Altarum Research Shows Resiliency of the PACE Program During the COVID-19 Pandemic

February 02, 2024

With funding from the Agency on Healthcare Research and Quality (AHRQ) and endorsement from the National PACE Association (NPA), Altarum cataloged innovations and adaptations made at PACE sites nationwide in response to the COVID-19 pandemic from 2020 and 2021. The project entailed a mixed-methods approach.

The Program of All-Inclusive Care for the Elderly (PACE) offers Medicare and Medicaid services to older adults, covering (and often providing) all necessary services for participants based on their individual plans of care. Like other providers, PACE organizations faced a crisis when the COVID-19 pandemic began, mainly because of the older age and high acuity of their participants. While some evidence suggested PACE organizations adapted rapidly, critical knowledge gaps remained about the nationwide PACE response, including the range and distribution of the adaptations implemented to continue delivering services, to the COVID-19 pandemic. 

To fill these knowledge gaps, we fielded two surveys with nearly every PACE organization in the country in mid-2021 and 2022 to understand how they responded to the pandemic and whether they planned to continue the adaptations they implemented. Between the two surveys, we conducted six follow-up interviews with PACE directors. Our goal was to gather information on how PACE organizations met the needs of older adults with complex care and functional requirements during the pandemic's initial and later stages. We also examined whether the PACE model, with its capitated payment structure, integrated and flexible services, and focus on person-centered care, facilitated adaptation. 

This study complements a second companion study that examined care outcomes for PACE participants versus a similar cohort of fee-for-service Medicare enrollees. 

For Altarum’s PACE evaluation, we partnered with the National PACE Association (NPA), a membership association that provides leadership and support for the growth, innovation, quality, and success of the PACE model of care. For this study, NPA assisted with survey development and dissemination, arranging informant interviews, and interpreting research findings. 

The study revealed PACE organizations implemented a range of strategies to continue delivering services to participants—including providing in-person care at home, delivering services remotely, expanding safety protocols, increasing home-based nutrition services, and preventing boredom and social isolation. Most PACE organizations plan to continue delivering services at home according to participants’ needs and preferences. These findings could help inform initiatives to expand programs like PACE to best serve a growing population of older adults with complex care needs.

Read more about this study in "Program of All-Inclusive Care for the Elderly (PACE) Organizations Flip the Script in Response to the COVID-19 Pandemic" in the December 2023 issue of Journal of Post-Acute and Long-Term Care Medicine (JAMDA).

Altarum works to improve health care services for older adults and people with disabilities by focusing on quality improvement, policy initiatives, and models of reform to ensure that high-quality care and supportive services are available for all who need them. Learn more about our initiatives to shift residential long-term care to a person-centered model and evaluate the PACE model of care at


Stephan McCall
Senior Analyst, Health Economics and Policy