Project Summary/Abstract. PACE (the Program of All-Inclusive Care for the Elderly) is a well-known and
respected financing and care delivery model for a very challenging population: Medicaid-covered adults over
age 55 needing a nursing home level of care, 90% of whom are also covered by Medicare. PACE participants
are generally dependent in at least 2 activities of daily living (ADLs) or need constant supervision due to
cognitive disability. To be eligible for PACE enrollment, participants must be able to live safely in the
community with PACE services. The heart of the PACE model lies in its comprehensive service array, starting
with a participant-centered care plan constructed in partnership with a multidisciplinary care team and
anchored in a PACE Day Center that regularly offers medical care, personal care, therapies, meals,
socialization, transportation, and activities.
During the COVID-19 pandemic, PACE programs have used their flexibility as a community-based provider of
medical and long-term services and supports (LTSS) to redesign service delivery and keep frail elders as safe
as possible in the community. Preliminary reports to the National PACE Association (NPA) indicate that most
programs quickly expanded telehealth and moved many services to the home. Anecdotal accounts indicate
that some programs have implemented remarkable adaptations: e.g., providing overnight care (not typically
allowed in PACE), renting hotel rooms for infected participants, making part of the PACE Center an isolation
area, redefining staff roles and providing training in those new roles, and providing post-hospital therapies in
the PACE Center to avoid sending frail elders to post-acute stays in nursing homes, which have had high rates
of COVID-19 infection. However, to this point, researchers have not systematically investigated, compiled, and
evaluated the responses of PACE programs.
Our project will provide authoritative information for each of three six-month phases of the COVID-19
experience, identify emerging best practices, and compare PACE performance to traditional Medicare
services, adding to the knowledge base of innovative responses used during the COVID-19 pandemic to guide
ongoing policy and practice. We will build on an existing NPA database, supplementing it with an online survey
of PACE programs. We will identify responses that PACE programs report as being substantially beneficial,
and those that have not been effective, for the following: PACE participants, their families, the availability and
quality of eldercare services in the geographic community, the healthcare workforce, and PACE program
finances. We will compare the utilization and quality outcomes of PACE participants and comparable Medicare
fee-for-service beneficiaries. We will dig deeper into promising adaptations through structured interviews. We
will estimate the potential effects of broad spread of better practices, and we will continuously feed our insights
into the research, clinical practice, and policy worlds to engender improvements in eldercare arrangements.
