1. Hansen, Jennie Chin MS, RN
  2. Van Steenberg, Carol MSS

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PACE-the Program of All- Inclusive Care for the Elderly-serves older adults in 18 states who need long-term care and want to remain in the community. PACE provides a cost-effective approach to the provision of comprehensive care to Medicare and Medicaid beneficiaries. Providing health care and social services by an interdisciplinary team, PACE includes adult day health care, as well as primary, specialty (such as dentistry, optometry, and cardiology), ancillary, and home care; hospital and nursing home care; medication oversight; and transportation to medical appointments. PACE is available to anyone age 55 or older who meets state criteria for nursing home admission, resides in the service area, and can live safely in the community.


There were 9,028 participants in PACE in 2003. The average participant was over age 80; had eight diagnosed medical conditions; took seven prescribed medications; and needed help with 2.52 activities of daily living, including bathing, dressing, grooming, using the bathroom, walking, and eating. Almost two-thirds suffered from cognitive deficits. In 2003 PACE participants averaged hospital stays of 2,581 days per 1,000 enrollees, and 7% resided in nursing homes. This is in keeping with the most recent data available on the general elderly population: in 2001, in people ages and over 75, there were 2,734 days of hospitalization per 1,000 people, and in 1999 18% of those ages 85 and over resided in nursing homes (calculated according to data from the U.S. Census and the National Nursing Home Survey).


Each PACE center combines adult day health care and primary care, has its own interdisciplinary team, and serves between 70 and 150 participants. The team includes at least one each of the following: physicians, nurses, social workers, occupational and physical therapists, dietitians, recreational therapists, managers, and others such as drivers and home care workers. The team assesses each participant before enrollment and, along with the participant and family, decides upon a treatment plan. All participants are assessed at least every six months (more frequently if needed). PACE programs feature strong nursing leadership and emphasize professional nursing values: they provide person-centered, comprehensive care that's interdisciplinary, of high quality, and committed to innovative problem solving while remaining affordable.


On Lok SeniorHealth Services in San Francisco created the prototype for PACE in the early 1970s, and it spread to other communities with the support of the John A. Hartford Foundation, the Robert Wood Johnson Foundation, the Retirement Research Foundation, and other major foundations. Since 1997 Medicare and Medicaid have provided most PACE funding through monthly capitation payments to approved nonprofit organizations. Today, there are 32 PACE providers in 18 states; another 12 pre-PACE programs operate under Medicaid only, and dozens more are under development.


To consumers, PACE provides one-stop shopping for health care, as well as support to live in the community as long as possible. To health care organizations, PACE offers control over the range of services and freedom from traditional fee-for-service reimbursement restrictions. To payers, PACE yields cost savings. For more information, visit




[black down pointing small triangle] In 2000, 71% of home health care recipients were ages 65 and over.


[black down pointing small triangle] Of older adults living in the community in 2003, those who needed help with personal care from others included 3% of adults ages 65 to 74, 7% of adults ages 75 to 84, and 23% of adults ages 85 and over.


[black down pointing small triangle] In 2002 more than 1.6 million fall-related injuries to persons ages 65 and over (4,603 per 100,000 population) were treated in EDs, and more than 351,000 (21%) resulted in hospitalization.