PACE: Enabling older adults to live independently at home and in their communities

In 1971, On Lok — a family of community-based nonprofits in the San Francisco Bay Area — piloted a program for Chinese Americans who needed nursing home care but wished to age at home and in community. The program provided medical care, meal delivery, transportation, and group activities, among other aspects of eldercare.

Over five decades later, the successful model launched at On Lok (Cantonese for “peaceful, happy abode”) has grown into a national program called the Program of All-Inclusive Care for the Elderly (PACE), with 326 centers in 32 states serving over 70,000 older adults annually.

The Weinberg Foundation began supporting On Lok in 2018 as part of its longtime commitment to enable older adults to remain at home and lead independent lives for as long as possible. Weinberg’s funding helps On Lok and other PACE programs around the country provide an age-friendly health system for low-income older adults who need the level of care they would get in a nursing home, allowing them to live at home, have their needs met, and enjoy a high quality of life. 

To be eligible for the program, participants must be at least 55 years old, require nursing home care, and be able to live safely in the community with PACE support. PACE centers provide all Medicare- and Medicaid-covered services — such as primary care, adult day care, rehabilitative care, and meals — through an interdisciplinary team of professionals. This team includes primary care doctors to prevent illness and injury; nurses and social workers to coordinate care; pharmacists to assist with medication management; chefs to ensure nutritious meal options; and other staff to offer supportive care for daily activities. For off-site services, such as trips to medical specialists, the program provides transportation.

“PACE provides all the support older adults need in one place,” said Earl Millett, who leads the Foundation’s grantmaking focused on older adults. “Instead of having to figure out medical and dental appointments — and even hair care appointments — everything is funneled through PACE. And it’s all done at lower costs.”

Studies show the PACE model works, reducing hospitalizations, emergency room visits, and nursing home stays while increasing longevity and quality of life. In South Carolina, for example, PACE saves nearly $9,000 annually per participant when compared to nursing home care. In Wyoming, the program saves over $12,000 per participant each year.

A recent Harvard Business Review article touted PACE Southeast Michigan, another grantee, as an exemplar of “how PACE successfully delivers individualized, home-centered care to poor older adults while lowering overall costs.” The Michigan center serves 1,600 participants each year and increases its enrollment by 30 participants every month, compared to an increase of two individuals in PACE centers nationwide. Additionally, just 15% require visits to the emergency room, compared to 25% nationally. The center also offers behavioral health and spiritual care specialists to bolster its whole-person approach.

Given the program’s effectiveness, the Weinberg Foundation, along with The John A. Hartford Foundation and West Health, has supported further expansion of PACE centers over the past several years, with the long-term goal of reaching 200,000 participants annually by 2028. The Foundation’s grants have contributed to centers in seven states, serving nearly 4,500 older adults. Recent funding has also gone toward helping to develop a center in New York City to serve older adults who are lesbian, gay, bisexual, transgender, or queer.

The Foundation plans to continue increasing access to the program. “Helping older adults age safely and with dignity in their homes enables them to decide how they want to live,” Millett said. “PACE should be available to everyone in every community.”

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