May 8, 2025 • 38 mins
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Championing PACE: Comprehensive Care for the Elderly with Donna Wilhelm
In this episode, Erin reconnects with Donna Wilhelm, Vice President for Advocacy and Government Relations for Trinity Health Continuing Care, to discuss the impactful PACE (Programs of All-Inclusive Care for the Elderly) program. Donna shares insights about her career shift into senior living services, her role in the PACE initiative, and the comprehensive support it offers for seniors and their caregivers, from medical care to everyday necessities like air conditioners and laundry. The conversation also covers the political challenges PACE faces, including the necessity to advocate for federal and state support to ensure its sustainability and expansion. Both Erin and Donna emphasize the critical need for programs like PACE to become mandatory, amid the growing demand for senior care solutions.
00:00 Introduction and Guest Welcome
00:38 Donna Wilhelm's Role and Background
01:55 Overview of the PACE Program
02:28 Eligibility and Services of PACE
03:18 Financial Aspects and Risk Management
05:17 Real-Life Examples and Impact
06:46 Interdisciplinary Team and Care Approach
08:22 Expansion and Advocacy for PACE
15:53 Caregiver Support and Holistic Care
18:52 Dementia Care in PACE
20:37 Managing Expenses and Medicare Coverage
21:34 Political Implications and Advocacy
23:23 Medicaid Funding Challenges
25:27 Potential Cuts and Their Impact
27:22 The Importance of PACE
35:16 Scalability and Future of PACE
36:59 Conclusion and Call to Action
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Erin (00:00):
y'all.
In my best Southern voice I'mreally excited about today
because you get to hear anothersouthern lady, miss Donna
Wilhelm, who I worked with at aprevious community, a locally
owned, community for a littlewhile called Mercy Medical.
she was the vice president ofsales.
What was your.
Yeah,
Donna (00:20):
I was vice president of sales and marketing for Mercy
Medical, so
Erin (00:25):
yeah.
Donna (00:25):
Yeah.
Seems like a hundred years ago,Erin.
Erin (00:27):
it does seem like a hundred years ago and now, she's
working in, such a purposedriven, Service inside Senior
living, which is the PACEprogram.
And I want to give Donna thefloor so she can talk about her
title, what she does.
But before I do that, I justwanna say to everyone who's
listening, this is a bit of afull circle moment for me
(00:49):
because having Donna on theepisode, on this podcast, on
this episode is something that,you know.
14 years ago, I don't know if Iever would have thought that
this was a possibility.
Donna was high up in the foodchain and I was an administrator
of, a 64 apartment memory carecommunity that was struggling.
(01:13):
Mightily and there were manydifferent pools going on, and,
the dynamics were interesting,but here we are.
And it's really exciting for me.
Donna, welcome.
Donna (01:29):
we learned from each other, Erin.
We've learned from each other,and that's, I think, the way
it's supposed to be.
but I'm happy to be here.
Happy to, to be, speaking towith your listeners.
And just a little bit about me.
I am the Vice President, foradvocacy and government
relations for Trinity HealthContinuing Care, which includes
Trinity Health Pace.
We have three nationalministries under continuing
(01:51):
care, and that's seniorCommunities, our Home Health and
Hospice, and our PACE Program.
but we're here today to talkabout pace.
I serve as the.
The advocacy person, which meansI, I fight for all sorts of
things, but mostly I fight forour participants to remain in
our program for the funding tobe appropriate, to cover the
level of care that we have, andfor access and growth.
(02:13):
So it's important that theprogram grows, so that more and
more seniors have access to,this very important home and
community service that allowspeople who are nursing home
eligible to remain in theirhome.
So that's me in a nutshell.
Erin (02:27):
Yeah, that's a lot.
So PACE stands for, it's anacronym.
Tell us what it stands for.
Donna (02:33):
Yeah, PACE stands for Programs of All Inclusive Care
for the Elderly.
I think what's so importantabout that is it's all
inclusive.
So it's important to note thatfor people who enter the
program, they have to meetcertain eligibility
requirements.
They have to be 55 and older.
they have to require nursinghome level of care.
So that's one big caveat.
(02:53):
Nursing home level of care, theyhave to live in an area that's
served by pace.
It's not every area has pace init, in its, in its district.
and they have to be able toremain at home and in the
community safely with thesupport of the PACE program.
So not everybody will qualifyfor pace, but for those who do,
we provide wraparound.
(03:15):
All inclusive services for thosefolks.
So for them to remain at home,we usually get paid in a
capitated, we always get paid ina capitated bundle, so we
receive payments from Medicareand Medicaid if the person
qualifies for both, if they aredually eligible, if they are
only Medicaid, then we receivejust that capitated amount, and
(03:37):
if they're only Medicare, wereceive that capitated amount,
plus a private pay portion.
however, 99% of PACEparticipants are Medicaid
enrolled and over 80% are duallyenrolled in Medicare and
Medicaid, and that's nationwide.
so most of the folks havecoverage on, both Medicare and
(03:59):
Medicaid.
All of them are nursing homeeligible.
So when I say it's, it'scapitated, so we take that
bundled payment, so to speak,and it's a monthly per member
per month payment that wereceive for that amount of
money.
We are 100% full risk.
So what the heck did that mean?
That means that for that we areon the hook for their care for
(04:20):
everything.
So if this person has to go tothe hospital.
we pay for that.
If this person has to see acardiologist, we pay for that.
If they need a kidneytransplant, we pay for that.
so all of it we are on the hookfor, so we behooves the PACE
program obviously to do theright thing and really take good
(04:41):
care of our participants.
You should be doing that anywaybecause it's the right thing to
do.
from the financial aspect, itcertainly means a lot to, to
provide the care that preventssome of those really big,
medical episodes from happening.
So we do our best to do that andtake really good care of our
participants.
(05:02):
But it also enables us, becausePACE has a little more freedom
than some of those Medicare andMedicaid programs.
It enables us to, I like to sayit allows us to take care of our
participants like we would ourown mother.
and I'll give you a very goodexample, Erin, and I think I've
shared this with you before inour PACE program in mobile, we
(05:24):
live in the deep south.
It gets darn hot and sticky herein the summertime, as you well
know.
So we had a participant who wasin our mobile pace program who,
she lived alone.
She lived in a very small home,and she had a lot of, lung
issues.
so the, the heat was really badfor her.
and her air conditioner died ather house.
(05:46):
she did not have the money tofix it.
are not wealthy individuals.
Air conditioners.
Price.
So it made, without pace, thisparticular lady who, was well
into her eighties, could nothave stayed in that home.
And because of her chronicconditions would've likely end
up in a nursing home withoutpace.
there was just no other option.
(06:07):
for us, for the PACE program, wewere like, it would serve her
better, and is a heck of a lotless expensive to just fix her
air conditioner.
So we were able to use thatmoney to fix her air
conditioner, which compared to anursing home with, it's just
like a drop in the bucket.
It's just like a total drop inthe bucket.
And it allowed her to stay inher home where she preferred to
(06:30):
be, and she was able to staywith the supportive piece.
And there are thousand otherstories like that, that it's
just common sense thinking, whatwould you do if this was your.
Mother, would you stick her in anursing home or would you fix
the air conditioner?
some of it's just very commonsense stuff.
a lot of those, all thedecisions in pace are made by
the interdisciplinary team.
(06:52):
It's a group of professionalsthat, you have physicians, you
have nurse practitioners, youhave therapists, you have the,
the aide, the driver of the busthat drops off, the little lady
at home.
All of these folks sit on theIDT.
And so when those discussionsare made about.
what's best to be done for thisindividual?
It's a team approach.
(07:13):
it's not as if the physiciansits at the head and directs
everything down.
Everybody has a voice at thetable and is able to say, I
think this would work best forthis person, or This wouldn't
work best for this person, or,we can't recommend that because
of, so it, it's.
