Rural program aims to keep elderly in homes, communities

Lack of family practice physicians, availability of transportation, and high fuel costs. These are three of the challenges faced by state Medicaid directors who are trying to increase health care options for elderly populations in rural regions.

North Dakota Medicaid worked with the Northland Healthcare Alliance to develop the Program of All-Inclusive Care for the Elderly (PACE) program to meet the needs of elderly residents.

"As the state's elderly population continues to grow, we must explore options to allow individuals to remain in their homes and communities safely," says Tania Hellman, RN, BSN, MM, CCM, administrator of managed care for the medical services division at the North Dakota Department of Human Services.

The goals of the program are twofold: To provide quality health care services with a strong focus on prevention, and at the same time, to provide a comprehensive package of services in a "one-stop shop."

PACE recipients receive health benefits such as immunizations, along with ongoing monitoring of their health and well-being.

"These benefits are made available by a variety of providers which make up the health care team," says Ms. Hellman. "We feel this is an excellent way to provide seniors with another option to live independently. We provide a simple method of meeting their needs by having contact with one entity."

By using a coordinated approach, the medical team is alerted to potential problems at a much earlier point in time, thus possibly preventing complications. The health care team includes transportation personnel, medical assistants, physical and occupational therapists, dietitians, nurses, physicians, and others.

"The comprehensive package of services involves a primary network of medical providers and others who are able to provide coordinated care and other services," says Ms. Hellman. "By maintaining ongoing communication through events such as interdisciplinary team meetings, this may allow for the decrease of potential medical complications."

Program in early stages

Since the program is in its early stages, Ms. Hellman says she does not yet have results on cost savings that have resulted. "However, we are hoping for continued quality care and services," she says. "This will hopefully allow PACE recipients to remain as independent as possible in their homes and communities."

Ms. Hellman says she anticipates that the PACE program's focus on preventive care, health and well-being will decrease hospitalizations, lower inpatient bed days, and decrease emergency department visits.

However, providing comprehensive health care services and support to seniors is going to be difficult, according to Ms. Hellman. "North Dakota Medicaid clients do not have a great deal of experience with services delivered through capitated managed care arrangements," she says. "Therefore, educating the population on these types of programs may be challenging."

Telemedicine will be used at the rural PACE site to assist in communicating and providing health care from the rural site to the primary Bismarck location. This decreases the need for PACE recipients to travel long distances when they are in need of specialized health care that may not be readily available in the rural area.

"We will be monitoring our results, with the option to expand and meet the needs of other communities in North Dakota," says Ms. Hellman. "We are hoping our state will become a model for others contemplating a rural PACE site."

Contact Ms. Hellman at (701) 328-3598 or