User:Wojcickij/Program of All-Inclusive Care for the Elderly

PACE was developed by On Lok Senior Health Services, a not-for-profit community-based organization launched in the early 1970s in the Chinatown-North Beach area of San Francisco, California.

1971–1978

On Lok Senior Health Services was created in 1971 to address the long-term care needs of older immigrants in San Francisco's Chinatown-North Beach neighborhood. After its founding, between 1973-1975, On Lok expanded to include day centers, in-home care, home-delivered meals, and housing assistance. In 1974, On Lok started being reimbursed by Medicaid for its provision of adult day health services. Later, in 1978, these health services were broadened to include comprehensive medical care for older adults certified to be nursing home-eligible.

1979

The Department of Health and Human Services provided a four-year grant to On Lok to develop a model of care delivery for individuals with long-term care needs.

1986-1987

10 other organizations implemented the care delivery model developed by On Lok, with approval from the federal level. In 1987, the 11 existing sites received funding from the Robert Wood Johnson Foundation, John A. Hartford Foundation, and Retirement Research Foundation.

1990

The care delivery model developed by On Lok became known as "Program of All-Inclusive Care for the Elderly" or PACE. The first replication sites received Medicare and Medicaid waivers.

1994

The National PACE Association (NPA) was formed.

1997

The Balanced Budget Act of 1997 (P.L. 105-33, Section 4801-4804) established PACE as a permanent part of the Medicare program and an option under state Medicaid programs.

2005-2006

The Deficit Reduction Act (DRA) of 2005 authorized a Rural PACE initiative and in 2006, the Centers for Medicare and Medicaid Services (CMS) announced 15 rural PACE grantees.

2015

President Obama signed the PACE Innovation Act into law.

2019

As of 2019, there were 130 PACE organizations in 31 states, serving over 50,000 individuals.

In 1978, they expanded the model to include complete medical care and social support for the frail elderly and received federal waivers in 1979 that allowed reimbursement from Medicare for all outpatient health and health-related services. In 1980 inpatient services were added, including skilled nursing care and acute hospitalization. 1983 amendments to the Social Security Act provided that On Lok be given authority to test a risk-based financing system involving Medicare, Medicaid, and private pay. Major grants from the Robert Wood Johnson Foundation, the John A. Hartford Foundation, and the Retirement Research Foundation underwrote research and development activities to support this demonstration. Congress extended On Lok's waivers indefinitely (1985) and provided waivers for the replication of the model at 10 sites (1986). This support enabled On Lok to provide technical assistance to help new sites develop and to create a cross-site database to track performance. In 1990 the first replication sites received Medicare and Medicaid waivers as demonstration programs and the model became known as the "Program of All-inclusive Care for the Elderly" or PACE. Existing PACE demonstration programs became permanent PACE providers by 2003.

As of September 2018, there are 134 PACE programs operating in 31 states. The largest of these has more than 2,500 frail elderly enrollees, but most serve a few hundred on average.

Outcomes
Several studies point to the numerous benefits that PACE programs have had on their patient populations, including allowing them to live safely within their communities. [1]

The more positive research on effectiveness centers on outcomes of interest tied to PACE programs. These include greater adult day health care use along with decreased numbers of hospitalizations and nursing home admissions. In fact, patients were less likely to be institutionalized when compared to those who waived 1915(c) home- and community-based services. [2]

Similarly, it has been noted that patients remain in contact with primary care longer, have greater survival rates, better health, better functional status, and better quality of life as reflected by increased social interaction, less depression, and fewer concerns after enrollment. [3-9]

There are, however, some drawbacks that patients have come to perceive with certain aspects of the PACE experience. Some patients have reported that they are not receiving enough information about their conditions and that their input into their own care is not being taken into consideration by providers. [3] In addition, there is a prevalent concern amongst enrollees centered on losing their primary care physician with whom they have established a relationship and trust with. [3]