I like to say it's in your facecase management because the pace
IDT really knows everythingthat's going on with that
(07:37):
participant.
So those wraparound services arepretty significant.
they are meeting the needs ofthis individual at a level that,
that really has not been metbefore.
but so allowing them to remainin their home safely.
So it's a super program.
It, it really allows for theperson to, to be where they
(07:57):
wanna be, and I'm an advocatefor nursing homes.
I think we'll always neednursing homes.
I think we always need assistedliving.
I will say, there will always bea place for them, in the medical
world.
however, I think if you askanybody, really anybody.
Would you rather stay at home?
I think they're gonna say yesfor absolutely as long as
possible.
I want to remain at my home.
(08:19):
so it's important, an importantprogram to do that.
Now, I touched on earlier thatyou have to live in an area that
is served by pace.
So you're thinking, gosh, Inever heard of it.
and there's probably a reallygood reason you've never heard
of it, is it's a really, thebest kept secret.
and that's not because we wantto be, it's just because pace is
still relatively small.
(08:39):
So Trinity Health Paces, where Iwork, we have programs in 12
State.
we serve over 3,500 participantsin our PACE programs.
But nationally, like I said,there are over 80,000 people in
PACE programs, in 33 states andthe District of Columbia.
and you may ask, why is it notin, in every state?
(09:01):
the issue with that is.
The Centers for Medicare andMedicaid, which oversees PACE
programs and most every other,medical program out there, has
told the state that, you havemandated programs like say
nursing homes are mandated andyou have to have them, Medicaid
(09:22):
has to pay for them through thestate.
And then you have optionalprograms that are fine to have,
States can opt in, states canchoose to have these optional
programs and pay for those as,as people choose.
to be in, PACE is optional inCMS, so only 33 states and the
(09:42):
District of Columbia have chosento.
Although some states have prettygood coverage, meaning they
cover the entire state, very fewstates have 100% coverage of all
locations.
for an example, we are inAlabama.
There's one PACE program, andit's ours and it's in mobile.
(10:05):
We only cover two counties, themobile and Baldwin County.
there needs to be a push from,constituents, in the state to go
to their state legislators andsay, Hey, I want pace.
I want pace in Montgomery and Iwant PACE in Birmingham, and I
want pace in Huntsville, to beable to speak to that and so
that the state can expand it.
(10:25):
And also in other states, wehave successfully expanded pace.
in a lot of states, recently wejust had our grant opening,
actually Friday for a program inMontgomery County, Maryland.
They had one PACE grant programfor 20 years.
20 years.
It took Maryland's amount oftime to finally move forward.
(10:46):
so now we have the second one inMontgomery County, but we've
expanded into Louisiana.
We've expanded into, Florida.
And a lot of states that arevery supportive of the PACE
program have really, embracedit.
Really embraced it becausethey've seen what a wonderful
program it is.
And from a state perspective, ifI'm a state Medicaid director,
(11:09):
I'm gonna be like, how much doesthis cost me?
And what's the difference incost between caring for this
person in a PACE program andcaring for this person in a
nursing home?
Nationally, that's over a 12%savings to the state.
So if I were a Medicaid directorand someone said, you can save
12% for these very high cost,individuals to be cared for, I'm
(11:33):
gonna sign up for that all daylong.
so states are really adoptingthis at, a much faster pace than
they used to.
but still the word needs to getdown and these states need to
jump on board and adopt pace.
Erin (11:46):
Yeah.
So there's a lot to unpack here.
Yes, because for people insidesenior living, we get phone
calls all the time.
About how, and there are peoplethat we can serve and there are
people that we can't serve, andpeople who are eligible for pace
typically are the people that wecannot serve.
Because number one, they qualifyfor skilled nursing.
(12:10):
Which some people who qualifyfor skilled nursing can live
successfully inside seniorliving.
But not every single one ofthem, and not in every single
state.
So there's lots of gray areathat to navigate.
But when we look at, from afinancial standpoint, and
there's all kinds of talk goingon about how to serve the
(12:31):
underserved.
And when a sales director.
Can help problem solve forpeople In these 33 states, which
are obviously specific tocounties in those 33 states,
Donna (12:45):
it's,
Erin (12:46):
if you have a PACE program and somebody calls you and they
don't know about it, you couldjust be giving them, one of the
greatest gifts that they couldever receive.
to be able to replace somebody'sair conditioner, or correct me
if I'm wrong, build a ramp insomeone's house.
Exactly.
Because I remember have someother
Donna (13:04):
examples.
Erin (13:05):
yes.
I remember.
way back when hearing about thatand thinking oh my God, that is
God's work.
Donna (13:10):
Yes.
Erin (13:11):
You know what I mean?
Like it's, yes.
to be able to say to someone,we're going to do this for you
because you need this and itaffects you medically like.
that is, that's an amazingconversation to have to be able
to actually do that forsomebody.
(13:32):
And something as simple, and Ihave a personal experience with
it because I tried to get mygrandmother on the PACE program
and then I have another familymember that I think could
benefit from this, that I'mworking with a family about is
something as simple as justpicking up laundry.
You have laundry routes?
Donna (13:50):
We do.
Erin (13:51):
You go pick up people's laundry, which yes, is mind
blowing to me because that costsa lot of money to just go pick
up people's laundry.
That costs money, that costs
Donna (14:09):
personnel,
Erin (14:09):
that cost gas, that costs like cars like so much.
Donna (14:14):
I would say so much services.
Are really issues of dignity forthe participants that we serve.
And I'll never forget this, andthis was, gosh, I dunno, 14
years ago, but when we had ourgrand opening at our PACE
program in mobile, thearchbishop was there, he had the
blessing.
It was like this big to do.
And I remember touring him.
through the facility and we cameto the room that has the
(14:37):
laundry, that has showers, thathas a little lockers for people
to put their stuff up in.
It had a place that we canactually wash people's hair and
cut their hair.
and his comment to me was, whatthis says, he said, what this
says to me is you are caring forthe dignity of the person.
(14:59):
So many folks, and these arenot, again, wealthy people.
They, their homes are theirhomes and they may not be
fabulous places for everybody,but they're home to them.
they may not have access evento, or the ability to get into a
shower anymore, or a tub that's,safe.
And so we can go pick them up.
(15:20):
We can bring them to our paysite.
And, they get shaves, they getshowers, their hair is fixed,
their laundry's done.
And so when they go home,they're in clean clothes.
They've got their clean clotheswith them.
They've had a meal, they've beencared for, they've been checked
out by the nurses and thephysician.
so those are things that, thatgo a lot deeper than people
(15:42):
really expect.
I think we tend to take thesethings for granted as people get
all oh, they have that.
A lot of people just don't havethat, and a PACE program can
provide that with folks.
Erin (15:52):
Yeah.
it really is amazing.
And let's talk about thecaregiver support.
We know that there's a hugesandwich generation Yes.
surge where I even see it withsome of my friends who have
younger kids and then they haveolder parents and they're trying
to navigate it.
And so yes, we're talking aboutcaring for.
The person, but we are alsocaring for the caregiver as well
(16:16):
because like you were saying,there's like a daycare kind of
component, like a day programwhere they can come in and see
the doctors, see all thespecialists or the, the type of
care that they need, Eat,shower, and then be able to come
home.
And there's transportationinvolved with that as well.
(16:38):
Yeah.
Donna (16:39):
We do provide transportation for our
participants both to the centerand to their physician
appointments.
if they have an outsideappointment, we take them.
we have dialysis patients thatwe're providing transportation
for three times a week todialysis.
So those are all, included inthe services that we provide.
And I think you touched onsomething that's real important
and that's caregiver the care ofthe caregiver.
(17:00):
most, if not all of ourparticipants have somebody that
helps care for them in the home.
maybe it's a daughter, maybeit's a spouse.
and so they have come to pacebecause they're struggling doing
that, but they want to do that.
they still want this person toremain in their home.
