Kansas hospice describes how its PACE program works

Participants receive day-long help

The first hospice to implement services under Medicare/Medicaid's Programs of All-inclusive Care for the Elderly (PACE) has made the philosophical skip to expanding its care to the frail and elderly who are not hospice-eligible.

"PACE is about helping people maintain the highest cognitive and physical levels possible, and it's about wellness, coordinating, and managing care, and it's more palliative in nature than aggressive," says Karren Weichert, president and chief executive officer of Midland Hospice Care of Midland Care Corp. in Topeka, KS.

"It's aggressive to the point that you want to help people maintain their independence," Weichert says. "There are some aggressive components in terms of how much physical therapy and occupational therapy a person needs, but our goal is to keep people healthy as long as possible so they can focus on their quality of life."

When the Midland Care Corporation's PACE program officially opened Feb. 1, 2007, it consisted of an adult day center in which 51 frail, elderly people could receive services on any given day. It also has a clinic, showers, and a therapy room.

The PACE team is interdisciplinary and consists of a nurse, social worker, home care coordinator, clinic nurse representative, a transportation coordinator, adult day center site director, an occupational therapist, a physical therapist, a dietitian/nutritionist, and a physician. A speech therapist is called in when deemed necessary, Weichert says.

"Essentially, PACE provides everything a participant needs in terms of health support services, from the primary care to cardiologists, to eyeglasses, to a podiatrist, to a wheelchair and lifeline in case the person falls," Weichert explains. "We even provide meals if the person needs them, we help to keep the person's diabetes under control, and we provide all pharmaceutical needs."

PACE enrollees typically meet eligibility requirements for both Medicaid and Medicare, as well as for these 4 criteria:

  • they are age 55 or older;
  • they live in the service area of the PACE site;
  • they meet the threshold score set by their state to be eligible for long-term care services; and
  • they have the ability to live safely in the community with supports in place.

If the potential enrollee is already on Medicaid, the enrollment could be concluded in as little as 10 days, Weichert says.

"If someone is filling out the Medicaid application, too, it could take 45 to 50 days," she says. "From the time we get our information into the state for their assessment in determining the frailty score, the state will take about 48 hours to turn it around, so the process can be quick if the other components are in place."

A typical PACE enrollee may be 85-years-old with congestive heart failure. He will have had a stroke and is wheelchair bound. PACE staff will encourage him to attend the day center as much as possible after first bringing him to the center on a trial basis, Weichert says.

Once enrolled, the man is assessed by a nurse, a physician, a dietician, occupational/physical therapists, and an activities coordinator.

"They talk to the patient about what his goals are, and we develop a plan of care around the goals," Weichert says.

Goals might be as simple as these:

  • "I want to be able to transfer myself to go to the bathroom."
  • "I want to get out of this wheelchair."

"These people want to live as fully as possible, so we develop a plan of care around that idea," Weichert says.

The recommended course of action might be to have the person come to the day center 3 days a week. PACE will send someone to the person's home to get him ready and to pick him up. Once at the center, the person will be given physical therapy by a physical therapist or physical therapy assistant, Weichert says.

The person will receive a consultation with the dietitian, as well as see the nurse practitioner once a week. The physician will see the person once a month unless the health needs are complicated, she adds.

"We will involve the person with a product called 'It's never too late,'" Weichert says. "It's an interactive computer system that's great to utilize to improve cognitive and physical ability."

The PACE enrollee also will have lunch while at the day center, and he'll receive a teeth cleaning from a dental hygienist. If the person has an appointment with a cardiologist or another specialist, PACE staff will transport him to the appointment, stay with him during the doctor's visit, and then escort him back to the day center, Weichert says.

"Then we'll take him home in the evening, and we'll send out a home health aide to get him ready for bed, prepare his evening meal, and let the dog out before he settles in for the night," she adds.