News » Summit Eldercare program expands
Summit Eldercare program expands
January 1, 2006
From The Healthcare Ledger, Vol 3 Issue 1 January 2006
By Katherine A. Kahn
It's 2 pm at Summit ElderCare,a Worcester-based Program for the All- Inclusive Care of the Elderly (PACE) run by Fallon Community Health Plan.The adult day facility on East Mountain Street buzzes with activity. Santa is just wrapping up his popular annual visit. Staff members are busy helping some participants put on their coats and get ready for the ride home in specially-equipped vans. A few family members have arrived to pick up their loved ones and chat amiably with staff.
"At this time of day, it's a little like Grand Central Station in here," executive director Karen Longo says apologetically. Longo, who is clearly passionate about the PACE program at Summit ElderCare, looks out over the busy room and adds, "This program gives families huge assistance and relief in caring for their elders. It makes a world of difference."
An Alternative to Nursing Homes
The benefits of PACE are not limited to adult day care facilities. The goal of this innovative elder care program is to allow frail, older people—who would otherwise meet standards for nursing home care—to remain at home.
PACE accomplishes this by providing a smorgasbord of services that address both the medical and social needs of each participant and his or her family. In addition to adult day services, participants receive primary and specialty medical care, meals, full prescription drug coverage, ongoing physical and occupational therapy, and support for the participant's family. When necessary, PACE also provides home health care, hospital and nursing home care.
While Medicare, Medicaid or other programs may pay for these services on a fee-for-service basis, PACE provides full coverage in what can be best described as one-stop shopping. Participants receive medical and other services primarily at the adult day facility. A team of on-site doctors, nurses and other healthcare professionals provide the care. They meet daily to coordinate each participant's treatment, therapies and even transportation arrangements. There is even 24-hour phone access to a nursing professional who can help coordinate any emergency care.
Kate McEvoy-Zdonczyk, Summit ElderCare's marketing director, says that because PACE is a coordinated care program, "there is just a higher level of staff engagement with the patients here than what you typically see at a long-term care facility."
Nancy Grigas, the activities director, agrees. "The staff is incredible here. They just care so much. It's so nice to be able to enjoy what you do for work."
Eileen Mdiguette, 83, is one of the participants at Summit ElderCare. She says, "My daughter works, so I come here. It's a very nice place to come. The help is very good, and I get to meet different people."
The PACE program seems to work best when family members or friends are available to help with at least some of the caregiving. But McEvoy-Zdonczyk says that PACE can sometimes work for elders who don't have friends or family nearby. "We have one arrangement with a senior housing organization where we have participants in several contiguous apartments. We provide a home health aide to cover all the apartments. We'd like to have more of these arrangements in the future."
Of the 245 participants in the Summit ElderCare PACE program, greater than ninety percent are both Medicare and Medicaid eligible, says Longo. This means the PACE program is available at no cost to them. Some participants who are not eligible for Medicaid may have to pay a monthly premium. But once enrolled, there is no paperwork to fill out and no out-of-pocket expenses or deductibles. And even for those who do have to pay a monthly premium, the cost is often far less than assisted living or long-term care. "When you add it all up, it's a no-brainer," says Longo. "This program makes the most financial sense."
Expansion plans
Eileen Mdiguette, 83, a PACE program participant with Nancy Grigas, activities director
The current Summit ElderCare facility consists of two large adult day areas (one designed for those with dementia and another for those less cognitively impaired), a physical therapy room, a kitchen where snacks and a hot meal are brought in every day, two quiet areas for participants needing a break from activities, offices for the program's two full-time staff physicians, other staff offices, shower facilities and a laundry area.
However, major expansion plans are in the works to better serve residents in the northern and southern portions of Worcester County. The Worcester PACE program at Fallon Community Health Plan first started in 1995 and has grown steadily. "This center is really operating at maximum capacity. Now that our center has grown, it makes sense for us to add additional sites," Longo says.
The first new PACE site will be at the Overlook Masonic Health System, a continuing care retirement community and nursing home facility in Charlton. The facility will open in January in a temporary space on the Overlook Masonic campus. By the summer, however, Summit ElderCare will move permanently to its own newly- renovated building on the Masonic campus.
Another Summit ElderCare location is also in the planning stages. "At the end of 2006 we are looking at expanding in the north county area—probably Leominster, but the location is not confirmed yet," says Longo.
Respite for care givers
One key benefit of the PACE program is the respite it provides to caregivers. McEvoy-Zdonczyk knows first-hand what it means to struggle with decisions about an aging family member's care. Years ago, her father-in-law had had a number of disabling strokes. Her family chose to care for him at home. She remembers it as a very difficult time."We did not know of any way of getting help, except in a sort of piece-meal way," she says. Ironically, the PACE program had just opened that year, but no one knew about it. "As a family, we felt so alone and that no one understood what we were going through." She says that the PACE program, in addition to supplying needed care for an elderly relative, also helps caregivers "see that there are others going through the same thing that they are going through."
Increasing awareness of PACE Programs
McEvoy says that, even many years later, "there is still a low awareness of the PACE program" among healthcare providers.
Longo concurs. "We have to constantly be putting information about this program in front of physicians. Doctors have a lot of competing demands for their time. And when a patient needs this level of care, it's usually a crisis situation." But, she adds, "if a doctor thinks to refer a patient to the PACE program,that physician has just given that family an alternative to putting their relative in a nursing home. He or she can be a real hero."
Other referrals to the PACE program come from hospital discharge planners and social workers, families who have had a positive experience with the program, and even nursing home personnel who recognize when a patient may not really need 24 hour skilled nursing care.
PACE first started in San Francisco in the 1970s. It began as an experimental home- and community-based alternative to nursing home care. Because the program was successful and cost-effective, the US Department of Health and Human Services took an interest in the program and developed a model that could be duplicated in other parts of the country. States can now choose whether or not to offer PACE programs. Surprisingly, as of January 2005, only eighteen states have PACE programs. Nationwide there are a total of seventy-three centers and an enrollment of about 10,500 participants, according to the National PACE Association.
McEvoy-Zdonczyk predicts that the number of PACE programs will soon grow. "With baby boomers aging, the sheer numbers of people who want alternatives to nursing home care is bound to increase." Longo adds, "It took years for PACE programs to get established. Then it took even more years for them to get recognized by the government. This is the time that PACE programs will bloom."
Reprinted from The Healthcare Ledger.
About Summit ElderCare
Summit ElderCare is an insurance, medical care and social support program in one convenient package that includes: geriatric case management, home care, medical care prescription drugs and other services, when approved. Summit ElderCare is one of approximately 73 Programs of All-inclusive Care for the Elderly (PACE) in the country, and the only one in Worcester County. Summit ElderCare operates 4 PACE adult day health centers which are located in Worcester, Charlton and Leominster. Since 1995, Summit ElderCare, sponsored by Fallon Community Health Plan, has served the needs of elders and their caregivers with its innovative and personalized approach to care.
About Fallon Community Health Plan
Founded in 1977, Fallon Community Health Plan is a nationally recognized, not-for-profit health care services organization. From traditional health insurance products available throughout Massachusetts for all populations, to innovative health care programs and services for seniors, FCHP supports the diverse and changing needs of all those it serves. FCHP has consistently ranked among the nation’s top health plans, and is the only health plan in Massachusetts to have been awarded “Excellent” accreditation by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit www.fchp.org.