But I think one awesome thingthat, that we give caregivers
that you know, that, aside fromthe support of all those things
(17:22):
that you just mentioned.
Is it somebody to callimmediately if something
happens, or if you thinksomething's happening or if you
have a question?
we've always said, call pacefirst.
call us first so you know,before you think there's, a
possibility that person needs tomaybe go to the er.
Certainly don't hesitate ifthat's your thinking.
but if you do have questions,call us and let us triage that
(17:45):
person and make sure that it'snothing else that could be
handled either in the home orthe nurse coming out, to manage
that.
So it gives those caregivers thepeace of mind of saying, I've
got someone on the other end ofthe phone all the time, that can
help me if I have thesequestions or feel like there's
an urgency and that's peace ofmind that, most caregivers just
(18:06):
simply don't
Erin (18:06):
have.
Yeah, it's great.
It's, and to help make decisionsto, to have, help make
decisions.
Yeah.
Yeah.
because we all get decisionfatigue and to be able to have
somebody who is at your call,at, to be able to say, this is
what's going on.
And they have seen them thatweek and the driver has seen
(18:27):
them and they have all theseinput.
There's just a holistic level ofcare there that, is.
I find it to be very valuable,just from, it's
Donna (18:37):
very valuable
Erin (18:38):
yes.
to be a caregiver for 15 yearsfor my grandmother to know what
that would've been like, and tobe walking with certain family
members for having thatcomponent and dementia care is
something that's rising.
And so how does PACE handledementia care, per se.
So let, what if you havesomebody who's on your.
(18:59):
Who is a participant and now allof a sudden dementia becomes
prevalent.
is it works the same way, Sameway.
You have to,
Donna (19:08):
and I'll be honest, more than half of our participants
have some form of dementia.
that is a very common diagnosisfor people in a PACE program, as
it is common for people innursing homes.
we care for them in the verysame way, making sure they're
safe at home, making sure theyhave what they need at home.
bringing them into our PACEprogram and our PACE programs
for those, folks that sayAlzheimer's intend to wander, we
(19:31):
actually have day rooms that aresecured.
So they, they can't get out andwander about or get out of the
building and if they do, allsorts of alarms go off.
So we have ways that protectthem.
but that is a very commondiagnosis within the PACE world.
Yeah.
Erin (19:48):
And so just to reiterate, 'cause this sounds amazing.
who wouldn't want this?
Donna (19:52):
They could, yeah.
Erin (19:53):
It is for very specific People.
Yes.
And income limits.
So we're going back to Medicare,Medicaid.
there's financial stipulationsfor this and it's very specific,
right?
yes.
Donna (20:11):
It differs in what those, financial requirements are for
the PACE program.
They are, mirrored after thenursing home eligibility
requirements.
you know what you have are folksthat have to qualify, for
long-term care.
I will say that what is fabulousabout pace, because our folks
are still in their homes.
(20:33):
They don't have copays, theydon't have deductibles.
their income is to manage theexpenses in their home, not to
pay us.
it's wonderful that they canmaintain that, especially if
they have a spouse, if they havea caregiver giver living with
them, that the household ismaintained, for their care and
their safety.
the Medicare and the Medicaidcapitation rate covers it 100%.
Erin (20:57):
That's so good.
Donna (20:58):
It's so good.
Erin (20:59):
It is so good.
So good.
33 states, and that's specificto counties.
It's not necessarily, statewideand it's
Donna (21:10):
actually spelled out by zip codes, which even gets more
granular.
However, most of the time whenthose, territories are awarded,
they of course fill up a zipcode.
They're included, but that's allinclusive within a county.
we have very few where theremight be some, lines drawn
where, one zip code doesn't,doesn't qualify and another one
does.
(21:30):
And those are tricky because,you can't cross that line.
Erin (21:34):
this is gonna take us into a bit of a political
conversation, which, I am notpolitical.
Oh, my
Donna (21:39):
favorite.
Erin (21:40):
Yeah.
I know.
I am not political.
I don't, I am drawn to chaos andso I have been paying a little
bit more attention to what'sgoing on this past, year, but
don't have a real, opinion.
I.
To share on any official level,but I do, and I'm going to my
(22:02):
first advocacy day to, to beable to become an advocate for
senior living and differentthings like that.
And you mentioned, how peopleneed to call their senators and,
all their, whoever it is thatthey need to call to say, Hey,
we want more of this in ourstate.
But as great as PACE is, and youhave made it out, made it sound
(22:26):
like it is an amazing,opportunity.
And it is.
And we know that there's thishuge boom that's coming that's
going to need senior living atall levels, right?
And there's not enough seniorliving housing and there's four
people, and then there's a lotof people who can't afford
senior living.
And so PACE certainly is a hugeviable option.
(22:49):
For a select few, and I say allthis to say to reiterate what
you said is it's optional.
Donna (22:57):
Yeah.
Erin (22:59):
Optional being the key word there.
Absolute.
And any fluctuation you know of.
Budget cuts and perceptions andopinions and anything else that
can get in the way could removethis benefit, this opportunity.
This program from people.
(23:21):
Am I correct with that?
Donna (23:23):
You are so correct and we are in kind of an unknown,
political, position.
and I won't get political withit, but I will say that there's
a lot of discussion right nowabout Medicaid funding on the
federal level.
although Medicaid is a stateprogram, it is, very highly
(23:44):
financed by the federalgovernment.
there are matching rates.
There are, provider taxes, thereare all sorts of things that the
feds for years, and this is no,nothing new.
this has been going on fordecades and decades, where the
state simply just can't affordto cover Medicaid 100%.
it, it's just, it's never been athing.
it's not a thing now.
(24:05):
so right now there are.
Some threats to Medicaid at thefederal level, which will impact
every single state.
So not just states that Pacer,happens to be in, but every
single state.
So as we're watching whatCongress is doing, and some of
the proposals that have been putout there, some of these could
(24:25):
be quite drastic and couldreally eliminate, Tens of
millions million to each of thestate.
hundreds of millions, quitepossibly to each of the states.
So I know I live in a state andwe work in a lot of states with
Trinity.
I'll be honest, there's not aMedicaid program out there
that's yeah, we'll just use allthat extra money we have sitting
(24:46):
out here, or legislature raisetaxes.
These are not things that, theseare not conversations that are
had because they're notrealistic.
So when states get into budgetcuts, and we seem to have this
stance every single year, evenwithout the federal threats,
(25:07):
where.
The budgets are tight.
And so you talk about funding,you talk about what you can do,
what you can't do.
you talk about, rates, you talkabout optional programs and in
the end, they all seem to workit out and get to a point that,
sustains the Medicaid programand the eligibility requirements
and the right, however.
(25:27):
If some of these cuts that areproposed at the federal level go
through the states will have nochoice.
they're going to have it,they're gonna be in a situation
where they don't know what todo.
they will be minus a lot ofmoney.
So what do you do?
and you can look at this evenfrom your own, budget that you
(25:49):
do at home.
you get rid of the things thatyou don't have to have, right?
So you're like, like I no longeralarm for my Starbucks coffee
every day, and I'm gonna have tocut off the cable.
these are all things that we allhave those conversations about.
so for Medicaid, they're gonnasay, what do I have to do?
I have to provide care and anursing home, I have to
(26:09):
hospitalization, laundry list ofthings that I'm gonna.
And then on the other side, whatdo I not have to do?
So these are things that, arenot dictated by the feds that
you have to do.
So cms, it's great that you havethem, but you don't have to have
into that bucket.
as do a lot of, dentistry,eyeglasses, all those things are
(26:30):
optional in the states.
a lot of home and communitybased services, lot of waiver
programs.
