Program Review: PACE/ESPs

 

PACE (Program of All-Inclusive Care for the Elderly) is a model of delivering health care that focuses on elders who are frail enough to qualify for nursing home care. PACE offers and manages all of the medical, social and rehabilitative services their enrollees need to preserve or restore their independence and to remain in their homes and communities. The PACE service package must include all Medicare and Medicaid services provided by that state. In addition, the PACE organization provides any service determined necessary by the interdisciplinary team. Minimum services that must be provided in the PACE center include primary care services, social services, restorative therapies (PT, OT), personal care and supportive services, nutritional counseling, recreational therapy and meals. Generally, these services are provided in an adult day health center setting, but may also include in-home and other referral services that enrollees may need. This includes such services as medical specialists, laboratory and other diagnostic services, hospital and nursing home care.

A team of doctors, nurses and other health professionals assess participant needs, develop care plans, and deliver all services. In Massachusetts PACE plans are known as Elder Service Plans (ESPs).

ESP Eligibility

• age 55 or older
• live in the service area of an ESP/PACE organization
• able to live safely in the community
• certified by the state as eligible for nursing home care
• agree to receive health services exclusively through the ESP/PACE organization

The MassHealth income and asset rules for ESP/PACE are:

• countable income must be no greater than $2022 per month in 2011.
  Note: The income limit is three times the federal SSI benefit amount. In 2011, the federal SSI benefit amount is $674 per month.
• countable assets must be no greater than $2000.
• a spouse's income and assets are not counted.

Fees

ESPs are covered by Medicare and MassHealth. Those who do not qualify for MassHealth may have to pay a monthly premium, but there are no copayments, deductibles, or other cost-sharing fees.

FAQs

• Can I keep my doctor and my specialists?
  No, when you sign up for the program you agree to get all of your care through the program. An ESP doctor will be provided who will coordinate your care. As of this writing, MGH primary care physicians do not participate in any ESP programs. Each ESP program has certain specialists that they use on a case-by-case basis.
• What doctor will see me if I am hospitalized?
  The same team of clinicians manages each participant's care, whether in the home, a contracted assisted living facility, a contracted hospital, or a contracted nursing home.
• How many hours of home health aide services will I get if I stay at home?
  This is determined by the team, family and participant. Due to the preventive nature of the program, participants usually receive daily service.
• How do ESPs work with assisted living facilities?
  We have a listing of contracted facilities. We cover the cost of the home-care component in these settings. You are responsible for rent. For more information, contact an Elder Service Plan representative.
• What do they do at the day-care center? Do I have to attend every day?
  The Adult Day Health Center has recreational activities. Clinicians and rehabilitation staff are located on-site. Each case is reviewed on an individual basis to determine the ideal number of days of participation per week, which is then discussed with the family and the participant. Some participants come for appointments only.
• What happens if I need nursing home care?
  ESP has contracts with specific nursing homes in the area. (Call us for a list of contracted nursing homes).

Locations

There are six PACE programs in the State, each of which covers its own geographic area. Contact one of the sites listed below to see if your city or town is covered:

1. Harbor Health Elder Service Plan
   ( Suffolk County and many parts of Norfolk County): 617-533-2400
2. Uphams Elder Service Plan ( Suffolk County): 617-288-0970
3. Summit Elder Care ( Worcester County): 508-852-2026
4. Elder Service Plan of the North Shore ( Essex County): 781-581-7565
5. Elder Service Plan of East Boston Neighborhood Health Center
   ( Chelsea, East Boston, Revere and Winthrop): 617-568-4602
6. Elder Service Plan of Cambridge Health Alliance : 617-575-5850

Thanks to Rachel Stronge for this story idea.

-Adapted from: http://www.medicare.gov/nursing/alternatives/pace.asp, http://www.massresources.org/elder-service-plans.html (no longer operational), and http://www.elderserviceplan.org/faqs/index.htm

 

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