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

Last Updated: June 01, 2022

 

What is PACE?

The Program of All-Inclusive Care for the Elderly (PACE) or sometimes called Living Independently for the Elderly (LIFE) blends medical and social service benefits together. The program supports all aspects of elderly care, especially those with chronic health problems. This enables the programs to address a variety of problems and needs that a patient could have. Supporting the patient as a whole from their doctors’ visits through their living situation provides a higher quality of life. Generally, most enrollees are eligible for Medicare and Medicaid, streamlining the benefits of both programs into a single program.

PACE/LIFE is intended for people 55 years of age and older who require a nursing home level of care. One of the main goals is to prevent or delay nursing home admissions. PACE has proved to be especially beneficial for people with Alzheimer’s disease and related dementias. According to the National PACE Association, 49% of people enrolled in PACE have a diagnosis of dementia.

Benefits can include emergency care, preventative appointments, medications, and many others. Especially beneficial for persons with dementia are adult day care, home health care, in-home assistance with daily living activities, meal delivery, and respite care. With the assistance of PACE, some people with dementia can remain living independently in their homes. Others can continue to live with an informal caregiver (generally a relative) as PACE’s benefits can supplement the care and supervision they are already receiving.

Unfortunately, PACE is not a nationwide program. Currently, it is available in 31 states. Within these states, there are 145 PACE programs that operate a total of 273 PACE centers.

 Did You Know? There are free resources for persons with dementia and their family members.
Help finding memory care communities that meet your requirements.
Help finding in-home care with dementia training.
Medicaid eligibility test and free consult on qualifying.

 

PACE Eligibility Requirements

For people with dementia to qualify for PACE, they must meet the following eligibility requirements.

– 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. People with dementia commonly need help with daily life activities. This is especially true 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 2022, 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 2022, in most states, the income limit for a single applicant is $2,523 / month and the asset limit is $2,000. More on Medicaid eligibility. You do not need to be enrolled in Medicare or Medicaid to enroll in PACE. Participants can pay privately although most 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 people 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 or prevent institutionalization is often ideal.

Patients 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, people may benefit from in-home personal care assistance, meal delivery, and housekeeping services. Medical equipment, such as walkers and wheelchairs, may also prove to be especially beneficial for dementia patients.

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 people with dementia who are eligible for Medicaid, there are no costs with receiving long-term care services and support. 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, like Medicare Part D. People without Medicaid or Medicare have the option to enroll in PACE and pay out of pocket to be enrolled in the program.

With PACE, program participants do not have copays 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 the state you live in and in your area. To find out if there is a local PACE program, click here. If there is a PACE program, contact the program directly 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.