Rapid PACE Responses in a Covid-19 Era

In the spring of 2020, the Covid-19 pandemic began rapidly reshaping long-term services and supports (LTSS). For frail elders, whose needs span both medical care and LTSS, the impact of the highly contagious virus has been catastrophic. High morbidity and mortality rates among those who are infected have been widely reported, with the most severe impact occurring in the nursing home resident population. Due to high death rates in congregate residential LTSS settings, such as nursing homes and assisted living facilities, interest in alternative LTSS models offering home and community-based services (HCBS) has been rising quickly.

Yet to date, little HCBS policy analysis has focused on arrangements that could serve the middle-class Medicare population in need of LTSS; rather, these discussions have mainly looked at lower-income individuals who already meet the clinical and financial eligibility requirements of state-administered Medicaid programs. This foreshortened perspective ignores important national policy strategies that could help to expand access to LTSS for tens of millions of “baby boomers” eligible just for Medicare. Surveys clearly demonstrate that this historically large cohort is hoping to avoid (or delay for as long as possible) “spending down” in order to qualify for Medicaid-funded LTSS which, although it provides a source of payment for services, also requires living with few choices, barely adequate services, and severe impoverishment.ⁱ

Against this backdrop, the Program of All-Inclusive Care for the Elderly (PACE), which serves over 54,000 participants in 31 states (as of August 1, 2020), has emerged as a highly adaptable HCBS model that could help many more Medicare-only beneficiaries. PACE’s strength lies in the fact that it is deliberately designed to provide a comprehensive range of medical care and LTSS for disabled older adults who meet their state’s Medicaid criteria for nursing home care and who are seeking highly coordinated, community-based care. In other words, the PACE model of care is designed to keep frail elders as well as possible, manage any medical crises at home, and reduce admissions to both hospital and residential LTSS settings, where transmission rates of Covid-19 have been high.

During the spring and summer of 2020, the responses of several PACE organizations during the initial Covid-19 outbreak were varied and ingenious.

Actions taken by PACE organizations included:

• Reorienting care planning and close monitoring of enrolled participants by using telehealth technology in lieu of center-based face to face interactions;
• Reassigning of vans that are normally used to transport participants to and from their homes to the PACE Center to instead deliver home-based care and services, nutrition services, durable medical equipment, medications and more;
• Repurposing of PACE Centers to be Covid-19-only infirmaries providing 24-hour care;
• Using PACE Centers to offer respite care (including overnight care) for families who need a safe place for their elderly loved ones to be while they are working or needing a break; and
• Inventing of new programming that combats social isolation.

Descriptions and accounts of these and other innovations deployed by PACE organizations during Covid-19 were gathered in interviews with key staff in Michigan and Massachusetts, and through information presented by PACE officials during a June 30, 2020 webinar from organizations based in North Carolina and Colorado.ⁱⁱ