This article is part of State of Health, a series about how Michigan communities are rising to address health challenges. It is made possible with funding from the Michigan Health Endowment Fund.

When Judy's* Parkinson's disease forced her to leave Colorado and move in with her children in Grand Rapids, she was 57, unable to sit without assistance, and using a walker to stand. She couldn't even go to the bathroom by herself. Her children repurposed their family room to accommodate her.

But Judy ended up making a major turnaround with the help of a Program of All-Inclusive Care for the Elderly (PACE). The PACE model provides comprehensive medical and social services at low or no cost to older adults who live at home, including many services available at an adult day health center as well as in-home services. 
Lacey Cole leads a seated aerobics class at the LifeCircles Center in Muskegon. PACE participants are encouraged to stay active and move their bodies with low impact exercise, keeping them mobile and independent for longer.
Veronica Horsley-Pettigrew is the outreach marketing supervisor for Care Resources PACE, serving patients in Kent County and portions of Ottawa County. She says Judy's condition was "heartbreaking" when she first became a client of Care Resources PACE. But when Horsley-Pettigrew ran into Judy at Care Resources' day center gym six months later, she was astonished. 

"I could not believe my eyes," Horsley-Pettigrew says. "She went from a wheelchair to a walker to a cane to walking on her own. I just cried with happiness."

Judy now lives independently in her own apartment. The PACE program didn't work a miracle. Its multidisciplinary team simply addressed the various facets of Judy's disease. Pharmacists determined the main culprit in her decline was incorrect medication dosage. Once her medications were balanced, having unlimited access to physical therapy helped her to regain strength. Transportation to the day center gave Judy the opportunity to connect with friends, engage in activities, and lift her mood. The center's on-site gym gave her the space and equipment to continue the exercises her physical therapy team prescribes.

"We have 11 disciplines that come together and take care of this one person. That's a lot of love and expertise," Horsley-Pettigrew says. "We have medical specialists, a dietitian, and social workers to help them navigate the process. Our care starts when the driver picks up the person. Each person on our team gets it." 

All-inclusive care
 
Launched nationally in 1997, 131 PACE programs in 31 states serve more than 54,000 older adults. Managed by nonprofit private or public entities, the programs can offer all Medicaid- and Medicare-covered services as well as additional services that are needed to improve and maintain health. Because the Centers for Medicaid and Medicare Services (CMS) restrict PACE marketing activities and providers do not want to lose patients, many older adults are not aware that PACE programs exist. In Michigan, 14 independent PACE organizations serve 21 locations, covering more than 87% of the state. To check eligibility, Michigan adults aged 55 or over can call (877) 2MI-PACE 9 a.m. to 5 p.m. Monday through Friday.
A PACE participant is helped onto an exercise bike at the LifeCircles Center in Muskegon. PACE participants are encouraged to stay active and move their bodies with low-impact exercise, keeping them mobile and independent for longer.
"It's Michigan's best-kept secret," says Stephanie Winslow, executive director of the PACE Association of Michigan. "We offer all-inclusive care for the elderly, all aspects of their care. If they need to go see a specialist or they need hearing aids, personal care chores, or maybe a ramp, we provide everything to make them able to live safely in their homes. We provide it all."

No PACE programs operate in the U.P. Winslow hopes that recently passed changes to the CMS and the Affordable Care Act will change that.

"There is some federal funding on the table and we would love to use some of these funds to offer PACE in Alpena, Mackinac, Marquette and Escanaba," Winslow says. "The opportunities are out there. Hopefully, our legislature and administration will move forward on some of those asks."

Healthier and happier at home

A recent AARP survey found that three out of four people aged 50 and older want to age at home, not in a facility.

"It's better to be able to stay in your own home because it is comforting," Winslow says. "Typically, as you age, you start to lose many things — family, friends, the ability to drive. Being at home gives you comfort that adds to your physical health and mental health. … At the end of the day, even in the dark, you can navigate the terrain with no problem. Having your own things in your own space contributes to wellness."

PACE services make it possible for older adults to age in place — and at less cost than living in an assisted living or nursing home facility.