Are optional.
states really won't have a wholelot of wiggle room or a whole
lot of choice in what they do.
so for pace, and really for anyoptional program, it puts a, a
bullseye in your bag that says,if these cuts, if any cuts are
(26:50):
mandated by the feds, paces at.
A pretty heavy risk ofelimination.
certainly some states willmaintain it, I think because
they have just really committedto it.
and they'll have to cut in otherareas.
But what does that mean, cut inother areas?
Does that mean, provider ratesgo down that are no longer, so
(27:11):
it's no longer sustainable to dobusiness in that state?
and it could well be acombination of both of those
things.
It could be elimination ofoptional programs and a decrease
in rates for providers.
Either way, it's just, thesustainability of Medicaid,
with, without the federal matchis just not even a thing, and I
(27:32):
say that Medicaid because itcovers children and elderly.
It really is the foundation forhealthcare in this country
because it covers so many peoplethat would not have coverage
otherwise.
It's the foundation of it.
and what happens when you messwith a foundation?
you're putting cracks in it,you're basically tearing it up.
(27:55):
Then the whole system relies onthat.
that foundation, you could seesome pretty drastic things
happen in healthcare should someof these things that are being
proposed, they're being talkedabout and, I'm not making this
up.
the consequences could be quitedire across the board.
Erin (28:12):
Ooh.
So if that were to happen, let'sjust say worst case scenario,
all the participants that are onpace now, like they would lose
those services because it wouldjust.
it, you wouldn't evenpotentially see it.
Say, okay, you can keep it forwho you have, but you can't take
on anymore.
(28:32):
We wouldn't even see that.
Donna (28:34):
Yeah.
And that's our fear, certainly,that message is getting across
to, to the members of Congressthat, these are potential
outcomes for this decision.
and I think, and trust me, paceis not the only organization out
there saying, You know what Imean?
The hospitals are out theresaying, this will impact
(28:54):
coverage.
we're, we'll go back to the dayswhen, where, so many people
coming to e our er, our ERs,that's hard to say and not have
any coverage.
our rates are likely to be cutfor those that do you have
coverage?
Y so the scenario, plays out ineach of those, healthcare
(29:14):
entities in a different way.
but it's big enough that thevoice on the hill right now is
very loud.
So I'm not sure how that couldbe ignored by members of
Congress, by members of theadministration.
I just don't know how they canignore those, the number of
people that are out there sayingthis is a terrible idea.
Erin (29:34):
Yeah.
And you save them 12%.
Hello?
12%?
Yeah.
Yeah, 12%.
not every waiver program, notevery optional program actually
has an ROI that you can givethem,
Donna (29:48):
and in some states it's more than 12%.
It depends on what their nursinghome rates are.
I think in Alabama it's over20%.
Erin (29:55):
Amazing.
and I guess it's important tosay this is not like.
You only have a certain amountof people that can be
participants at the same time.
Donna (30:03):
That's right.
Erin (30:04):
So it's not like you can have 10,000 participants and
you're making,
Donna (30:09):
or cap in Alabama at 200, Erin.
we would love to have better,impact, more impact on more
lives, but we are capped at 200participants.
Erin (30:19):
And what about other states?
Are they the same?
Is it like the same number?
A lot of.
Donna (30:23):
A lot of states have caps, but many states do not
have caps on enrollment.
They're just like, if you cantake them.
So no.
A lot of states do not capenrollment because they see the
value in it.
They really have seen the valuein it.
Yeah.
Erin (30:39):
Oh, that's interesting.
Okay, so go back to, if you canremember those senior living
days.
senior Living does have theopportunity to refer to the PACE
program to be a service, is pacefriendly to senior living?
is actually moving into seniorliving an option potentially for
(31:00):
some case participants.
Donna (31:01):
it can be an option where it's a problem.
I will tell you, it's probablywhat we've experienced in
Alabama is the regulations don'tallow you to admit somebody's
nursing home eligible.
And I'll be honest, most of ourfolks are pretty darn sick.
the, they're not coming to us.
because they, Need help in onelittle area.
these are folks with a lot ofchronic conditions.
(31:23):
These are folks on a lot ofmedications.
They have a lot of needs.
there's a dually eligible andthey're, they are known for
being significantly more costlyand having more needs than other
populations.
And but that is the populationthat we serve.
So now I would say that seniorliving, may not always be the
right choice.
(31:45):
for a lot of reasons, but mostlybecause I'm not sure it would be
a good fit for the level of carethat they're at.
Erin (31:51):
Yeah.
Yeah.
I do believe that pace is God'swork, like literally at hand.
Clearly the government is payingfor it, but the implementers and
the facilitators are.
I mean, Trinity is aCatholic-based company, right?
We're
Donna (32:07):
a faith-based, not-for-profit.
Yes.
Erin (32:09):
Yeah.
Faith-based, not-for-profitcompany.
And, do an amazing job to beable to do the decks or the
ramps or, the air conditioner,to take care of dignity in such
a powerful way that anunderserved population may never
have had been taken care of inthat way.
(32:30):
Yeah.
Which is powerful.
Donna (32:32):
Yeah.
and I've heard a lot of,comparisons, but, I heard one of
our executive directors once saythat it, it allows people that
have never been at the front ofthe line to come to the front of
the line.
And that's a real meaningful,picture that you're drawing of a
population that, that you know,somewhat on the fringes.
and It allows them care thatmaybe others can afford.
(32:54):
And so they're always at thefront of the line receiving
those things, but just movesthem, up into a space that they
haven't been able to be inbefore.
Erin (33:03):
Yeah.
I view pace as being like thecaboose engine that can, Like
it's catching some steam, we arevaluable.
We offer amazing opportunitiesand care and programs.
for the most vulnerable of oursociety.
And it needs to be championed,it needs to be supported.
(33:26):
And we can do that by calling orwriting, to our congressmen, our
senators, both on the federaland state level.
Donna (33:35):
in the state level.
Yes.
Absolutely.
absolutely.
and I think as more and morejoin that.
That conversation, will see morepace growth.
I think it's important that pacegets moved out of the optional
bucket.
CMS move.
there was legislation that wasintroduced in the last Congress
that should be introduced inthis, Congress as well that does
(33:59):
that makes some changes.
Act actually amends the SocialSecurity Act to include some,
some language from case thatwould make it mandatory under
CMS.
so there, it's not like theconversation's not been had,
it's not as if the, there aren'tfolks working on that, but, Just
say it would require an act ofCongress.
And I laugh a little bit when Isay that because it would
require an act of Congress.
(34:20):
but it's, but it's not out ofreach.
I've always said, I would retirebefore I, I saw pace, as a
mandatory program.
I don't think so.
I think I will see it, beforethat, mostly because I won't
retire.
The, I think there is a movementthat's pretty strong.
If we can survive what'shappening now, like literally
(34:41):
now, with the Medicaid stuff,then I think really the sky's
the limit for where PACE can gowith this.
Erin (34:49):
Yeah, man, the goal is to make it mandatory.
Donna (34:52):
Mandatory, yes.
Erin (34:53):
Not optional.
It's mandatory with the numbersthat we have that are coming, we
need this, uncapped, mandatoryuncapped.
We're saving you 12 to 20% likehard in a hard ROI.
Yeah.
This only makes sense.
(35:13):
This only makes sense.
Donna (35:16):
I heard a, someone say, is pace scalable?
how could you grow it acrossthe, and this is my, this has
always been my response.
I imagine a hundred years ago,literally like a hundred years
ago, when nursing homes wereexpanding across the country, I
bet somebody said, is thisreally scalable?
how are you gonna build theseenormous buildings, have them
(35:37):
everywhere and, have peopleliving in the, all these little
rooms.
I.
Impossible.
like such a big, and now there'sfour or five in every community.
they're all over the state.
They're all over the country.
so I think we need to use thatsame mindset with pace.
