Program of All-Inclusive Care for the Elderly

James Borders, PACE Medical Director, MD • August 25, 2023

Originally published by the Lexington Medical Society on July 14, 2023 and MD-Update in November 2023.

PACE, which stands for “Program of All-Inclusive Care of the Elderly,” is perhaps the most well-kept secret in healthcare. Although PACE has been in existence in the United States since the 1970s, Kentucky’s first PACE program started operating in 2022. PACE is a program primarily designed for patients with Medicare/Medicaid (the “dually eligible”), whose needs traditionally require skilled nursing home care. The ultimate goal of PACE is to allow participants to “age in place,” avoiding nursing home or other long-term care. Federal and state governments recognize that placing such patients into skilled nursing facilities is the most expensive option for care provision and often not the best plan for maintaining an acceptable quality of life for these patients.


Services are 100 percent covered for participants with both Medicare and Medicaid who transition completely to PACE program care. The physician at PACE becomes the participant’s primary care physician. All non-emergency care, including primary care and specialist services, must be provided by the program or an authorized entity to be covered by PACE. Other costs and restrictions apply to individuals who only have Medicare or are paying privately.


PACE programs must have a facility capable of providing health evaluations, adult daycare, meals, transportation to and from the center or other healthcare providers and facilities, and any other services to provide optimal healthcare. It is typical for PACE patients to be seen in the Center 2-3 days per week. This allows PACE staff to become familiar with all aspects of each patient’s healthcare needs. Participants are also visited in their homes when needed by PACE staff who are equipped and empowered to determine appropriate interventions in order to maintain their health and quality of life in their homes and thus avoid moving them to an inpatient facility. PACE staff members work to anticipate problems before they grow more complex and difficult to manage. Although concierge Medicare care has become a luxury offering to some people in the community, the holistic care provided by PACE serves an historically medically underserved and marginalized population.


Evidence shows that, compared with age and morbidity-matched cohorts treated in traditional care models, PACE participants fare better by several important measures. Cited in Leavitt’s 2009 interim report to Congress, a U.S. Department of Health and Human Services study found that PACE participants reported better self-rated health statuses, better preventive care involving vision and hearing screenings, higher rates of seasonal vaccine administration, and fewer cases of depression. A 2010 study in The Journals of Gerontology by Wieland et al reported the five-year survival in a PACE population compared with alternative institutional and home- and community-based care. Despite PACE participants being older and more cognitively and functionally impaired than those in an otherwise matched cohort, PACE participants had a substantial long-term survival advantage after five years of follow-up. The benefit was especially apparent in moderate- to high-risk participants.


PACE centers serve as adult daycare centers where medical personnel get to know each participant on a personal level to provide any needed medical evaluations, including both wellness and acute care visits, physical and occupational therapy, nutritional assessments, meals, and the socialization that is so essential to the person’s sense of well-being. Transportation to and from the PACE Center and other medically related visits is provided by PACE if transportation is a barrier.

To be most effective, the PACE team assumes primary care for the patient and oversees all aspects of their healthcare, including that provided by specialists. Although specialty care remains available, contracted specialists understand that the PACE physician and PACE Center teams will give as much specialty care as they are qualified to provide.


When fully understood and implemented, PACE offers relief to all parties involved: the patient, patient’s family, and the patient’s primary care physician struggling to manage the care of someone with inadequate healthcare infrastructure to prevent the frequent pleas for help represented by a chaotic healthcare experience. These patients are often characterized by frequent emergency room visits, hospitalizations, missed appointments due to lack of transportation, or inadequate social support.


To qualify for the program, a patient must be at least 55 years old, live within counties assigned to active PACE programs, be able to live safely in the community with PACE services at the time of enrollment, and meet state-defined criteria for skilled-nursing home care.



It is critical to share with prospective PACE participants the restrictions and fees, particularly for those who are not dually eligible with both Medicaid and Medicare coverage. Individuals who have only Medicare are eligible for PACE but must pay a fee. Other participants may pay privately for PACE services and have different payment structures.


For all PACE participants, all healthcare must be received at or coordinated by the PACE Center. Participants may be fully or personally liable for the cost of services not authorized by PACE. PACE participants may voluntarily disenroll from the program without cause at any time. The disenrollment date will be coordinated between Medicare and Medicaid for a participant who is dually eligible.


As of July 2023, there are three approved PACE programs in Kentucky. If you have dually eligible or Medicare-only patients whose healthcare needs you are struggling to meet, consider whether PACE may be an option. PACE personnel can evaluate the patient to see if they meet the required criteria for acceptance.