"Most people want to live in their own home as they age. They want to live in their own community rather than in a facility or institution. It's what people want," says Sarah Milanowski, marketing and communications specialist with LifeCircles PACE. "We also know the cost of institutional care is quite high. If we can provide services to make someone safe in their own home, and less likely to run out of assets and use Medicaid, it also costs the system less money."
Sarah Milanowski, marketing and communications specialist with LifeCircles PACE, with one of the LifeCircles buses. LifeCircles provides accessible medical transportation to the LifeCircles day center and to other specialty medical providers.
Medicaid-eligible older adults receive all PACE services at no charge. The out-of-pocket cost for older adults not eligible for Medicaid in Kent County, for example, is approximately $4,600 per month. The median cost of nursing home care in Michigan ranges from $8,300 to $9,400 a month. Issues with how Medicare pays for services, specifically Part D medication coverages, prevent PACE from serving those Michiganders who hover above the poverty line until their life savings, and often their health, have been sadly spent down.

"There is more freedom in our funding model," Milanowski says. "Our patients are getting out and about on bus tours of farm country, picnics at the lake, fishing, going to the Critter Barn [in Zeeland], and enjoying boat rides. We make their experiences as dynamic as possible. It's nice to have something to look forward to even when you're limited in mobility and cognition."

PACE programs also bring relief to the growing number of family caregivers meeting the needs of older adults who can no longer handle their own households or personal care. These caregivers often sacrifice personal lives, career advancement, and even physical and mental health as they care for a declining family member. PACE transportation services mean they will not have to take that day off work to get mom to the doctor. Day centers allow them to keep their jobs outside of the home. And respite services preserve their health.
LifeCircles PACE participant Angie Dill at home. PACE participants like Dill have been empowered to stay in their own homes through the support of care partners from organizations like LifeCircles.
For example, one LifeCircles PACE patient with memory impairment was showing signs of a blood clot. His wife cared both for him and their special needs adult child in the home. Instead of suggesting she juggle a difficult trip to the ER, a PACE physician assistant used diagnostic equipment in the home and was able to prescribe the care that the patient needed on the spot.

"This was a better outcome for the frail older adult and the care partner who has other competing demands," Milanowski says.

Pick up the PACE

National PACE Association studies have found that PACE programs are effective and efficient in treating individuals with multiple and complex health care needs. Older adults enrolled in PACE programs report they are healthier, happier, and more independent than their counterparts in other care settings. The PACE model has been shown to reduce need for costly, long-term nursing home care and significantly reduces preventable hospitalizations and emergency room visits. Milanowski sees confirmation of those findings in LifeCircles PACE's service area in Muskegon County and portions of Ottawa and Allegan counties.

"Although a hospital typically does a great job correcting the reason for admission, other complex factors can be exacerbated there, especially if the patient has dementia, memory loss, or multiple chronic conditions. It can be as simple as not getting any rest or being in an unfamiliar environment," Milanowski says. "Our traditional emergency rooms and hospital systems aren't always the best place for frail, older adults. We reduce those visits if we can."
A LifeCircles PACE participant shows off their coloring. LifeCircles provides a day center and encourages participants to attend for socialization.
Studies have shown that when older adults are hospitalized, they often experience a decline in their ability to function independently. So, in addition to the obvious cost savings, reducing hospital visits also increases an older adult's chances of aging in place at home.

"We're an aging population. People need services and there are staff shortages, not a lot of caregivers. We're here. We stand ready, willing, and able to serve seniors in Michigan," Winslow says. "My grandma turns 94 in October. She lives in Alpena, where there is no PACE program. I'm going to try my darndest to get a PACE program in her area so she can remain in her home and not go to a nursing home like my grandfather did."

A freelance writer and editor, Estelle Slootmaker is happiest writing about social justice, wellness, and the arts. She is development news editor for Rapid Growth Media and chairs The Tree Amigos, City of Wyoming Tree Commission. Her finest accomplishment is her five amazing adult children. You can contact Estelle at Estelle.Slootmaker@gmail.com or www.constellations.biz.

Photos by Pat ApPaul.