Of course, it's scalable,Absolutely.
It's scalable to be able to dothat.
(35:59):
If you could do it with theseginormous buildings as our
nursing homes, you can do itwith a PACE program.
So sometimes I think we, we tendto look at the challenges,
understanding that there aredefinite ways around them.
and yes, I think pace isabsolutely,
Erin (36:19):
who doesn't wanna work in an environment where you give,
when you're almost a hero everyday.
Donna (36:27):
Yeah.
Yeah.
Erin (36:28):
You feel that way inside senior living to some extent,
but I feel like in, in a pacestandpoint, like it's very
different.
It could be senior, it's very
Donna (36:40):
different as I've done both, and it's very, it is
different.
there's a level of, appreciationand gratitude that may be a, a
little higher.
but, you.
Lived in the world.
but it's, it's a program worthsaving.
It's a program worth growing.
Ah,
Erin (36:57):
love it.
That's great.
And I think that's the end rightthere.
It is a program worth saving.
And it is a program worth lovingand it is scalable and it needs
to be mandatory.
Donna (37:09):
Yes, definitely love it.
Erin (37:11):
I'm fired up.
I would go and help advocate onpace advocacy days.
You just let me know.
Yeah, I'll be there.
yeah, for sure.
if that's a thing because I knowsenior living does it.
I saw Alzheimer's awareness,people going to advocate for it,
the state.
And I'm like, okay.
So once I get my, we just
Donna (37:29):
on the hill in March doing that very thing, and I'll
be back in just a few weeks totalk about.
It's very same subject.
So yes,
Erin (37:37):
so good.
So good.
Thank you Donna for being here.
Thank you for educating me andother people on pace and what we
need to do to support, thisprogram.
It's very important.
Thanks for having
Donna (37:49):
me.
Super to see you again.
And go pace.
Erin (37:52):
That's right.
Go pace.
And as always, for my listeners,aspire for more for you and
Pace.
And.
y'all.
In my best Southern voice I'mreally excited about today
because you get to hear anothersouthern lady, miss Donna
Wilhelm, who I worked with at aprevious community, a locally
owned, community for a littlewhile called Mercy Medical.
she was the vice president ofsales.
What was your.
Yeah,
Donna (00:20):
I was vice president of sales and marketing for Mercy
Medical, so
Erin (00:25):
yeah.
Donna (00:25):
Yeah.
Seems like a hundred years ago,Erin.
Erin (00:27):
it does seem like a hundred years ago and now, she's
working in, such a purposedriven, Service inside Senior
living, which is the PACEprogram.
And I want to give Donna thefloor so she can talk about her
title, what she does.
But before I do that, I justwanna say to everyone who's
listening, this is a bit of afull circle moment for me
(00:49):
because having Donna on theepisode, on this podcast, on
this episode is something that,you know.
14 years ago, I don't know if Iever would have thought that
this was a possibility.
Donna was high up in the foodchain and I was an administrator
of, a 64 apartment memory carecommunity that was struggling.
(01:13):
Mightily and there were manydifferent pools going on, and,
the dynamics were interesting,but here we are.
And it's really exciting for me.
Donna, welcome.
Donna (01:29):
we learned from each other, Erin.
We've learned from each other,and that's, I think, the way
it's supposed to be.
but I'm happy to be here.
Happy to, to be, speaking towith your listeners.
And just a little bit about me.
I am the Vice President, foradvocacy and government
relations for Trinity HealthContinuing Care, which includes
Trinity Health Pace.
We have three nationalministries under continuing
(01:51):
care, and that's seniorCommunities, our Home Health and
Hospice, and our PACE Program.
but we're here today to talkabout pace.
I serve as the.
The advocacy person, which meansI, I fight for all sorts of
things, but mostly I fight forour participants to remain in
our program for the funding tobe appropriate, to cover the
level of care that we have, andfor access and growth.
(02:13):
So it's important that theprogram grows, so that more and
more seniors have access to,this very important home and
community service that allowspeople who are nursing home
eligible to remain in theirhome.
So that's me in a nutshell.
Erin (02:27):
Yeah, that's a lot.
So PACE stands for, it's anacronym.
Tell us what it stands for.
Donna (02:33):
Yeah, PACE stands for Programs of All Inclusive Care
for the Elderly.
I think what's so importantabout that is it's all
inclusive.
So it's important to note thatfor people who enter the
program, they have to meetcertain eligibility
requirements.
They have to be 55 and older.
they have to require nursinghome level of care.
So that's one big caveat.
(02:53):
Nursing home level of care, theyhave to live in an area that's
served by pace.
It's not every area has pace init, in its, in its district.
and they have to be able toremain at home and in the
community safely with thesupport of the PACE program.
So not everybody will qualifyfor pace, but for those who do,
we provide wraparound.
(03:15):
All inclusive services for thosefolks.
So for them to remain at home,we usually get paid in a
capitated, we always get paid ina capitated bundle, so we
receive payments from Medicareand Medicaid if the person
qualifies for both, if they aredually eligible, if they are
only Medicaid, then we receivejust that capitated amount, and
(03:37):
if they're only Medicare, wereceive that capitated amount,
plus a private pay portion.
however, 99% of PACEparticipants are Medicaid
enrolled and over 80% are duallyenrolled in Medicare and
Medicaid, and that's nationwide.
so most of the folks havecoverage on, both Medicare and
(03:59):
Medicaid.
All of them are nursing homeeligible.
So when I say it's, it'scapitated, so we take that
bundled payment, so to speak,and it's a monthly per member
per month payment that wereceive for that amount of
money.
We are 100% full risk.
So what the heck did that mean?
That means that for that we areon the hook for their care for
(04:20):
everything.
So if this person has to go tothe hospital.
we pay for that.
If this person has to see acardiologist, we pay for that.
If they need a kidneytransplant, we pay for that.
so all of it we are on the hookfor, so we behooves the PACE
program obviously to do theright thing and really take good
(04:41):
care of our participants.
You should be doing that anywaybecause it's the right thing to
do.
from the financial aspect, itcertainly means a lot to, to
provide the care that preventssome of those really big,
medical episodes from happening.
So we do our best to do that andtake really good care of our
participants.
(05:02):
But it also enables us, becausePACE has a little more freedom
than some of those Medicare andMedicaid programs.
It enables us to, I like to sayit allows us to take care of our
participants like we would ourown mother.
and I'll give you a very goodexample, Erin, and I think I've
shared this with you before inour PACE program in mobile, we
(05:24):
live in the deep south.
It gets darn hot and sticky herein the summertime, as you well
know.
So we had a participant who wasin our mobile pace program who,
she lived alone.
She lived in a very small home,and she had a lot of, lung
issues.
so the, the heat was really badfor her.
and her air conditioner died ather house.
(05:46):
she did not have the money tofix it.
are not wealthy individuals.
Air conditioners.
Price.
So it made, without pace, thisparticular lady who, was well
into her eighties, could nothave stayed in that home.
And because of her chronicconditions would've likely end
up in a nursing home withoutpace.
there was just no other option.
(06:07):
for us, for the PACE program, wewere like, it would serve her
better, and is a heck of a lotless expensive to just fix her
air conditioner.
So we were able to use thatmoney to fix her air
conditioner, which compared to anursing home with, it's just
like a drop in the bucket.
It's just like a total drop inthe bucket.
And it allowed her to stay inher home where she preferred to
(06:30):
be, and she was able to staywith the supportive piece.
And there are thousand otherstories like that, that it's
just common sense thinking, whatwould you do if this was your.
Mother, would you stick her in anursing home or would you fix
the air conditioner?
some of it's just very commonsense stuff.
a lot of those, all thedecisions in pace are made by
the interdisciplinary team.
(06:52):
It's a group of professionalsthat, you have physicians, you
have nurse practitioners, youhave therapists, you have the,
the aide, the driver of the busthat drops off, the little lady
at home.
