PACE program helps seniors to live independently

As the baby boomer generation faces retirement, there is heightened interest in the best ways to care for older adults and prolong their abilities to live independently. A new study looks at seniors' abilities to perform essential daily functions after entering the PACE program, a large-scale managed-care initiative with 15,000 current U.S. participants.

“The objective of PACE is to enable individuals to live independently in the community and with a high quality of life,” said Dana Mukamel, Ph.D., lead study author and a senior fellow at the Center for Health Policy Research, University of California. “Maintaining or improving function is important in enabling frail elderly individuals to do so.”

The average program participant is 80 years old. Study data showed that at three months, 61 percent of enrollees reported no decline in functional skills and by 12 months, 43.3 percent still reported no decline.

Although these statistics might not seem like progress to a casual observer, study authors considered the slower rate of decline an important factor in the ability to prolong independent living.

The study appears in the latest issue of The Milbank Quarterly.

PACE participants must already be eligible for a nursing home, as the organization provides services in day centers. In the centers, enrollees receive therapy, personal and medical services, and supportive care. An interdisciplinary team of doctors provides both acute and long-term care. Therapy also includes help with functional skills such as bathing, dressing, grooming, walking and feeding.

One reason PACE successfully can integrate services is its ability to pool funding from Medicaid and Medicare. “This allows the program to be more flexible financially,” Mukamel said. Such flexibility can make it easier to deal with the whole patient and not just the patients' health problems.

“There's a bias in Medicare to provide acute care,” said Lynda Burton, Sc.D, associate professor at the Johns Hopkins Bloomberg School of Public Health. “If we can use Medicaid funds to deal with minor problems, we can sometimes prevent them from becoming acute.”

Despite the program's overall success, the study showed that there is room for improvement. According to Mukamel, PACE's medical teams are most efficient when a medical director who is also a geriatrician leads them. Patients seem to respond better to aides from a similar cultural background, the study also found.