Operators of a program designed to keep older adults out of nursing homes are looking to attract enrollees by integrating with senior housing communities.
Programs of All-Inclusive Care for the Elderly in Massachusetts, New York, Michigan and California are locating PACE centers within or adjacent to senior housing facilities. These locations make it easier for participants to access PACE services, help operators recruit new members and help older adults remain in senior housing and their communities longer. Locating centers close to where participants live can also reduce operating costs, though there can be challenges to colocating PACE centers with senior housing.
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PACE offers home and center-based care to mostly dual-eligible Medicare and Medicaid enrollees who qualify for skilled nursing, but can still live in their communities. Providers receive capitated payments — a predictable, upfront amount of money — from Medicare and Medicaid to cover each participant. Enrollees receive some in-home services, in addition to meals, medical services and social activities at approximately 300 neighborhood PACE centers.
But launching and scaling PACE can be difficult and expensive. The program, which started about 50 years ago in California, is relatively unknown with only about 80,000 older adults enrolled in PACE nationwide, according to the National PACE Association.
PACE operaters said gaining access to a large pool of eligible participants is a top reason for integrating with senior living communities.
Lynn, Massachusetts-based Element Care PACE opened a PACE center late last year on the ground floor of the J.J. Carroll House, a newly renovated 142-unit apartment building in Boston connected by walkways to four other senior apartment buildings. The entire community has more than 900 units.
So far, 23 of the 25 people enrolled in the PACE program live in the J.J. Carroll House, according to Element Care PACE CEO Douglas Thompson. He said he expects the program to scale easily to 400 participants over the next few years as Element Care connects with other residents living on the campus.
“Our name is out there and our staff are out and about the campus,” Thompson said. “When you have an immersive experience like that, it has a much greater impact on participation.”
A similar strategy has worked for nearly 30 years for CNY PACE in Syracuse, New York. The nonprofit operates a PACE center connected by walkways to two housing complexes for approximately 90 low-income older adults.
CNY PACE Vice President Stephanie Button said the facilities are a reliable participant pipeline and their locations make it easier for the residents to access the center.
She said the nonprofit is hoping to integrate any future PACE centers with other housing developments for older adults.
“When centers are physically attached, it’s more comfortable for enrollees to just wander down to them,” Button said.
There are also financial benefits to integrating PACE centers with communities for older adults.
The programs are responsible for bringing participants to and from the centers, so having enrollees nearby can reduce transportation expenses that can make up anywhere from 6% to 8% of total operating costs, according to providers.
Partnering with a senior housing community can sometimes make it less expensive to build PACE centers, which can run anywhere from $7 million to $20 million, according to Tom Stitt, a consultant with Health Dimensions Group who advises PACE operators.
Nonprofit senior housing developer 2Life Communities owns and operates the J.J. Carroll House in a neighborhood the Housing and Urban Development Department designates as a difficult to develop area. Construction on the center entitled 2Life Communities and Element Care PACE to long-term tax credits that helped reduce the overall costs of the project, 2Life Communities President Lizbeth Heyer said.
But colocating housing and PACE centers can present challenges, according to Jade Gong, a senior advisor at healthcare research and advisory firm ATI Advisory. Gong said senior housing and PACE have different regulations, so cutting through the red tape to launch a PACE center can stretch the program's development timeline.
San Francisco-based On Lok PACE has operated a center on the ground floor of an apartment building for older adults in Fremont, California, for more than a decade. Nathan McKenzie, senior director of operations for the nonprofit, also said integrating the center with senior housing helped it gain access to members and can make it easier to provide them services.
But McKenzie said PACE operators can also reap similar benefits by simply collaborating with operators of senior housing developments. He said some senior housing developments also provide services like transportation and meals for residents. Working with PACE can help those developments better coordinate services for residents enrolled in such programs and keep people in their communities longer even without a PACE center onsite.
