March 11, 2021
Preliminary reports indicate that PACE, the Program for All-Inclusive Care for the Elderly, responded swiftly to the Covid-19 pandemic to keep its participants safe and well cared for—without leaving them lonely or isolated.
What can we learn from PACE’s response that will improve our system of long-term services and supports (LTSS)?
Altarum is examining this question in a two-year evaluation of PACE’s Covid-19 adaptations with a research grant from the Agency for Healthcare Research and Quality (AHRQ). The National PACE Association and others are assisting Altarum and encouraging their members to provide data.
PACE is a comprehensive and highly coordinated model of financing and delivering community-based care that is designed for Medicare and Medicaid-eligible frail elders who require both medical services and LTSS.
When the pandemic arrived, PACE organizations implemented a variety of adaptations, including adopting telehealth technology to communicate with and monitor participants virtually, creating mobile clinics, and repurposing PACE day centers to serve as Covid-19 infirmaries providing 24-hour care.
Altarum’s evaluation aims to comprehensively explore such adaptations at PACE sites around the country focusing on three key phases of the pandemic: the spring and summer of 2020 as the virus arrived and every state and community participated in a crisis response, the fall and winter as responding to the pandemic became the new normal, and the first six months of 2021 during the vaccine rollout.
Using quantitative and qualitative research methods to identify the adaptations implemented by PACE programs throughout the country, Altarum will compare PACE outcomes to those of similar beneficiaries who received care outside of the program and examine the potential to expand some helpful adaptations to other parts of our long-term care system.
Altarum has worked closely on the PACE model in Michigan and at the federal level to expand the model’s availability and affordability to more middle-class older adults who are too wealthy to qualify for PACE under Medicaid. Many stand to benefit from the all-inclusive coordinated care that PACE provides, but face pricing and regulatory barriers to enrollment that require a policy solution.
After enduring one of the most difficult years in memory—with strict lockdowns, lonely and isolated elders, a vulnerable direct care workforce, economic shocks, and a devastating death toll—the long-term care sector is starting to try to recover. Altarum’s evaluation of what worked well during PACE’s Covid response will be essential to informing the recovery and further efforts toward building a more robust and more equitable system of community-anchored care.
Altarum will publicly release the results of the evaluation, adding to its body of research and innovative solutions to build a stronger and more equitable long-term care system, including fortifying the direct care workforce; improving home and community-based services; and strengthening nursing homes through comprehensive culture change initiatives.
Joanne Lynn, MD, an LTSS expert at Altarum and geriatrician, and Christine Stanik, PhD, a psychologist and senior researcher at Altarum, are leading the project.