For patients residing in Anderson, Fayette, Franklin, Jessamine and Woodford counties, contact Bluegrass Care Navigators at 855-492-0812 for more information. For the counties of Barron, Clinton, Estill, Jackson, Laurel, Madison, McCreary, Pulaski, Rockcastle, Warren, and Wayne, contact Horizon PACE at 877-589-3053. Residents of Jefferson County can contact Senior CommUnity Care of Kentucky at 502-314-2059.

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1. Reflect and remember Relive experiences in your thoughts. Allow the details and the emotions that come with them to be fully expressed. Explore memories as they come up. Trust that your system is bringing up these thoughts as part of your healing process. The repetition of painful memories helps flush out the strong emotions attached to them. 2. Share stories Talking about your loss provides a great deal of release. You may need to tell the same stories over and over as part of your healing. Support groups provide a place where you have the opportunity to be heard and can continue to talk about your grief in a supportive environment. 3. Write it down Keeping a journal is not for everyone, but it can be a powerful tool for healing. Writing about feelings and events can help you to identify emotions. Words help constructively channel these emotions and show a record of your progress. 4. Don’t be afraid to cry Tears can relieve a lot of pressure and tension. Learn to trust your body’s need to cry or not. Individuals grieve differently. Tears are not a sign of weakness and do not mean that your emotions are out of control. 5. Make space for your loss People commonly fall out of their routines after the loss of a loved one. Because of this, they may feel they have too much unstructured time in which to grieve. It is OK to take time to sit with a loss. Other days, you may feel the need to be as busy as possible. Make time to create quite moments to work through your feelings. Respecting your needs for healing and creating opportunities to grieve is important. 6. Take care of yourself Do your best to nourish your body and rest. Get outside and enjoy the fresh air. Exercise can release a surprising amount of tension, anger and frustration. It is important to make self-care a priority. Our grief care services are for anyone in the community who has experienced the loss of a loved one. Discover how our team can help you and your family by contacting us through our website or calling 855.492.0812 .
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Everyone deals with grief, which can be painful at times. Most grieving people will experience some of the feelings outlined below. Ask yourself the following questions to help determine if you might benefit from grief services. Has your patience level changed? Are you always irritable? Are you always annoyed? Are you always intolerant? Are you always angry? Do you feel numbness or isolation? Are you experiencing an ongoing sense of numbness? Are you experiencing an ongoing sense of being isolated from yourself or from others? Do you feel alone with your grief? Do you usually feel that you have no one to talk to about what has happened? Are you anxious or fearful about death? Since your loved one died, are you highly anxious most of the time about your own death or the death of someone you love? Are these feelings beginning to interfere with your relationships, your ability to concentrate or your ability to live as you would like to live? Are you consumed by thoughts of your loved one or their death? Do you feel that you are always and continually preoccupied with memories or thoughts of your loved one? Do you feel that you are always and continually preoccupied with the death itself? Do you feel that you are always and continually preoccupied with certain aspects of the death even after several months? Do you feel restlessness or the need to stay busy? Do you usually feel restless or in “high gear?” Do you feel the need to be constantly busy beyond what is normal for you? Do you fear intimacy or closeness with others? Are you afraid of becoming close to new people in fear of losing them? Do you think being close with others will cause pain? Are your behaviors becoming harmful? Are you drinking more than you used to? Are you using more prescription or non-prescription drugs? Are you engaging in sexual activity that is unsafe or unwise? Are you driving in an unsafe or reckless manner? Are you considering serious thoughts of suicide? Do you feel overwhelmed with responsibility for surviving family and close friends? Are you feeling heavily burdened or like you are taking on too much? Are you angry or feel like the situation is suffocating? Are you resentful because you feel as though no one is there for you? Are you continually limiting your reactions and emotions? Are you experiencing only a few of the reactions or emotions that usually come with grief? Are you unable to express your thoughts or feelings about your loved one and their death through words and actions? Are you only remembering certain aspects of your loved one or your relationship together? Do you feel like you are going crazy? Are you wondering if what you are experiencing is normal? Do you feel stuck or unable to move on? A helping hand and a listening ear can be valuable while grieving. If any of these feelings continue for a prolonged period of time, or become extremely intense, you may benefit from additional help from a grief care professional. Our grief care services are for anyone in the community who has experienced the loss of a loved one. Discover how our team can help you and your family by contacting us through our website or calling 855.492.0812 .
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