Theres no place like home.
Thats a sentiment that everyone seems to share, and it is no less true for older adults, most of whom feel a deep attachment to the familiar places, possessions and community that have signified “home” to them for decades. Disrupting that attachment is sometimes necessary, when it becomes unsafe for an aging adult to continue living independently. But ideally, older adults who prefer to remain at home should have the option to do so, living out their vintage years in the comfort of the home environment, with the supports and services they need to have the highest possible quality of life. That is the premise of PACE, a national program that provides comprehensive health and social support services for persons age 55 and over who wish to remain at home as long as possible. PACE, which is an acronym for Program of All-Inclusive Care for the Elderly, was created in San Francisco in 1971, as an alternative to nursing home care, by Chinese-Americans who wanted to care for their older loved ones with the respect and honor that is their cultural tradition. PACE represents a dramatic and humane departure from the standard model of placing seniors into long term care facilities, where they are isolated from their families and communities.
The first and only PACE program in Florida is located in Miami and is affiliated with the Miami Jewish Hospital and Home for the Aging (MJHHA). Known as the Florida PACE Center, Inc. (FPC), the program provides and coordinates all essential preventive, primary, acute and long term care services to participants, who are nursing-home eligible seniors with chronic or complex care needs. FPC opened in February 2003 and in just four short years has distinguished itself as exceptionally responsive to the needs of the participants and families.
“This is a program that works,” says Dan Brady, Ph.D., FPC executive director. “We have had our patient satisfaction measured by the Doug Williams Group, and the satisfaction levels are extraordinarily high. We believe that the PACE program is the best response to the needs of the frail elderly, and that they are best served within their own communities. PACE is based on a day care model and is well designed to meet a range of needs. The beauty of the model is its flexibility, which allows our multidisciplinary care team to meet needs in creative ways that are highly individualized. Our mission is to help older adults maintain the highest possible productivity and quality of life.
“Participants come to the Center several days each week. The PACE model of adult day care is a wonderful platform for monitoring and immediate access to care. If a participant has the sniffles, he or she will be seen that same day by one of our physicians, who are geriatricians. We get them stabilized and keep them stabilized, and their health and functioning improve in our program.”
PACE also provides home health care, personal care, and a full range of therapies, including occupational, physical and speech therapy and nutrition services, in the home or at the Center, located on the MJHHA campus. The program includes recreation and socialization; transportation to and from the PACE center, appointments and shopping; and coverage of prescription and non-prescription medications. Hospitalization and nursing home care are provided when necessary, and respite admissions are available to ease the strain for family caregivers. The PACE multidisciplinary team meets daily and provides constant monitoring and assessment of needs.
“Were a managed care organization, and our interdisciplinary team acts as a case manager,” says Karen Wells, R.N., M.A., Program Director of PACE programs for FPC. “Every participant is re-assessed by the team every six months, or more often. We emphasize physical functionality because that fosters social interaction and quality of life.”
Both Brady and Wells are passionate about the rights of older adults to determine for themselves what quality of life means as they approach the end of life. “Quality of life is an individual matter,” says Wells, “and the human spirit is an amazing thing. Age is only a number on a piece of paper, and we have learned never to presume anything about our clients. We love to find out about them, about the things theyve done in their lives.”
To Brady, the PACE program provides affirmation that life holds limitless possibilities and that one can have a meaningful old age. “Many of our clients are physically compromised but are still intelligent, engaging people. They teach me that we can have a productive and pleasant life at any age. Its enormously satisfying to work with them and to help them live with purpose.”
PACE is a voluntary program and there is no cost for those who have Medicare and Medicaid. PACE is supported through cooperative agreements with the Florida Department of Elder Affairs, the Florida Agency for Health Care Administration and the Centers for Medicare and Medicaid Services. It is affiliated with the University of Miami and is a teaching site for gerontology fellows.
