A change of pace in healthcare

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Barbara Ruben

Oscar Fritz reaches to catch a ball during a session with a physical therapist at the InovaCares for Seniors’ PACE program. Based in Fairfax, the program is one of 90 PACE programs nationwide that enable older adults with significant health needs to continue living in their own home rather than move to a nursing home.
Photo Courtesy of InovaCares for Seniors

Although Frank Gold suffered from polio as a child, it didn’t stop him from becoming a paratrooper in the Pacific during World War II.

A stroke a couple years ago slowed his gait and slurred his speech. But like the determined, independent young man he was in the 1940s, Gold, now 89, can’t imagine moving into a nursing home.

Instead, he lives with his daughter in Burke, Va., and joined InovaCares for Seniors’ PACE program. PACE, which stands for Program of All-inclusive Care for the Elderly, is designed to offer a home-based alternative to nursing homes for older adults who need skilled nursing care.

The comprehensive program, affiliated with the Inova Health System, offers an adult day program every weekday in Fairfax, Va., with one-stop shopping for healthcare services. The center is staffed with a doctor, nurse, and physical and occupational therapists, and transportation is provided to the offices of specialists affiliated with Inova.

Two meals a day are provided, along with social and recreational activities. When participants go home at day’s end, additional homecare, if needed, is also available.

PACE manages the participants’ prescriptions, provides transportation to and from the center, and offers respite care services for family caregivers.

“All the staff collaborate to keep people living at home as long as possible,” said Rose Mario, manager of marketing and business development for the program.

“Do they need help bathing? Are they going to need food on the weekend? Do their caregivers need a break? These are all things we look at,” Mario said. “There is no other model of care in Northern Virginia like this.”

In fact, while there are 90 similar PACE programs across the country, there are no others in the entire Washington metro area, and none are planned in the near future, according to the National PACE Association. The closest one is located in Baltimore, affiliated with the Johns Hopkins Bayview Medical Center.

The Northern Virginia program opened in 2012 and has 51 participants, with room for about 25 more.

To qualify for PACE, individuals must be 55 or older, need a nursing facility level of care, and live in the program’s “service area,” which includes 45 Fairfax County Zip codes, including those in Centerville, Herndon, Reston, Falls Church, McLean, Springfield, Vienna and Alexandria.

The typical PACE participant is on average 80 years old, has eight medical conditions, and is limited in approximately three activities of daily living. Nearly half of PACE participants have been diagnosed with dementia, as well.

No place like home

While Gold needs help with several activities of daily living, including such things as bathing and dressing, he balked at living in a nursing home after moving from California to be closer to his daughter.

What sold Gold on PACE? “I liked the idea that I can go home at night to my own bed,” he said. “It makes you feel like you’re not in jail.”

Gold, who enjoys piecing together intricate jigsaw puzzles at PACE, serves as a kind of unofficial welcome wagon for new members.

“I’m very happy with the program. I think it’s great, and I tell people that,” he said. Wayman Gooden has a similar view. Diagnosed with multiple sclerosis nearly 20 years ago, he had no intention of leaving his apartment in Alexandria, Va., where the 59-year-old lives alone.

“MS hasn’t defeated me. I was staying home. Period,” Gooden said. “I can still clean. I can wash my dishes. Cooking is a gray area because I can only stand but so long.”

Gooden said he relishes coming to the PACE program and appreciates the home health aides that come to his apartment.

“My life is most definitely easier. I am so glad for all of it: food, information, fellowship with people. You get out of the house. Keeps me out of trouble, too. PACE is wonderful. I recommend it to anybody.”

Unlike most PACE participants, Oscar Fritz lives in an assisted living community just down the street from the InovaCares center. But after suffering a stroke, he needs a little more help than it offers. He said, however, “I wouldn’t even think about having to live in a nursing home.”

“I really like that this is so close to me, and the people are so friendly,” Fritz said. “There’s a doctor on hand if I need one, and they send aides to my apartment to clean and do the laundry.”

Paying for it

The entire cost of the PACE program is covered for Medicaid beneficiaries. Those whose incomes and assets are too high to qualify for Medicaid must shoulder the cost themselves. If they spend down all their savings, however, PACE helps them apply for Medicaid.

The cost for those without Medicaid is $5,041 a month, considerably less than the average nursing home cost in Northern Virginia. (In 2012, the average cost of a semi-private nursing home room here was $279 a day, or $8,370 a month, according to the MetLife Survey of Long-term Care Costs.)

For Audrey Mirsky-Ashby, who pays full fare for her mother, the wrap-around care offered by PACE is priceless.

Her mother, Edith Mirsky, who has memory impairments, lived in New York City on her own, but one day she went to the bank and couldn’t find her way home. She forgot how to use her cell phone.

So Mirsky-Ashby moved her mother to Fairfax to live with her and her family. Even after employing home health aides for 10 hours a day and adding the services of an adult day center for her mom, she still found caregiving stressful.

But PACE “has made a tremendous, tremendous difference. It’s been a godsend,” she said.

“When I realized that I was paying $15 an hour for the home health aides and their Social Security, and going through the horrors of scheduling them and all the doctor appointments, and the nightmare of keeping track of all her prescriptions, I feel like I get a lot for my $5,000,” Mirsky-Ashby said.

She is also happy that PACE offers respite care. When Mirsky-Ashby went on a camping trip with her son and husband last summer, PACE placed her mother in a Sunrise assisted living community for the weekend.

A liberating service

Similarly, Naja Brown has found the PACE program invaluable in augmenting her caregiving for her parents.

“I do not have a medical background, and being the liaison between my parents and all of their various physicians was a very stressful position to be in,” said Brown, who lives in Burke, Va. “The fact that I could hand that component of their care to an organization that could definitely do it better was liberating.”

Bobbi Longworth, of Centreville, has also found more peace of mind with PACE. Longworth had been helping care for her mother, who lives in an independent living community for seniors but needed more help than was provided there. Her mother was one of the first participants to sign up for InovaCare’s PACE.

“I would have appreciated any help at all, so the comprehensive coordination of care appealed to me and almost seemed too good to be true. Fortunately, it wasn’t,” Longworth said.

“The benefits have been great in that our mother-daughter relationship has improved. I’m no longer as overwhelmed by the numerous, seemingly endless caregiver duties that precluded us from actually enjoying some of our time together.

“It’s not always easy, but life is much more balanced for myself and my mother thanks to our partners at PACE.”

For more information on the InovaCares for Seniors PACE program, call (703) 239-5888 or see www.inova.org/pace. Information on the program nationally is available at www.pace4you.org.