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Elderly Get Another Option to Stay Out of Nursing Homes

State decides to keep PACE a separate program under proposed Medicaid Waiver.

PACE, a special program for the frail elderly, has been added to the list of four managed-care companies that will be responsible for New Jersey's long-term care and nursing home patients under the state's proposed Comprehensive Medicaid Waiver.

The goal of PACE, which stands for "program of all-inclusive care for the elderly," is to help seniors who are frail enough to be in nursing homes to live at home instead. Medicaid and Medicare pay PACE providers to deliver all the services seniors need, from medical care to wheelchair ramps to transportation. Currently, nearly 500 seniors are served by the program.

There are currently four PACE facilities: The Hamilton center, operated by St. Francis Medical Center in Trenton; Lutheran Senior Life, located at Jersey City Medical Center; the Pennsauken PACE center, operated by Our Lady of Lourdes Medical Center; and the Vineland center, operated by South Jersey Healthcare. Ten other healthcare providers have applied to the state for approval to launch PACE programs.

Medicaid beneficiaries who are eligible for nursing-home care will be able to chose among the four managed-care companies or to enroll in PACE if there is program serving their community.

The original plan was to put PACE under the purview of the state's managed-care companies, which will be tasked with providing services for approximately 30,000 participants. But New Jersey's PACE providers argued that moving them into the system might lead to the elimination of the program, which was first launched in New Jersey in 2009 (but available in some states since 1997). The state decided instead to retain PACE as a standalone option for seniors.

Jill Viggiano, executive director of the Hamilton center, explained that as a federal program PACE is authorized by Medicaid and Medicare to deliver a broad range of services, including primary care, adult daycare, and homecare. But if PACE were to come under the managed-care providers, she added, it was unclear that it would still have the authority to provide services, which might have put its continued operation in jeopardy.

In a January 20 letter to the four PACE programs, Health Commissioner Mary E. O'Dowd and Human Services Commissioner Jennifer Velez wrote, "After careful consideration we have concluded that PACE should continue as a direct-care management option under the Medicaid Comprehensive Waiver."

The decision, according to the commissioners, was made, "after many discussions with PACE advocates, managed-care organizations, and visiting a PACE program. Working together, we can develop policies that will ensure our most-challenging Medicaid beneficiaries are provided with options that allow them to live with independence, dignity and choice."

To be eligible for PACE, individuals must be at least 55 years old and have physical and medical needs that could qualify them for a nursing home placement. PACE endeavors to keep them at home.

Viggiano, a registered nurse, said that PACE providers receive a single monthly ("capitated") payment from Medicare and Medicare, and then provide all required services. At the Hamilton facility, an interdisciplinary team of doctors, nurses, social workers, and other professionals delivers comprehensive services to 190 members; some services are provided at the center; others, in the member's home. A half-dozen Hamilton clients are now living in nursing homes, but PACE remains responsible for overseeing and coordinating their care.

According to Viggiano, the team at Hamilton creates a customized care plan for each individual. "We provide primary care, specialty medical care, dental services, hearing aids, dentures, eyeglasses. We provide services at home: skilled nursing, home health aides, and transportation. We make sure they have a healthy diet, and that they get physical and occupational therapy, speech therapy."

The customized plan is designed to "promote your quality of life and help keep you safe in your home," Viggiano said. Members may come to the center to exercise, get their laundry done, take a shower. A member of the staff may go to the individual's home to provide respite to a family caregiver.

"We do a lot of home adaptations to help keep someone safe," said Viggiano. "We've installed hand rails, ramps, a stair glide. We've exterminated bed bugs. Whatever it takes to keep people safe at home."

"Our team sits down every morning face to face and talks about anything that happens over night," Viggiano said.

Randy Minniear, senior vice president, government relations and policy, for the New Jersey Hospital Association, said when the state released its comprehensive waiver application in September, the association realized the restructuring of PACE would have negative consequences, "and we were engaged pretty quickly. The state was very accommodating; they had several phone conference calls and in person meetings with PACE providers and were very willing to listen what the impact would be."

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