The Program of All-Inclusive Care for the Elderly (PACE) in California stands as a vital initiative, offering a comprehensive and integrated healthcare model tailored for older adults. Funded through both federal and state resources, PACE is designed to support seniors who wish to remain living in their communities but require a level of care typically provided in nursing homes. This innovative program coordinates a wide array of medical and social services, ensuring that participants receive the holistic support they need to maintain their independence and quality of life. PACE distinguishes itself by bringing together in-home care with access to adult day health care centers, where participants can benefit from medical attention, rehabilitation services, and social engagement.
Locating PACE Providers in California
It’s important to note that PACE services are not universally available across California. They are specifically offered within certain counties and zip codes. To determine if PACE is accessible in your area, the California Department of Health Care Services (DHCS) provides an updated online list of PACE service areas. You can find this information at the DHCS website dedicated to PACE programs: https://www.dhcs.ca.gov/individuals/Pages/PACEPlans.aspx. This resource is essential for anyone looking to explore PACE options for themselves or a loved one.
Eligibility Requirements for PACE in California
To be considered eligible for the Program for All-Inclusive Care for the Elderly in California, applicants must meet several key criteria. Firstly, the individual must be 55 years of age or older. A critical aspect of eligibility is the need for a level of care that aligns with the requirements for skilled nursing facility placement, as determined by the California Department of Health Care Services. This assessment ensures that PACE serves those who genuinely require comprehensive support. Furthermore, applicants must be able to reside safely within a community setting at the time of enrollment. Finally, and crucially, the applicant must live within a zip code that is serviced by a PACE program. Prospective participants can verify eligible service areas by visiting the DHCS website, www.dhcs.ca.gov/individuals/Pages/PACEPlans.aspx, where detailed lists of zip codes are maintained.
Understanding Payment Options for PACE Services
PACE in California operates through contracts with both Medi-Cal and Medicare, making it financially accessible for a wide range of eligible seniors. For individuals who qualify for Medi-Cal, PACE services are fully covered, incurring no additional out-of-pocket expenses beyond any existing Medi-Cal obligations, such as a shared monthly cost. It’s important to note that even Medi-Cal beneficiaries with a set monthly share of cost are still responsible for meeting this individual financial obligation. For those who are Medicare beneficiaries but do not have Medi-Cal, there is an option to enroll in PACE by privately paying the premiums for the long-term care portion of the program, which would typically be covered by Medi-Cal.
In situations where only one spouse requires PACE services, while the other does not, California’s Medi-Cal spousal impoverishment provisions offer significant financial protections. These provisions are designed to prevent spousal impoverishment, ensuring that the spouse not enrolled in PACE may be able to retain a greater portion of their income and assets, safeguarding their financial stability while their partner receives necessary care.
Comprehensive Services Provided by PACE Programs
Participants in the Program for All-Inclusive Care for the Elderly benefit from a highly personalized approach to healthcare. Upon enrollment, each participant undergoes a thorough evaluation by an interdisciplinary team. This team collaboratively develops a comprehensive care plan that is specifically tailored to meet the individual’s unique health and social needs. The range of services offered through PACE is extensive, aiming to address every aspect of a participant’s well-being.
Medical Care Services within PACE
The medical care component of PACE is robust and designed to be all-encompassing. Key services include:
- Primary Care Physician: Each participant receives primary medical care from a dedicated physician who is part of the PACE interdisciplinary team. This ensures consistent and coordinated medical oversight.
- Specialized Medical Care: Access to a variety of specialists is available, including audiology, dentistry, optometry, podiatry, and speech therapy, addressing a wide spectrum of healthcare needs.
- Medication and Medical Equipment: PACE covers prescription and non-prescription medications, as well as necessary medical equipment, ensuring participants have access to what they need without additional financial burden.
- Emergency and Hospital Care: PACE provides for emergency care, nursing home care when necessary, and hospitalization, ensuring that participants are covered across all levels of medical need.
In-Home Care Services
For many seniors, remaining at home is a priority. PACE supports this through in-home care services, which include:
- Assistance with Daily Living: Participants receive help with activities of daily living, such as bathing, dressing, and meal preparation, promoting independence at home.
- Light Housekeeping: To maintain a safe and comfortable living environment, light housekeeping services are also provided.
Adult Day Health Center Benefits
A significant feature of PACE is the adult day health center, which offers a range of therapeutic and social services:
- Rehabilitative Therapies: Physical and occupational therapies are available to help participants maintain or improve their physical function and mobility.
- Nutritional Support: Meals and nutritional counseling are provided, ensuring participants receive balanced nutrition and dietary guidance.
- Social Services and Case Management: Social workers offer case management services, connecting participants with resources and support systems to address their social and emotional needs.
- Recreational and Social Activities: The centers offer a variety of recreational and social activities, fostering social interaction and mental stimulation, which are crucial for overall well-being.