All of these folks sit on theIDT.
And so when those discussionsare made about.
what's best to be done for thisindividual?
It's a team approach.
(07:13):
it's not as if the physiciansits at the head and directs
everything down.
Everybody has a voice at thetable and is able to say, I
think this would work best forthis person, or This wouldn't
work best for this person, or,we can't recommend that because
of, so it, it's.
I like to say it's in your facecase management because the pace
IDT really knows everythingthat's going on with that
(07:37):
participant.
So those wraparound services arepretty significant.
they are meeting the needs ofthis individual at a level that,
that really has not been metbefore.
but so allowing them to remainin their home safely.
So it's a super program.
It, it really allows for theperson to, to be where they
(07:57):
wanna be, and I'm an advocatefor nursing homes.
I think we'll always neednursing homes.
I think we always need assistedliving.
I will say, there will always bea place for them, in the medical
world.
however, I think if you askanybody, really anybody.
Would you rather stay at home?
I think they're gonna say yesfor absolutely as long as
possible.
I want to remain at my home.
(08:19):
so it's important, an importantprogram to do that.
Now, I touched on earlier thatyou have to live in an area that
is served by pace.
So you're thinking, gosh, Inever heard of it.
and there's probably a reallygood reason you've never heard
of it, is it's a really, thebest kept secret.
and that's not because we wantto be, it's just because pace is
still relatively small.
(08:39):
So Trinity Health Paces, where Iwork, we have programs in 12
State.
we serve over 3,500 participantsin our PACE programs.
But nationally, like I said,there are over 80,000 people in
PACE programs, in 33 states andthe District of Columbia.
and you may ask, why is it notin, in every state?
(09:01):
the issue with that is.
The Centers for Medicare andMedicaid, which oversees PACE
programs and most every other,medical program out there, has
told the state that, you havemandated programs like say
nursing homes are mandated andyou have to have them, Medicaid
(09:22):
has to pay for them through thestate.
And then you have optionalprograms that are fine to have,
States can opt in, states canchoose to have these optional
programs and pay for those as,as people choose.
to be in, PACE is optional inCMS, so only 33 states and the
(09:42):
District of Columbia have chosento.
Although some states have prettygood coverage, meaning they
cover the entire state, very fewstates have 100% coverage of all
locations.
for an example, we are inAlabama.
There's one PACE program, andit's ours and it's in mobile.
(10:05):
We only cover two counties, themobile and Baldwin County.
there needs to be a push from,constituents, in the state to go
to their state legislators andsay, Hey, I want pace.
I want pace in Montgomery and Iwant PACE in Birmingham, and I
want pace in Huntsville, to beable to speak to that and so
that the state can expand it.
(10:25):
And also in other states, wehave successfully expanded pace.
in a lot of states, recently wejust had our grant opening,
actually Friday for a program inMontgomery County, Maryland.
They had one PACE grant programfor 20 years.
20 years.
It took Maryland's amount oftime to finally move forward.
(10:46):
so now we have the second one inMontgomery County, but we've
expanded into Louisiana.
We've expanded into, Florida.
And a lot of states that arevery supportive of the PACE
program have really, embracedit.
Really embraced it becausethey've seen what a wonderful
program it is.
And from a state perspective, ifI'm a state Medicaid director,
(11:09):
I'm gonna be like, how much doesthis cost me?
And what's the difference incost between caring for this
person in a PACE program andcaring for this person in a
nursing home?
Nationally, that's over a 12%savings to the state.
So if I were a Medicaid directorand someone said, you can save
12% for these very high cost,individuals to be cared for, I'm
(11:33):
gonna sign up for that all daylong.
so states are really adoptingthis at, a much faster pace than
they used to.
but still the word needs to getdown and these states need to
jump on board and adopt pace.
Erin (11:46):
Yeah.
So there's a lot to unpack here.
Yes, because for people insidesenior living, we get phone
calls all the time.
About how, and there are peoplethat we can serve and there are
people that we can't serve, andpeople who are eligible for pace
typically are the people that wecannot serve.
Because number one, they qualifyfor skilled nursing.
(12:10):
Which some people who qualifyfor skilled nursing can live
successfully inside seniorliving.
But not every single one ofthem, and not in every single
state.
So there's lots of gray areathat to navigate.
But when we look at, from afinancial standpoint, and
there's all kinds of talk goingon about how to serve the
(12:31):
underserved.
And when a sales director.
Can help problem solve forpeople In these 33 states, which
are obviously specific tocounties in those 33 states,
Donna (12:45):
it's,
Erin (12:46):
if you have a PACE program and somebody calls you and they
don't know about it, you couldjust be giving them, one of the
greatest gifts that they couldever receive.
to be able to replace somebody'sair conditioner, or correct me
if I'm wrong, build a ramp insomeone's house.
Exactly.
Because I remember have someother
Donna (13:04):
examples.
Erin (13:05):
yes.
I remember.
way back when hearing about thatand thinking oh my God, that is
God's work.
Donna (13:10):
Yes.
Erin (13:11):
You know what I mean?
Like it's, yes.
to be able to say to someone,we're going to do this for you
because you need this and itaffects you medically like.
that is, that's an amazingconversation to have to be able
to actually do that forsomebody.
(13:32):
And something as simple, and Ihave a personal experience with
it because I tried to get mygrandmother on the PACE program
and then I have another familymember that I think could
benefit from this, that I'mworking with a family about is
something as simple as justpicking up laundry.
You have laundry routes?
Donna (13:50):
We do.
Erin (13:51):
You go pick up people's laundry, which yes, is mind
blowing to me because that costsa lot of money to just go pick
up people's laundry.
That costs money, that costs
Donna (14:09):
personnel,
Erin (14:09):
that cost gas, that costs like cars like so much.
Donna (14:14):
I would say so much services.
Are really issues of dignity forthe participants that we serve.
And I'll never forget this, andthis was, gosh, I dunno, 14
years ago, but when we had ourgrand opening at our PACE
program in mobile, thearchbishop was there, he had the
blessing.
It was like this big to do.
And I remember touring him.
through the facility and we cameto the room that has the
(14:37):
laundry, that has showers, thathas a little lockers for people
to put their stuff up in.
It had a place that we canactually wash people's hair and
cut their hair.
and his comment to me was, whatthis says, he said, what this
says to me is you are caring forthe dignity of the person.
(14:59):
So many folks, and these arenot, again, wealthy people.
They, their homes are theirhomes and they may not be
fabulous places for everybody,but they're home to them.
they may not have access evento, or the ability to get into a
shower anymore, or a tub that's,safe.
And so we can go pick them up.
(15:20):
We can bring them to our paysite.
And, they get shaves, they getshowers, their hair is fixed,
their laundry's done.
And so when they go home,they're in clean clothes.
They've got their clean clotheswith them.
They've had a meal, they've beencared for, they've been checked
out by the nurses and thephysician.
so those are things that, thatgo a lot deeper than people
(15:42):
really expect.
I think we tend to take thesethings for granted as people get
all oh, they have that.
A lot of people just don't havethat, and a PACE program can
provide that with folks.
Erin (15:52):
Yeah.
it really is amazing.
And let's talk about thecaregiver support.
We know that there's a hugesandwich generation Yes.
surge where I even see it withsome of my friends who have
younger kids and then they haveolder parents and they're trying
to navigate it.
And so yes, we're talking aboutcaring for.
The person, but we are alsocaring for the caregiver as well
(16:16):
because like you were saying,there's like a daycare kind of
component, like a day programwhere they can come in and see
the doctors, see all thespecialists or the, the type of
care that they need, Eat,shower, and then be able to come
home.
And there's transportationinvolved with that as well.
(16:38):
Yeah.
