PACE PROGRAM BEING DISCUSSED BY GROUPS

Silver City Daily Press Weds, 8/22/07

By Mary Alice Murphy

 

An informational meeting about the possibility of creating a Program of All-inclusive Care for the Elderly in the area was held Tuesday afternoon. Representatives from the medical community, Western New Mexico University, Senior Services, Grant County and the Community Health Council attended the teleconference with consultants of a PACE operation in San Francisco, Calif.
"Total Community Care in Albuquerque is the only PACE program in New Mexico," Les Rubin, Hidalgo Medical Services chief financial officer, said. "The program started out of the old St. Joseph's Hospital and got assistance from PACE programs in Denver and Milwaukee."
More than 30 years ago, a group of concerned citizens saw that the needs of San Francisco's frail elderly were not being met. On Lok Senior Health Services was created to provide them with comprehensive, integrated-health and long-term care. Combining medical, social, nutritional, rehabilitation, transportation and support services made it possible for seniors to continue to live in their homes. The success of the program led to the national replication of the program as PACE.
Rubin said, although the program began in urban settings, within the past few years, rural PACE programs have started. He offered to coordinate a tour of the PACE facility in Albuquerque, because "they know the nuances of the New Mexico Medicaid and Medicare systems."
Funding for PACE is provided through the federal programs,
"A year ago when the Department of Health and Human Services came to the area, we asked why there were not more PACE programs," Rubin said.
"It's because of the state," Dr. James Skee said. "In 1990, Fort Bayard Medical Center had transportation set up and was ready to go with the program, but couldn't get funding out of the state."
Rubin said he was told that other towns had tried to get PACE programs started, but the Human Services Department had held up Medicaid funding.
"Total Community Care can't expand their program for the same reason," Rubin said. "They have a waiting list."
He said the Interim Legislative Committee on Health and Human Services "is asking why there is not a model in the Southwest for rural PACE programs. Maybe, if we get a group collaborating, we can go to the Legislature and the governor and get Human Services to realize it's needed."
Skee said the program is "cheaper, provides better medical care, and it's common sense."
A common diagnosis among elders in Grant County is Alzheimer's disease, according to Skee. Although family members want to take care of their relatives at home, they may have to work, and can't leave them alone.
"If during the day, they are taken care of at adult day-care, then they go home to the family at night," Skee said. "It's a win-win proposition. Because facilities have clinics, everyone is seen by someone every day, so their health is better. It's so sane. It's the care we would want."
He said many of these patients would end up in nursing homes.
Frank Kenny, Senior Services Director, who organized the teleconference, said it would also add to the quality of life of the elders and their family members.
Transportation of the elders to the facilities is part of the PACE program. Skee said with rural programs, the transportation becomes a bigger issue.
Gale Green, Gila Regional Medical Center hospice staff member and Senior Services volunteer, said the program puts the focus on the patient, often reducing depression and the need for medications.
She asked about differences in cost.
Rubin said usually in the urban PACE programs, the reimbursement is at 90 percent of what nursing-home care would cost.
On the telephone, Gretchen Brickson, who heads up On Lok's PACEPartners consulting service, asked about the challenges for a program in Grant County. When presented with what the committee members had already discussed, she said the 15 rural models the Centers for Medicare and Medicaid Services had financed were filled, "but maybe some adaptations would work in your area."
Kenney expressed disappointment that no funding would be available for a Grant County PACE program. Rubin asked if another cycle of funding might be possible.
Brickson said she was not aware of any. Skee said with capital campaigns and the savings that could be pulled from better medical care, he thinks the program could be feasible for the area.
She explained what the PACE program is.
The provider-based Medicare and Medicaid managed-care program "integrates acute, chronic and long-term care for nursing-home certified seniors, using interdisciplinary teams to assess need, provide and manage care. PACE assumes full risk."
The program serves frail seniors and disabled people who are 55 years or older, certified as needing nursing home care, but able to live safely in the community at the time of enrollment.
According to Brickson, a typical On Lok participant is an 84-year-old female with eight medical conditions, some cognitive impairment, dually eligible for Medicare and Medicaid, and is enrolled in PACE for the last three years of her life. Three percent of participants also have private-pay insurance.
Comprehensive care, including home care; primary care; access to specialists; hospital, lab, X-ray and medication services; adult day health care with nursing, social service, physical and speech therapy, nutrition services, including boxed meals where needed; personal care, and transportation, is provided to the elders. The services are provided by an interdisciplinary team.
PACE organizations must operate a center with space and equipment for primary medical care, treatment, therapeutic recreation, socialization and dining.
Regulatory oversight for a Grant County rural PACE program would include CMS, the New Mexico Department of Health Division of Health Improvement, and New Mexico Health Facility Licensing and Certification.
Brickson said it would take 18 months to two years to implement a PACE program. She also discussed the aspects, such as enrollment and reimbursement, that are critical to a successful program.
County Manager Jon Paul Saari attended the meeting and mentioned possible sites for a PACE center, including near the Fort Bayard Medical Center replacement facility slated to be built on county-owned land. He also said he would try to find out if funding might be available through the sole indigent provider program.
A working group will continue pursuing the possibility of getting a PACE center in Grant County.
For more information on the program, visit the Web site www.npaonline.org.
-MARY ALICE MURPHY