The Program of All-inclusive Care for the Elderly (PACE) is a managed care model of acute and long-term care that integrates the provision and financing of medical and long-term care services. PACE programs assume full financial risk for enrollees' care without limits on dollars or duration and are responsible for a full range of needed services. The PACE model is centered around the belief that it is better for the well-being of seniors with chronic care needs and their families to be served in the community whenever possible. PACE is a comprehensive service delivery and financing model of acute and long-term care created by On Lok Senior Health Services in San Francisco, California. PACE programs, after achieving full provider status, receive Medicare and Medicaid capitation payments (dual capitation) for all enrollees eligible for services. Persons financially ineligible for Medicaid pay that amount privately (out-of-pocket).

PACE enrollees must be at least 55 years old, live in the catchment area of the PACE program, be able to live safely in the community at the time of enrollment and be certified as eligible for nursing home care by the appropriate state agency. The goal is to maximize each enrollee's autonomy and continued community residence and to provide quality care at lower cost to Medicare, Medicaid and private-pay enrollees relative to their payments in the traditional system. An interdisciplinary team, consisting of professional and paraprofessional staff, assesses enrollees' needs, develops care plans and delivers services which are integrated for a seamless provision of total care.

Services, including primary care, social work and restorative therapy, are provided in the PACE Center, at home and in the hospital. Specialty and ancillary medical services are provided, as are long-term care services such as transportation, meals and personal care. If the time comes when nursing home placement is the only alternative, PACE would provide funding for that service and maintain the continuity of care by regular monitoring of the enrollee's condition. Use of preventative and rehabilitative services can stabilize chronic conditions and prevent or lessen complications of disease, thereby enhancing participants' lives.

Delivering all needed medical and supportive services, the program is able to provide the entire continuum of care and services to seniors with chronic care needs, while maintaining their independence in their homes for as long as possible. Care and services include:

• Adult day care that offers nursing; physical, occupational and recreational therapies; meals; nutritional counseling; social work and personal care
• Medical care provided by a PACE physician familiar with the history, needs and preferences of each participant
• Home health care and personal care
• All necessary prescription drugs
• Social services
• Medical specialties such as audiology, dentistry, optometry, podiatry and speech therapy
• Respite care
• Hospital and nursing home care when necessary

Illinois' experience with PACE

Chicago REACH is presently a pre-PACE site with Medicaid capitation only, however, the department has been working with this provider to transition the program to full PACE (dual capitation). Medicare services for participants are paid on a fee-for-service basis. REACH has operated a pre-PACE model project in Chicago since 1995. Sacred Heart Hospital sponsors the program, which is a not-for-profit entity (501(c)(3)). As of As of January 2006, the census between the two REACH sites is about 215 participants.

REACH provides day care services at two sites as well as in-home services including homemaker/chore services, personal care attendants and nurse wellness checks.

REACH operates two sites:

Chicago REACH
4501 West Augusta Boulevard
Chicago, IL 60651
Phone: 773-252-8989
Fax: 773-252-8995
E-mail: chicagoreach1@aol.com
Web site: Chicago REACH

Chicago REACH
1223 West 87th Street
Chicago, IL 60620
Phone: 773-881-6822
Fax: 773-881-6818
E-mail: chicagoreach1@aol.com
Web site: Chicago REACH

More information on PACE

Centers for Medicare and Medicaid Services PACE Information for States and Providers

Centers for Medicare and Medicaid Services PACE for the Elderly

Federal Regulation 42 CFR 460

National PACE Association

On Lok SeniorHealth