Donna (16:39):
We do provide transportation for our
participants both to the centerand to their physician
appointments.
if they have an outsideappointment, we take them.
we have dialysis patients thatwe're providing transportation
for three times a week todialysis.
So those are all, included inthe services that we provide.
And I think you touched onsomething that's real important
and that's caregiver the care ofthe caregiver.
(17:00):
most, if not all of ourparticipants have somebody that
helps care for them in the home.
maybe it's a daughter, maybeit's a spouse.
and so they have come to pacebecause they're struggling doing
that, but they want to do that.
they still want this person toremain in their home.
But I think one awesome thingthat, that we give caregivers
that you know, that, aside fromthe support of all those things
(17:22):
that you just mentioned.
Is it somebody to callimmediately if something
happens, or if you thinksomething's happening or if you
have a question?
we've always said, call pacefirst.
call us first so you know,before you think there's, a
possibility that person needs tomaybe go to the er.
Certainly don't hesitate ifthat's your thinking.
but if you do have questions,call us and let us triage that
(17:45):
person and make sure that it'snothing else that could be
handled either in the home orthe nurse coming out, to manage
that.
So it gives those caregivers thepeace of mind of saying, I've
got someone on the other end ofthe phone all the time, that can
help me if I have thesequestions or feel like there's
an urgency and that's peace ofmind that, most caregivers just
(18:06):
simply don't
Erin (18:06):
have.
Yeah, it's great.
It's, and to help make decisionsto, to have, help make
decisions.
Yeah.
Yeah.
because we all get decisionfatigue and to be able to have
somebody who is at your call,at, to be able to say, this is
what's going on.
And they have seen them thatweek and the driver has seen
(18:27):
them and they have all theseinput.
There's just a holistic level ofcare there that, is.
I find it to be very valuable,just from, it's
Donna (18:37):
very valuable
Erin (18:38):
yes.
to be a caregiver for 15 yearsfor my grandmother to know what
that would've been like, and tobe walking with certain family
members for having thatcomponent and dementia care is
something that's rising.
And so how does PACE handledementia care, per se.
So let, what if you havesomebody who's on your.
(18:59):
Who is a participant and now allof a sudden dementia becomes
prevalent.
is it works the same way, Sameway.
You have to,
Donna (19:08):
and I'll be honest, more than half of our participants
have some form of dementia.
that is a very common diagnosisfor people in a PACE program, as
it is common for people innursing homes.
we care for them in the verysame way, making sure they're
safe at home, making sure theyhave what they need at home.
bringing them into our PACEprogram and our PACE programs
for those, folks that sayAlzheimer's intend to wander, we
(19:31):
actually have day rooms that aresecured.
So they, they can't get out andwander about or get out of the
building and if they do, allsorts of alarms go off.
So we have ways that protectthem.
but that is a very commondiagnosis within the PACE world.
Yeah.
Erin (19:48):
And so just to reiterate, 'cause this sounds amazing.
who wouldn't want this?
Donna (19:52):
They could, yeah.
Erin (19:53):
It is for very specific People.
Yes.
And income limits.
So we're going back to Medicare,Medicaid.
there's financial stipulationsfor this and it's very specific,
right?
yes.
Donna (20:11):
It differs in what those, financial requirements are for
the PACE program.
They are, mirrored after thenursing home eligibility
requirements.
you know what you have are folksthat have to qualify, for
long-term care.
I will say that what is fabulousabout pace, because our folks
are still in their homes.
(20:33):
They don't have copays, theydon't have deductibles.
their income is to manage theexpenses in their home, not to
pay us.
it's wonderful that they canmaintain that, especially if
they have a spouse, if they havea caregiver giver living with
them, that the household ismaintained, for their care and
their safety.
the Medicare and the Medicaidcapitation rate covers it 100%.
Erin (20:57):
That's so good.
Donna (20:58):
It's so good.
Erin (20:59):
It is so good.
So good.
33 states, and that's specificto counties.
It's not necessarily, statewideand it's
Donna (21:10):
actually spelled out by zip codes, which even gets more
granular.
However, most of the time whenthose, territories are awarded,
they of course fill up a zipcode.
They're included, but that's allinclusive within a county.
we have very few where theremight be some, lines drawn
where, one zip code doesn't,doesn't qualify and another one
does.
(21:30):
And those are tricky because,you can't cross that line.
Erin (21:34):
this is gonna take us into a bit of a political
conversation, which, I am notpolitical.
Oh, my
Donna (21:39):
favorite.
Erin (21:40):
Yeah.
I know.
I am not political.
I don't, I am drawn to chaos andso I have been paying a little
bit more attention to what'sgoing on this past, year, but
don't have a real, opinion.
I.
To share on any official level,but I do, and I'm going to my
(22:02):
first advocacy day to, to beable to become an advocate for
senior living and differentthings like that.
And you mentioned, how peopleneed to call their senators and,
all their, whoever it is thatthey need to call to say, Hey,
we want more of this in ourstate.
But as great as PACE is, and youhave made it out, made it sound
(22:26):
like it is an amazing,opportunity.
And it is.
And we know that there's thishuge boom that's coming that's
going to need senior living atall levels, right?
And there's not enough seniorliving housing and there's four
people, and then there's a lotof people who can't afford
senior living.
And so PACE certainly is a hugeviable option.
(22:49):
For a select few, and I say allthis to say to reiterate what
you said is it's optional.
Donna (22:57):
Yeah.
Erin (22:59):
Optional being the key word there.
Absolute.
And any fluctuation you know of.
Budget cuts and perceptions andopinions and anything else that
can get in the way could removethis benefit, this opportunity.
This program from people.
(23:21):
Am I correct with that?
Donna (23:23):
You are so correct and we are in kind of an unknown,
political, position.
and I won't get political withit, but I will say that there's
a lot of discussion right nowabout Medicaid funding on the
federal level.
although Medicaid is a stateprogram, it is, very highly
(23:44):
financed by the federalgovernment.
there are matching rates.
There are, provider taxes, thereare all sorts of things that the
feds for years, and this is no,nothing new.
this has been going on fordecades and decades, where the
state simply just can't affordto cover Medicaid 100%.
it, it's just, it's never been athing.
it's not a thing now.
(24:05):
so right now there are.
Some threats to Medicaid at thefederal level, which will impact
every single state.
So not just states that Pacer,happens to be in, but every
single state.
So as we're watching whatCongress is doing, and some of
the proposals that have been putout there, some of these could
(24:25):
be quite drastic and couldreally eliminate, Tens of
millions million to each of thestate.
hundreds of millions, quitepossibly to each of the states.
So I know I live in a state andwe work in a lot of states with
Trinity.
I'll be honest, there's not aMedicaid program out there
that's yeah, we'll just use allthat extra money we have sitting
(24:46):
out here, or legislature raisetaxes.
These are not things that, theseare not conversations that are
had because they're notrealistic.
So when states get into budgetcuts, and we seem to have this
stance every single year, evenwithout the federal threats,
(25:07):
where.
The budgets are tight.
And so you talk about funding,you talk about what you can do,
what you can't do.
you talk about, rates, you talkabout optional programs and in
the end, they all seem to workit out and get to a point that,
sustains the Medicaid programand the eligibility requirements
and the right, however.
(25:27):
If some of these cuts that areproposed at the federal level go
through the states will have nochoice.
they're going to have it,they're gonna be in a situation
where they don't know what todo.
they will be minus a lot ofmoney.
So what do you do?
and you can look at this evenfrom your own, budget that you
(25:49):
do at home.
you get rid of the things thatyou don't have to have, right?
So you're like, like I no longeralarm for my Starbucks coffee
every day, and I'm gonna have tocut off the cable.
these are all things that we allhave those conversations about.
so for Medicaid, they're gonnasay, what do I have to do?
I have to provide care and anursing home, I have to
(26:09):
hospitalization, laundry list ofthings that I'm gonna.
