Rural Elderly Offer Home in New Study by PACE

Feb. 22, 2003 - The National PACE Association (NPA) and the National Rural Health Association (NRHA) published a new report today, Setting the PACE for Rural Elder Care: A Framework for Action, providing a blueprint to improve the care for many seniors with long term care needs who live in rural areas while saving state and federal health care dollars by expanding access to Programs of All-inclusive care for the Elderly (PACE).

PACE programs serve people over age 55 who meet their state’s criteria for needing nursing home care, with a goal of helping them to live in the community. PACE has been shown to provide better clinical outcomes and higher rates of consumer satisfaction, while cutting costs to federal and state governments.

Today PACE only serves older people living in urban areas. However, rural areas of America have a disproportionate number of older Americans, with 18 percent of the population over age 65. Of these Americans, many lack adequate income to afford needed health care, and face more difficulty receiving care than their urban counterparts because of uniquely rural factors, such as the shortage of health care professionals, the distances between service providers and the lack of low-cost public transportation for residents

Interdisciplinary teams of professionals both provide and coordinate preventive, primary, acute and long term care services in PACE with an emphasis on keeping older individuals in the community. Program sponsors are reimbursed by Medicare and Medicaid based on a capitated rate for each eligible person who enrolls, so teams can deliver specific types of care and services to help each individual live as successfully in the community as possible. Because the program combines Medicare and Medicaid funding into one seamless program, it is proven effective in enabling even low-income person with few resources to continue living in the community.

“One key to a program like PACE is being able to enroll enough individuals in the program to support the program’s costs,” Shawn Bloom, president and CEO of NPA, said. “Being able to serve an adequate number of individuals to cover the cost of the program is more difficult in a rural area where fewer numbers of people are spread over greater distances.”

Although many rural communities have the resources and know-how to implement PACE programs, they need access to start-up funding and more flexibility with the PACE model than urban-based PACE sponsors, according to participants at the September 2002 “Rural PACE Summit,” co-sponsored by NPA and NRHA and supported by grant funds from The Robert Wood Johnson and John A. Hartford Foundations.

“Many rural communities have the ability to operate effective and beneficial PACE programs,” NRHA executive director Steve Wilhide, MSW, MPH said. “We need to work to ensure they receive adequate funding to help them get started and the flexibility they will need to successfully adapt the PACE model to various rural settings.”

As of January 2003, there were 28 PACE programs, all operating in urban areas. To ensure success in rural areas, program supporters say the program will need to be able to attract an adequate number of community members to enroll in the program.

After years of success as Medicare and Medicaid demonstration programs, PACE programs are in the process of becoming permanent providers under both the federal

Medicare program and the state’s Medicaid program. Many state and federal long term care health policy experts, including the Centers for Medicare and Medicaid Services (CMS) Administrator Thomas Scully, have expressed support for expanding the PACE model into rural areas.

Diane Braunstein, program director of health policy studies at the National Governors Association, echoes Scully saying, “Efforts to expand programs like PACE into rural areas are important as states continue to seek out new ways to deliver services to rural elders.”

While acknowledging that a rural PACE model could take many different forms, advocates are focusing on two likely scenarios such models might follow.

The Rural Network Model would be based on a high level of collaboration between many different providers serving a rural area. Health care providers in rural communities have a tradition of working together to provide for the community’s health care needs, as no single organization would have the resources or know-how to handle the services individually. In theory, the PACE model could adapt so several different organizations could work together.

Another model is the Rural-Urban Linkage Model based on partnerships between an urban-based PACE sponsor and rural health care providers in the area. While these partnerships could take many forms, they have the potential to offer several benefits, including specialized services, sharing of administrative costs and financial risks.

As a next step, NPA and NRHA are working together to build support in the Bush administration and Congress for a rural PACE demonstration program.

The National PACE Association works to advance the efforts of Programs of All-inclusive Care for the Elderly (PACE) to support, maintain, safeguard and promote the provision of quality, comprehensive and cost-effective health care services for frail older adults.

The NRHA is a national nonprofit membership organization that provides leadership on rural health issues. The association’s mission is to improve the health of rural Americans and to provide leadership on rural health issues through advocacy, communications, education and research. The NRHA membership is made up of a diverse collection of individuals and organizations.