Responses of the Program of All-Inclusive Care of the Elderly (PACE) Organizations to COVID-19 Challenges: Effects and Lessons Learned

Project Summary/Abstract. PACE (the Program of All-Inclusive Care for the Elderly) is a well-known and respected financing and care delivery model for a very challenging population: Medicaid-covered adults over age 55 needing a nursing home level of care, 90% of whom are also covered by Medicare. PACE participants are generally dependent in at least 2 activities of daily living (ADLs) or need constant supervision due to cognitive disability. To be eligible for PACE enrollment, participants must be able to live safely in the community with PACE services. The heart of the PACE model lies in its comprehensive service array, starting with a participant-centered care plan constructed in partnership with a multidisciplinary care team and anchored in a PACE Day Center that regularly offers medical care, personal care, therapies, meals, socialization, transportation, and activities. During the COVID-19 pandemic, PACE programs have used their flexibility as a community-based provider of medical and long-term services and supports (LTSS) to redesign service delivery and keep frail elders as safe as possible in the community. Preliminary reports to the National PACE Association (NPA) indicate that most programs quickly expanded telehealth and moved many services to the home. Anecdotal accounts indicate that some programs have implemented remarkable adaptations: e.g., providing overnight care (not typically allowed in PACE), renting hotel rooms for infected participants, making part of the PACE Center an isolation area, redefining staff roles and providing training in those new roles, and providing post-hospital therapies in the PACE Center to avoid sending frail elders to post-acute stays in nursing homes, which have had high rates of COVID-19 infection. However, to this point, researchers have not systematically investigated, compiled, and evaluated the responses of PACE programs. Our project will provide authoritative information for each of three six-month phases of the COVID-19 experience, identify emerging best practices, and compare PACE performance to traditional Medicare services, adding to the knowledge base of innovative responses used during the COVID-19 pandemic to guide ongoing policy and practice. We will build on an existing NPA database, supplementing it with an online survey of PACE programs. We will identify responses that PACE programs report as being substantially beneficial, and those that have not been effective, for the following: PACE participants, their families, the availability and quality of eldercare services in the geographic community, the healthcare workforce, and PACE program finances. We will compare the utilization and quality outcomes of PACE participants and comparable Medicare fee-for-service beneficiaries. We will dig deeper into promising adaptations through structured interviews. We will estimate the potential effects of broad spread of better practices, and we will continuously feed our insights into the research, clinical practice, and policy worlds to engender improvements in eldercare arrangements.