Keeping PACE with Eldercare

ABOUT ONE IN EVERY EIGHT Americans is 65 or older, and 3.8 million of that group live in California, according to the U.S. Department of Health and Human Services. While a relatively small number of those between 65 and 75 live in nursing homes, the percentages increase dramatically with age. Yet 83 percent of elderly Americans say they hope to remain in their homes until the end of their lives, and 30 percent say they “would rather die” than go to a nursing home, according to a CBS News report. But many older people have limited options. Fortunately for San Diego, 2007 may mark a major change in the way we care for the aging.

Early next year the county’s first PACE (Programs of All-Inclusive Care for the Elderly) clinic will open its doors in a 9,000-square-foot facility downtown on Elm Street. A consortium of elder-care providers, known as Community Eldercare of San Diego, led the effort to bring the program here.

PACE represents something of a revolution in the way continuing care and services are provided. The driving philosophy behind it is the belief that it is those with chronic care needs are served in the community where they live, rather than in a nursing home. These are folks who need caregiving but want to continue to live at home, alone or with family. And it’s more than just a belief on the part of PACE’s founders—studies consistently show that giving older people control over their lives is beneficial to their health.

When PACE is operational early next year, it will be a one-stop shop: an adult day health center providing medical and support services—physical and occupational therapy, meals, nutritional counseling, social work, personal care, respite care and prescription drugs. The center will be able to serve about 180 people. PACE physicians become familiar with the history, needs and preferences of each client, says Bill Metzdorf, executive director of St. Paul’s Retirement Homes Foundation.

Metzdorf became involved with St. Paul’s and PACE (a stand-alone corporation affiliated with St. Paul’s Retirement Homes Foundation) after spending 30 years as a Catholic priest. Shortly after September 11, 2001, he left active ministry to do something, he says, “that gave me the opportunity to invest my time, energy and skill sets in making a difference for a population that is very vulnerable, the forgotten population.”

Those who join the PACE program— which costs about 10-20 percent less than a traditional nursing home—receive transportation to and from the center or visits from medical staff, home health aides and, if necessary, meals delivered. A PACE home-care team puts together a plan for each client, preserving as much independence for that person as possible. If someone wants to be assisted in their home, rather than at the clinic, the home-care team “might decide they need help getting up in the morning, getting dressed and putting a meal together, but doesn’t need an aide with them all day,” says Metzdorf. “Or we might have someone pop in to make sure they took their medication. The idea is to let the client decide as much as possible what they want to do.”

Patients can spend the day at the health clinic getting the medication or therapy they need and socializing with peers, but at the end of the day they can go home. Valerie Er-O’Connor, PACE coordinator, says this makes an enormous difference in quality of life. “When we get older, we lose a lot more of what we can do independently and perceive ourselves as less purposeful,” she says.

As friends and spouses die, a person’s primary support system is usually diminished, says Metzdorf. “That’s when depression sets in and the television becomes their best friend,” he says. “We take them out and bring them together with others in the same age range, with similar backgrounds and histories, rather than leaving them housebound, without the will to live.”

AS INNOVATIVE AS IT IS, PACE isn’t new; in fact, the program exists in 35 other communities. It began 36 years ago in San Francisco’s Chinatown–North Beach community, and that’s when Er-O’Connor began her association with it, joining the center right out of college as a recreational therapist. At the time, her father, who lived in San Diego, had to be placed in a nursing home for a while, an experience that stuck with Er-O’Connor. “It broke my heart to see him there,” she says.

When that first PACE center opened in 1973, one of the nation’s few adult day centers, it was known as On Lok Senior Health Services. (“On lok” is Cantonese for “peaceful, happy abode.”) A year later, On Lok was receiving Medicaid reimbursement for services. Over the next several years the center expanded its offerings, receiving a federal grant in 1979 to further develop its model for delivering long-term care.

The program was renamed and designated by the federal government as a demonstration project. Eight years ago, says Er-O’Connor, it became a permanent, federally and state-funded program. The state legislature mandated a minimum of 10 PACE programs throughout California, but that’s easier said than done, says Cheryl Wilson, CEO of St. Paul’s Retirement Homes Foundation. Wilson has led the effort over the last seven and a half years to obtain approval from the state to bring PACE to San Diego. It was a grueling process.

After setting up PACE, Wilson and others prepared the application for state approval. But the Office of Long Term Care—short of staff and underfunded— abruptly stopped processing applications. Frustrated, Wilson began lobbying legislators to get things moving again.

“We started working with Dede Alpert, who at the time was our state senator. And she made inquiries, as did some of the county supervisors and the mayor, who all wrote letters on our behalf,” says Wilson. Finally, after an appeal to Governor Schwarzenegger and the intervention of state Senator Denise Ducheny, applications are again being processed.

Ducheny put the Department of Health Services (which includes the Office of Long Term Care) under intense questioning. “We discovered they had many PACE applications pending; they just didn’t have the staff they needed,” she says. Funding was provided for additional staff, and the application processing was restarted.

“I think the hearing helped them see that the legislature thinks PACE is an important program,” says Ducheny. “The idea of all-inclusive care and the ability to stay at home is better for the patient and also better for the state, because it costs less than serving people in a nursing home.”

So far, things at the state level are moving along, says Wilson. The first three chapters of her 10-chapter application have been approved. Now the biggest hurdle the program faces is financing. “We need $1.5 million more to have enough in our reserve fund to begin operating,” she explains. Right now the program has $750,000, and raising the rest won’t be easy.

Metzdorf says fund-raising for the elderly is the toughest part of his job, because people don’t want to think about them. “The elderly are the throw-away generation,” he says. “Which is ironic, because we are all headed in the same direction.”

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