we replace it,” said Walid Michelen, the program’s chief medical officer. “If there’s a snowstorm and they need food, we send it.”

With coordinated care and careful observation, “you prevent a urinary tract infection before it becomes sepsis,” said Jay Luxenberg, the former chief medical officer of the About LokPACE program in San Francisco. “Or pneumonia when it can still be treated with antibiotics, before it desperately needs a hospital.”

Still, growth has been slow. “We’ve had a lot of headwinds over the years,” said Shawn Bloom, the association’s chief executive.

Persuading state legislators to expand PACE enrollment or authorize new programs has proven difficult; such moves represent new expenses, even if they end up reducing costs.

For individuals, the registration process — which involves an evaluation by the state to determine whether their medical conditions, cognitive status and functional limitations would warrant a nursing home — can take weeks. A family that needs elder care immediately may not be able to wait.

Moreover, agreeing to receive all health care from PACE often means forgoing one’s personal physician, and some patients balk at this request. Programs can circumvent this barrier by allowing PACE programs to work with community physicians.

But potential patients may not know about PACE at all. “We’re trying to spread awareness, but we don’t have ‘Do you have any milk?’ budget,” Bloom said.

Yet the pandemic has heightened the desire of older Americans for alternative forms of long-term care. “If people didn’t want to be in care homes before Covid, they really don’t want to be there now,” Dr Lachs said. According to the association, Covid deaths among PACE participants were about a third of those among nursing home residents.

So PACE’s growth is accelerating, with 45 new programs expected to begin enrolling over the next two years, in part due to higher federal incentives. Additionally, for-profit companies are beginning to establish or acquire PACE programs, although skeptics fear that for-profit status will reduce the quality.

Several bills introduced in Congress would remove barriers to growth; partnerships would be established with veterans’ hospitals to make CAPC more accessible to veterans.

Another intriguing possibility is to encourage middle-class patients, for whom long-term care costs can also be devastating, to enroll in PACE. Seniors who aren’t poor enough to qualify for Medicaid can already participate, but few do because their monthly premiums would be high — in many states $4,000 to $5,000 a month.

But that’s still less than they would pay for nursing homes or assisted living facilities in many places. Policy analysts are looking for ways to cut costs and expand eligibility for middle-class CAPC.

In Jersey City, Ms. Biteranta is doing well, although she misses concerts, Zumba classes, birthday parties and other events at the PACE center. Administrators reduced these activities during the pandemic, but hope to restore them as Covid rates drop.

“Oh my God, I would be so depressed” without PACE, Ms Biteranta said. “It gives me a life.”