PACE Programs Keep Seniors Active
Monday March 15, 2010
Print This- Select Text Size:
advertisement
When Rick Rietgraf, PT, arrived in Sacramento, Calif., looking for work in 1996, he found the area was ground zero for the managed-care movement. As an alternative to the new practice landscape, he decided to temporarily join Sutter SeniorCare PACE and found he had tumbled into a calling.
PTs play a key role in the multidisciplinary team approach to PACE — Program of All-inclusive Care for the Elderly — a program that helps thousands of frail, elderly residents in 30 states stay mobile and healthy enough to live safely on their own.
In some government-run programs and HMO plans, “ ‘patient maintenance’ is a dirty word,” Rietgraf says. “Here, it’s the name of the game.”
Participant Pat Goodchild, who is in her late 80s, says Rietgraf has not only maintained but improved her mobility during her past year in the PACE program. “I’ve been in a power chair for more than 12 years, and now after having therapy with Rick this past year, I’m walking with the use of a walker,” says Goodchild, who receives physical therapy two to three times a week.
PACE is modeled on a project launched in the early 1970s in San Francisco’s Chinatown. The program, On Lok Senior Health Services (onlok.org), gave older Asian-Americans the community-based resources needed to live independently at home.
Since PACE gained permanent federal status in 1990, the number of providers operating a PACE option has grown to 70 (cms.hhs.gov/PACE). Since 1997, the model has been a permanent entity within the Medicare program and enables states to provide PACE services to Medicaid beneficiaries as a state option.
Participants must be at least 55 years old and certified as eligible for nursing home care by the state to enroll.
Focus on Prevention
PACE at Sutter has 221 participants, says Bill Clearwater, PT, MBA, who took the reins as director three years ago. “I’m excited about letting therapists focus on prevention without worrying about red tape and prior authorizations,” Clearwater says. “They have the freedom to do what they need to do to keep people healthy.”
The program has a full-time PT and a full-time OT who help evaluate new applicants, make home visits and rotate their time between two adult day centers with attached clinics. They get support from rehabilitation aides and a large interdisciplinary team that meets early each morning to plan patient care strategies.
Clearwater says he sees the alternative eldercare market growing as the first wave of the baby boom generation begins hitting age 65 next year. Although the average age of participants is 84, younger participants are starting to show up with complex medical problems and disabilities, he says.
Dale Avers, PT, DPT, PhD, an associate professor in the department of physical therapy at Syracuse (N.Y.) University’s Upstate Medical campus, says the PACE model frees PTs to do what they need to to prevent falls or enhance the continuum of care. “Any time you can stop doing piecemeal care is a good thing,” says Avers, who has done research showing falls to be one of managed care’s biggest cost factors in older populations.
Safety Net
If PACE participants have relapses, falls or return home after being hospitalized for pneumonia or other conditions, the PACE healthcare teams mobilize to get them back up and functioning at their previous levels.
“We’ve worked with some elderly members for 10 to 12 years and successfully maintained them in the home environment,” Rietgraf says. “I try to be satisfied with little victories. We can’t cure cancer, but we can see that they’re safe, happy and get through another day.”
The sprawling Riverside Health System in Virginia operates two PACE health centers.
“In PACE, you really need to be comfortable doing whatever is necessary to keep frail participants independent,” says Robert DiPasquale, PT, MA. ”We jump into things on the fly.”
DiPasquale joined the Riverside team when the Hampton branch opened two years ago, growing from 13 participants to 135. “Many participants have cognitive defects, so we utilize strategies that help them function,” DiPasquale says. In one family he visits, the mother wasn’t walking very well, but when he turned on James Brown music she started moving to the beat. To get women into a walking club, he hands out pedometers to make outings more fun.
Paul Heins, PT, became an advocate of independent living for frail seniors after spending six years as a therapist in nursing homes. He found many residents preferred to live at home but had few resources.
“It’s my firm belief the elderly shouldn’t be institutionalized,” says Heins, director of PT at New York Central PACE. “My grandfather made us promise we wouldn’t put him in a nursing home. He called the home he lived in 40 years ‘a memory vessel’ that he didn’t want to leave.”
CNY PACE supports hospice care, and PTs regularly visit end-of-life patients they have worked with to say hello, ease pressure spots, and help them stay comfortable. “PTs work with them right to the end,” Heins says.
