Op-Ed: Yes, It’s Possible to Care Safely for Frail Seniors in Their Homes

The COVID-19 pandemic has made it clear that better ways are required to meet all the needs of this vulnerable population

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By Jill Viggiano, Michael DiBiase, Christine Lesicko, Pinni Friedman

As New Jersey’s population ages, keeping the frail elderly safe in their homes is a growing challenge — one that has been made all too clear by the COVID-19 crisis. Already, we’ve begun to see the analyses and recommendations for improving our elder-care system, all of which inevitably conclude, “there has to be another way.”

In fact, there is another way. It’s called PACE, or Programs for All-Inclusive Care for the Elderly, a community-based approach that provides comprehensive medical and social services to frail, elderly or disabled people still living in their homes. We’ve been there for our participants throughout COVID-19 and believe that PACE deserves a closer look as we explore ways to offer more options for holistic, coordinated and cost-effective care in the community for these vulnerable populations.

New Jersey’s six PACE organizations provide care to more than 1,000 elders and disabled participants in their homes and at PACE centers, which participants usually travel to several days a week. But since the state’s first coronavirus case in March, PACE organizations rapidly transformed to “PACE without walls” by implementing new technology, including telehealth, Facetime check-ins and even gaming platforms to bring the full complement of PACE services into their homes. Redeployment of PACE staff to add even more home visits, make daily meal deliveries and conduct virtual group leisure activities has kept participants connected to the PACE team and to one another — and most importantly, allowed them to remain safe in their homes.

Rapidly, readily adaptable

The quick pivot amid a pandemic illustrates the adaptability of PACE. Day in and day out, participants have received services in their homes to assist with their medical treatments, medications, activities of daily living and personal care, thanks to our teams of nurses and home health aides, with the necessary personal protective equipment and screening processes to keep them and participants safe. Each day, PACE nurses and social workers have made follow-up phone calls to participants to check on their health and wellbeing. Participants also received balanced meals in their homes prepared in our PACE kitchens, with cooks and servers shifting gears to package hundreds of meals daily. The PACE transportation teams have made sure our vehicles were clean and safe for the delivery of those packaged meals and for providing rides for any other required care. At the same time, the clinical team of physicians, nurses and therapists inside each PACE center has made sure that immediate-care needs are still being met by arranging safe visits to the PACE clinic when home visits or telehealth visits were not able to address their needs.

These actions have helped maintain the health and independence of the PACE participants who live in their own homes, and also prevented unwarranted emergency room visits and hospital stays, especially during the height of the pandemic.

In short, PACE successfully transformed itself from a program based at a center where individuals came each day into an entirely home-based model. That was made possible by staying true to PACE’s foundation of delivering flexible, person-centered care, to meet people where they are best served.

PACE is focused on the Medicare and Medicaid population who often have multiple complex chronic conditions and are at high risk for receiving health services that are not well-coordinated. To enroll, a person must be at least 55 years old, able to live safely in the community at the time of enrollment and need nursing-home-level care.  Approximately 90% of PACE participants are eligible for both Medicare and Medicaid. We’re very proud that PACE participants typically experience fewer stays in nursing homes and hospitals than similar beneficiaries, and their satisfaction and experiences with PACE are consistently rated high. That creates good value for the state’s Medicaid dollars

Stressing life in the community

The PACE organization is responsible for providing and coordinating all services, including medical care, behavioral health care and long-term services and supports across all healthcare settings. They receive set monthly payments from Medicare and Medicaid to cover all services from at-home care to hospital care. In other words, PACE is completely responsible for addressing the care needs and supporting the independence of participants within a set fee. PACE organizations have the flexibility to use funds for any service that will help participants remain safe and healthy in their homes — even needs like home modifications or household appliances. These are outside the realm of usual healthcare services, but they focus on social determinants of health like safe and appropriate housing that are essential to our participants’ ability to live in the community.

COVID-19, with its unforgiving aim at seniors who are frail or who have underlying chronic conditions, has been a foe that PACE has confronted with flexibility and resolve. There have been many valuable lessons learned since March, when New Jersey’s PACE centers were required to stop bringing large groups of elders and disabled participants into our those centers for social activities, services, therapy and support.  Without a doubt, the use of technology-enabled visits, monitoring and social interaction has enriched the PACE organizations’ trusting relationships with participants. PACE organizations are committed to using this experience as a foundation for even greater service to our participants going forward. Also among the lessons learned: the power of ingenuity to deliver more person-centered, flexible, community-based care for even the frailest population of elders. PACE has led by example. Now let’s make the PACE success story available to every New Jersey community and to new populations as we seek to achieve a more responsive, better-coordinated, higher-value approach to serving New Jersey’s most frail and deserving residents.

— The authors are members of the New Jersey PACE Association board of directors.

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