![]() The basic philosophy is that care should include what matters most to older poor people: all-inclusive care comprising nutrition, social interaction, transportation, and home upkeep, in addition to medical and related services. ![]() There are now 150 PACE programs in 32 states. The PACE program, first developed in San Francisco in 1973, is a comprehensive, integrated, community-based care model that lets older adults continue to live at home as long as possible. Although nursing home and other institutionalized elder care clearly demand improvement, the United States also must invest in reimagining what elder care can be. Given that PACE currently serves only about 60,000 of these patients, expanding the program has useful management and cost implications for health care systems nationally. In-depth interviews with PACE staff and program participants conducted by two of us (Len Berry and Sunjay Letchuman) collaborations with PACE leaders, including two coauthors of this article (Mary Kummer Naber and Peter Fitzgerald) and our collective analysis of the features and daily operations of a PACE model in southeastern Michigan (led by Mary) reveal how PACE successfully delivers individualized, home-centered care to poor older adults while lowering overall costs. Few integrated-care programs serve this dual-eligible population, which now numbers 12.5 million Americans. We focused on this program because all PACE participants are vulnerable: They require nursing home–level care, and 90% are eligible for both Medicare and Medicaid. ![]() To help improve services for these patients, we analyzed the design and implementation of a national program called PACE: Program of All-Inclusive Care for the Elderly. They also encounter many health service hurdles, including inadequate care coordination, fee-for-service reimbursement that often reflexively encourages medical treatment over other forms of care, and a dysfunctional nursing home industry. Older poor people often face loneliness, depression, a lost sense of purpose, and an inability to live independently in their homes. health care system is not set up to improve the quality of life of the most vulnerable, chronically ill, elderly people, especially those who are poor.
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