The program has soared to about 400 participants at two sites, which Heins views as a sign of the times. “I don’t think most baby boomers agree with institutional care,” he says. “They want to use community-based resources.” •
John Leighty is a contributing writer for Today in PT.
PTs play a key role in the multidisciplinary team approach to PACE — Program of All-inclusive Care for the Elderly — a program that helps thousands of frail, elderly residents in 30 states stay mobile and healthy enough to live safely on their own.
In some government-run programs and HMO plans, “ ‘patient maintenance’ is a dirty word,” Rietgraf says. “Here, it’s the name of the game.”
Participant Pat Goodchild, who is in her late 80s, says Rietgraf has not only maintained but improved her mobility during her past year in the PACE program. “I’ve been in a power chair for more than 12 years, and now after having therapy with Rick this past year, I’m walking with the use of a walker,” says Goodchild, who receives physical therapy two to three times a week.
PACE is modeled on a project launched in the early 1970s in San Francisco’s Chinatown. The program, On Lok Senior Health Services (onlok.org), gave older Asian-Americans the community-based resources needed to live independently at home.
Since PACE gained permanent federal status in 1990, the number of providers operating a PACE option has grown to 70 (cms.hhs.gov/PACE). Since 1997, the model has been a permanent entity within the Medicare program and enables states to provide PACE services to Medicaid beneficiaries as a state option.
Participants must be at least 55 years old and certified as eligible for nursing home care by the state to enroll.
Focus on Prevention
PACE at Sutter has 221 participants, says Bill Clearwater, PT, MBA, who took the reins as director three years ago. “I’m excited about letting therapists focus on prevention without worrying about red tape and prior authorizations,” Clearwater says. “They have the freedom to do what they need to do to keep people healthy.”
The program has a full-time PT and a full-time OT who help evaluate new applicants, make home visits and rotate their time between two adult day centers with attached clinics. They get support from rehabilitation aides and a large interdisciplinary team that meets early each morning to plan patient care strategies.
Clearwater says he sees the alternative eldercare market growing as the first wave of the baby boom generation begins hitting age 65 next year. Although the average age of participants is 84, younger participants are starting to show up with complex medical problems and disabilities, he says.
Dale Avers, PT, DPT, PhD, an associate professor in the department of physical therapy at Syracuse (N.Y.) University’s Upstate Medical campus, says the PACE model frees PTs to do what they need to to prevent falls or enhance the continuum of care. “Any time you can stop doing piecemeal care is a good thing,” says Avers, who has done research showing falls to be one of managed care’s biggest cost factors in older populations.
Safety Net
If PACE participants have relapses, falls or return home after being hospitalized for pneumonia or other conditions, the PACE healthcare teams mobilize to get them back up and functioning at their previous levels.
“We’ve worked with some elderly members for 10 to 12 years and successfully maintained them in the home environment,” Rietgraf says. “I try to be satisfied with little victories. We can’t cure cancer, but we can see that they’re safe, happy and get through another day.”
The sprawling Riverside Health System in Virginia operates two PACE health centers.
“In PACE, you really need to be comfortable doing whatever is necessary to keep frail participants independent,” says Robert DiPasquale, PT, MA. ”We jump into things on the fly.”
DiPasquale joined the Riverside team when the Hampton branch opened two years ago, growing from 13 participants to 135. “Many participants have cognitive defects, so we utilize strategies that help them function,” DiPasquale says. In one family he visits, the mother wasn’t walking very well, but when he turned on James Brown music she started moving to the beat. To get women into a walking club, he hands out pedometers to make outings more fun.
Paul Heins, PT, became an advocate of independent living for frail seniors after spending six years as a therapist in nursing homes. He found many residents preferred to live at home but had few resources.
“It’s my firm belief the elderly shouldn’t be institutionalized,” says Heins, director of PT at New York Central PACE. “My grandfather made us promise we wouldn’t put him in a nursing home. He called the home he lived in 40 years ‘a memory vessel’ that he didn’t want to leave.”
CNY PACE supports hospice care, and PTs regularly visit end-of-life patients they have worked with to say hello, ease pressure spots, and help them stay comfortable. “PTs work with them right to the end,” Heins says.
The program has soared to about 400 participants at two sites, which Heins views as a sign of the times. “I don’t think most baby boomers agree with institutional care,” he says. “They want to use community-based resources.” •
John Leighty is a contributing writer for Today in PT.
To comment, e-mail pteditor@gannetthg.com.
Monday March 15, 2010