From ParentCare, Fall 2005
By Christina P. O’Neill
Fallon Community Health Plan’s Summit ElderCare program is intended to keep seniors—even those almost completely homebound—living independently for as long as possible. It accepts individuals age 55 and older who live in Worcester County or in the towns of Hudson and Marlboro, based on Summit ElderCare’s service area.
Summit ElderCare is a Program of All-inclusive Care for the Elderly, or PACE. Although it’s the only one of its kind in Central Massachusetts, there are six PACE programs in the state and more than 40 PACE programs nationwide.
A PACE program differs from most other elder day programs in that it offers a comprehensive medical service that includes primary medical care, prescription drugs, therapy, transportation to and from, medication management, and even in-home assistance. Summit ElderCare has a service capacity of more than 200 people and can actively serve about 112 attendees on any given day. And though the program is offered by Fallon Community Health Plan, Summit ElderCare participants need not be members of FCHP.
So, who judges a person’s eligibility? First of all, the Summit ElderCare interdisciplinary team does. Second, a Medicaid (in Massachusetts, it’s MassHealth) screening agent must determine whether the individual is nursing-home eligible. Annual recertification of eligibility applies for some participants.
Summit ElderCare participants must receive all their primary care from the Summit ElderCare team. The package includes primary care physicians who specialize in geriatrics, specialty care, full prescription drug coverage, 100 percent hospitalization coverage, assistance with activities of daily living, an adult day health program, medical transportation, family caregiver support, and specialized dementia and geriatric care.
When people join Summit ElderCare, they often come in with limited prescription coverage, according to Karen Longo, Summit ElderCare’s Executive Director. “They have prescriptions that, if they had more proactive care, they wouldn’t need. People end up reducing their prescriptions at Summit ElderCare and the program pays for all of it.”
Additionally, she notes, because Summit ElderCare members are closely and frequently monitored by the in-house health care team, small changes in health or demeanor are picked up a lot more quickly than they would be detected in a typical doctor’s office visit. That’s because the Summit ElderCare staff is more familiar with the patient’s “baseline”— medicalspeak for the individual’s existing physical, medical and mental conditions. Early intervention can prevent many an emergency room visit, Longo observes.
Summit ElderCare’s monthly premium is covered by Medicare or MassHealth for those eligible; some individuals bear a portion of their monthly cost and some are entirely self-paying. But whatever the monthly cost per individual, it covers all services—there are no co-pays or out-of-pocket expenses for participants.
As do all PACE programs, Summit ElderCare covers maintenance physical therapy as well as rehabilitative therapy, whereas Medicare by itself does not cover maintenance physical therapy.
Those seeking to enroll can contact an enrollment representative who coordinates with Summit ElderCare’s health care team, which then assesses the prospective participant’s health needs. The team creates a health assessment that’s sent to the appropriate regional state screening agency to determine the person’s eligibility for nursing home level care, in keeping with Summit ElderCare’s mission to help its members stay independent as long as possible.
Reprinted from ParentCare.
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