top

Medicare PACE / LIFE Programs for Persons with Alzheimer’s or Dementia

Last Updated: September 25, 2019

 

What is PACE?

The Program of All-Inclusive Care for the Elderly (PACE), sometimes called Living Independently for the Elderly (LIFE), is a Medicare and Medicaid program that streamlines the benefits of both programs into a single program. Intended for persons 55 years of age and older who require a nursing home level of care, one of the main goals of this program is to prevent and / or delay nursing home admissions. PACE has proved to be especially beneficial for persons with Alzheimer’s disease and related dementias. In fact, according to the National PACE Association, 49% of persons enrolled in PACE have a diagnosis of dementia.

While available benefits include emergency care, preventative appointments, medications, and many others, particularly relevant for persons diagnosed with dementia is long-term home and community-based care. These supports may include adult day care, home health care, in-home assistance with daily living activities, meal delivery, and respite care. With the assistance of PACE, some persons with dementia are able to remain living independently in their homes, and others are able to continue to live with informal caregivers (generally a relative), as PACE’s benefits can supplement the care and supervision they are already receiving.

Unfortunately, PACE is not a nationwide program. At the time of this writing, this program is available in 31 states, and within these states, there are 130 PACE programs that operate a total of 263 PACE centers. (PACE centers typically offer adult day care, rehabilitation services, medical care, and social services.)

 

 

PACE Eligibility Requirements

For persons with dementia to qualify for PACE, the following eligibility requirements must be met:

– Be a minimum of 55 years old.

– Require a nursing home level of care. Often this level of care equates to a need for assistance with activities of daily living, such as bathing, dressing, toiletry, mobility, transitioning, and eating. Persons with dementia commonly need help with these activities, particularly as the disease progresses, but may not require this level of care when diagnosed.

– Be able to safely live at home with assistance from PACE.

– Live in a state, and geographic region, that offers PACE. As of 2019, the following states have PACE/LIFE programs: Alabama, Arizona, California, Colorado, Delaware, Florida, Iowa, Indiana, Kansas, Louisiana, Massachusetts, Maryland, Michigan, North Carolina, North Dakota, Nebraska, New Jersey, New Mexico, New York, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Virginia, Washington, Wisconsin, and Wyoming. To see if there is a PACE program in your state and geographic region, click here.

There are no set income and asset limits for qualification purposes. However, most program participants are enrolled in Medicaid and / or Medicare. While there is no financial eligibility criteria for Medicare, there is for Medicaid. As of 2019, in most states, the income limit for a single applicant is $2,313 / month and the asset limit is $2,000. More on Medicaid eligibility. Interestingly enough, persons do not need to be enrolled in Medicare or Medicaid to enroll in PACE. Rather, these persons can pay privately, although the vast majority do not do so.

 

Program Benefits

A healthcare team, which includes nurses, occupational therapists, physical and speech therapists, doctors, social workers, and dieticians, work with PACE recipients to create an individualized care plan, deciding which services are needed and coordinating care. The following benefits may be provided via PACE:

– Adult Day Health Care
– Primary Medical Care (PACE Physician)
– Home health Care
– In-Home Personal Care Assistance
– Meal Delivery
– Homemaker and Chore Services
– Prescription / Non-Prescription Medications
– Case Management
– Nutritional Counseling
– Medical Specialists (Cardiology, Rheumatology, Dentistry, Audiology, Podiatry, Optometry, Speech Therapy, Women’s Services)
– Respite Care
– Emergency Care
– Hospitalization
– Laboratory Services
– X-Rays
– Therapies (Physical, Speech, Occupational)
– Inpatient Rehabilitation
– Durable Medical Equipment (walkers, wheelchairs, hospital beds, oxygen)
– Transportation (to and from PACE centers and medical appointments)
– Caregiver Training
– Caregiver Support Groups
– Nursing Home Care
– Hospice

 

Benefits Specifically for Persons with Dementia

Home and community based services (HCBS) via PACE allow persons with dementia who require a nursing home level of care to continue to live in their own homes or the homes of informal caregivers. Change can be especially stressful for those with dementia, and the ability to delay and / or prevent institutionalization is often ideal.

Persons in the earlier stages of dementia likely do not require 24/7 supervision and assistance, but may need some assistance in order to remain living independently. In this situation, persons may benefit from in-home personal care assistance, meal delivery, and homemaker services. Durable medical equipment, such as walkers and wheelchairs, may also prove to be especially beneficial for persons with dementia.

PACE can also help to relieve the stress and responsibilities of informal caregivers by supplementing the care they are already providing. A recent survey conducted by Vital Research in collaboration with the National PACE Association found that 58% of informal caregivers of PACE participants reported “decrease of burden after PACE enrollment”.

Adult day care can allow informal caregivers to continue to work during the day, and respite care can relieve caregivers of their caregiving duties and give them time to rest or run errands. In addition, caregiver training and caregiver support groups are available through PACE.

 

How Much Does PACE Cost?

Depending on a PACE recipient’s situation, there may be a cost associated with the program. For persons with dementia who are eligible for Medicaid, there are no fees associated with receiving long-term care services and supports. On the other hand, if a PACE recipient has Medicare, but not Medicaid, they must pay a monthly fee for long-term care benefits, as well as a monthly premium for prescription drugs (Medicare Part D). Persons who have neither Medicaid nor Medicare have the option to enroll in PACE and pay out of pocket.

With PACE, program participants do not have co-pays or deductibles for services and supports.

 

How to Apply for a PACE Program

In order to apply for PACE/LIFE, there must be a program in one’s geographic region within the state in which one resides. To find out if there is a PACE program in your area, click here. If there is a PACE program, contact the program to begin the application process.

Medicaid and Medicare recipients do not have to enroll in PACE, and those that do, can disenroll at any time and return to receiving traditional Medicaid and Medicare.