It is important to understand that PACE operates as an all-inclusive program. Participants cannot select individual services à la carte. Instead, the interdisciplinary team assesses each participant’s needs and designs a care plan that integrates the necessary services to best support their overall health and independence. This comprehensive approach ensures that all facets of a senior’s well-being are addressed, with the overarching goal of enabling them to live independently in their community for as long as possible.
The Role of the Interdisciplinary Team in PACE
A hallmark of the Program for All-Inclusive Care for the Elderly is its interdisciplinary team approach. This team is composed of a variety of healthcare professionals who work collaboratively to provide holistic care. Typically, a PACE interdisciplinary team includes:
- Primary Care Physician: Leads the medical care and overall health management.
- Clinic and Home Care Nurses: Provide nursing services both at the PACE center and in the participant’s home.
- Social Workers: Address the social, emotional, and resource needs of participants.
- Transportation Representatives: Coordinate transportation to and from the PACE center and medical appointments.
- Healthcare Workers: Assist with daily care and activities.
- Therapists: Occupational, physical, speech, and recreational therapists provide specialized therapies to improve function and quality of life.
All healthcare services a PACE participant receives are delivered and managed exclusively by this interdisciplinary team. Even if a participant requires hospitalization or nursing home care, the PACE team continues to oversee and coordinate their treatment and care, ensuring continuity and consistency. It’s also worth noting that PACE programs can contract with mental health specialists to provide mental health services as needed, further broadening the scope of care available. Important to note: Enrollment in PACE requires participants to receive care from PACE healthcare providers, meaning participants cannot continue with their existing doctors upon joining the program.
PACE and Residential Care Facilities for the Elderly (RCFEs)
For seniors residing in a Residential Care Facility for the Elderly (RCFE), PACE offers a unique opportunity. Individuals living in an RCFE can be enrolled in PACE simultaneously. While PACE does not cover the costs of room and board in the RCFE, it can cover a significant portion of medical expenses. This can be particularly beneficial for those who wish to remain in an RCFE setting and prefer not to move to a skilled nursing facility but require a higher level of medical care and face substantial medical bills. Given that RCFEs typically do not accept Medi-Cal for room and board, PACE can alleviate the financial strain of RCFE residency by covering the resident’s medical costs, making quality care more accessible.
Steps to Apply for PACE
Applying for the Program for All-Inclusive Care for the Elderly involves a straightforward process:
- Medi-Cal Enrollment: PACE is primarily funded through Medi-Cal. If you are not already enrolled in Medi-Cal, the first step is to apply at your local Social Services office.
- Service Area Verification: Visit the DHCS website (www.dhcs.ca.gov/individuals/Pages/PACEPlans.aspx) to confirm whether your zip code is within a PACE service area.
- Contact a Local PACE Provider: If PACE is available in your area, reach out to the PACE provider serving your location.
- Home Visit and Information Session: A PACE representative will schedule a home visit to provide detailed information about the program and answer any questions you may have.
- PACE Site Tour: Arrange to tour the PACE site to familiarize yourself with the facilities and meet some of the staff.
- Enrollment Agreement: If you decide to proceed, you will sign an Enrollment Agreement. This agreement remains in effect regardless of changes in health status, unless you choose to voluntarily disenroll or are involuntarily disenrolled based on program policies.
- Initial Assessment: Immediately following enrollment, a medical and social assessment will be scheduled with the interdisciplinary team to begin developing your personalized care plan.
Understanding the PACE Grievance Process
PACE ensures that participants have avenues to voice concerns and resolve issues. While participants are encouraged to initially discuss any dissatisfaction directly with PACE program staff, they also have formal rights to appeal decisions related to their covered services, including any denial or reduction of services. Every PACE program is required to provide participants with written details about their specific grievance and appeals process. If you have not received this information, contacting your PACE program directly is advisable. It is crucial to know that PACE services are mandated to continue uninterrupted throughout any grievance or appeals process. Common reasons for filing a grievance may include concerns about:
- Quality of PACE services received
- Wait times for staff assistance or service delivery
- Conduct of program staff or care providers
- Adequacy of PACE facilities
- Quality of provided food
- Reliability of transportation services
- Violations of participant rights
For a comprehensive understanding of PACE participant rights, Medicare offers a detailed guide titled “Your Rights in PACE“.
For participants covered solely by Medi-Cal, or by both Medi-Cal and Medicare, there is also the option to escalate grievances to the Department of Health Care Services. You can contact or write to the following departments:
Ombudsman Unit, Medi-Cal Managed Care Division
Department of Health Care Services
P.O. Box 997413, Mail Station 4412
Sacramento, CA 95899-7413
Telephone: 1-888-452-8609
TDD/TTY: 1-800-735-2922
PACE Compliance Team
Department of Health Care Services
[email protected]
916-713-8444