And then on the other side, whatdo I not have to do?
So these are things that, arenot dictated by the feds that
you have to do.
So cms, it's great that you havethem, but you don't have to have
into that bucket.
as do a lot of, dentistry,eyeglasses, all those things are
(26:30):
optional in the states.
a lot of home and communitybased services, lot of waiver
programs.
Are optional.
states really won't have a wholelot of wiggle room or a whole
lot of choice in what they do.
so for pace, and really for anyoptional program, it puts a, a
bullseye in your bag that says,if these cuts, if any cuts are
(26:50):
mandated by the feds, paces at.
A pretty heavy risk ofelimination.
certainly some states willmaintain it, I think because
they have just really committedto it.
and they'll have to cut in otherareas.
But what does that mean, cut inother areas?
Does that mean, provider ratesgo down that are no longer, so
(27:11):
it's no longer sustainable to dobusiness in that state?
and it could well be acombination of both of those
things.
It could be elimination ofoptional programs and a decrease
in rates for providers.
Either way, it's just, thesustainability of Medicaid,
with, without the federal matchis just not even a thing, and I
(27:32):
say that Medicaid because itcovers children and elderly.
It really is the foundation forhealthcare in this country
because it covers so many peoplethat would not have coverage
otherwise.
It's the foundation of it.
and what happens when you messwith a foundation?
you're putting cracks in it,you're basically tearing it up.
(27:55):
Then the whole system relies onthat.
that foundation, you could seesome pretty drastic things
happen in healthcare should someof these things that are being
proposed, they're being talkedabout and, I'm not making this
up.
the consequences could be quitedire across the board.
Erin (28:12):
Ooh.
So if that were to happen, let'sjust say worst case scenario,
all the participants that are onpace now, like they would lose
those services because it wouldjust.
it, you wouldn't evenpotentially see it.
Say, okay, you can keep it forwho you have, but you can't take
on anymore.
(28:32):
We wouldn't even see that.
Donna (28:34):
Yeah.
And that's our fear, certainly,that message is getting across
to, to the members of Congressthat, these are potential
outcomes for this decision.
and I think, and trust me, paceis not the only organization out
there saying, You know what Imean?
The hospitals are out theresaying, this will impact
(28:54):
coverage.
we're, we'll go back to the dayswhen, where, so many people
coming to e our er, our ERs,that's hard to say and not have
any coverage.
our rates are likely to be cutfor those that do you have
coverage?
Y so the scenario, plays out ineach of those, healthcare
(29:14):
entities in a different way.
but it's big enough that thevoice on the hill right now is
very loud.
So I'm not sure how that couldbe ignored by members of
Congress, by members of theadministration.
I just don't know how they canignore those, the number of
people that are out there sayingthis is a terrible idea.
Erin (29:34):
Yeah.
And you save them 12%.
Hello?
12%?
Yeah.
Yeah, 12%.
not every waiver program, notevery optional program actually
has an ROI that you can givethem,
Donna (29:48):
and in some states it's more than 12%.
It depends on what their nursinghome rates are.
I think in Alabama it's over20%.
Erin (29:55):
Amazing.
and I guess it's important tosay this is not like.
You only have a certain amountof people that can be
participants at the same time.
Donna (30:03):
That's right.
Erin (30:04):
So it's not like you can have 10,000 participants and
you're making,
Donna (30:09):
or cap in Alabama at 200, Erin.
we would love to have better,impact, more impact on more
lives, but we are capped at 200participants.
Erin (30:19):
And what about other states?
Are they the same?
Is it like the same number?
A lot of.
Donna (30:23):
A lot of states have caps, but many states do not
have caps on enrollment.
They're just like, if you cantake them.
So no.
A lot of states do not capenrollment because they see the
value in it.
They really have seen the valuein it.
Yeah.
Erin (30:39):
Oh, that's interesting.
Okay, so go back to, if you canremember those senior living
days.
senior Living does have theopportunity to refer to the PACE
program to be a service, is pacefriendly to senior living?
is actually moving into seniorliving an option potentially for
(31:00):
some case participants.
Donna (31:01):
it can be an option where it's a problem.
I will tell you, it's probablywhat we've experienced in
Alabama is the regulations don'tallow you to admit somebody's
nursing home eligible.
And I'll be honest, most of ourfolks are pretty darn sick.
the, they're not coming to us.
because they, Need help in onelittle area.
these are folks with a lot ofchronic conditions.
(31:23):
These are folks on a lot ofmedications.
They have a lot of needs.
there's a dually eligible andthey're, they are known for
being significantly more costlyand having more needs than other
populations.
And but that is the populationthat we serve.
So now I would say that seniorliving, may not always be the
right choice.
(31:45):
for a lot of reasons, but mostlybecause I'm not sure it would be
a good fit for the level of carethat they're at.
Erin (31:51):
Yeah.
Yeah.
I do believe that pace is God'swork, like literally at hand.
Clearly the government is payingfor it, but the implementers and
the facilitators are.
I mean, Trinity is aCatholic-based company, right?
We're
Donna (32:07):
a faith-based, not-for-profit.
Yes.
Erin (32:09):
Yeah.
Faith-based, not-for-profitcompany.
And, do an amazing job to beable to do the decks or the
ramps or, the air conditioner,to take care of dignity in such
a powerful way that anunderserved population may never
have had been taken care of inthat way.
(32:30):
Yeah.
Which is powerful.
Donna (32:32):
Yeah.
and I've heard a lot of,comparisons, but, I heard one of
our executive directors once saythat it, it allows people that
have never been at the front ofthe line to come to the front of
the line.
And that's a real meaningful,picture that you're drawing of a
population that, that you know,somewhat on the fringes.
and It allows them care thatmaybe others can afford.
(32:54):
And so they're always at thefront of the line receiving
those things, but just movesthem, up into a space that they
haven't been able to be inbefore.
Erin (33:03):
Yeah.
I view pace as being like thecaboose engine that can, Like
it's catching some steam, we arevaluable.
We offer amazing opportunitiesand care and programs.
for the most vulnerable of oursociety.
And it needs to be championed,it needs to be supported.
(33:26):
And we can do that by calling orwriting, to our congressmen, our
senators, both on the federaland state level.
Donna (33:35):
in the state level.
Yes.
Absolutely.
absolutely.
and I think as more and morejoin that.
That conversation, will see morepace growth.
I think it's important that pacegets moved out of the optional
bucket.
CMS move.
there was legislation that wasintroduced in the last Congress
that should be introduced inthis, Congress as well that does
(33:59):
that makes some changes.
Act actually amends the SocialSecurity Act to include some,
some language from case thatwould make it mandatory under
CMS.
so there, it's not like theconversation's not been had,
it's not as if the, there aren'tfolks working on that, but, Just
say it would require an act ofCongress.
And I laugh a little bit when Isay that because it would
require an act of Congress.
(34:20):
but it's, but it's not out ofreach.
I've always said, I would retirebefore I, I saw pace, as a
mandatory program.
I don't think so.
I think I will see it, beforethat, mostly because I won't
retire.
The, I think there is a movementthat's pretty strong.
If we can survive what'shappening now, like literally
(34:41):
now, with the Medicaid stuff,then I think really the sky's
the limit for where PACE can gowith this.
Erin (34:49):
Yeah, man, the goal is to make it mandatory.
Donna (34:52):
Mandatory, yes.
Erin (34:53):
Not optional.
It's mandatory with the numbersthat we have that are coming, we
need this, uncapped, mandatoryuncapped.
We're saving you 12 to 20% likehard in a hard ROI.
Yeah.
This only makes sense.
(35:13):
This only makes sense.
Donna (35:16):
I heard a, someone say, is pace scalable?
how could you grow it acrossthe, and this is my, this has
always been my response.
I imagine a hundred years ago,literally like a hundred years
ago, when nursing homes wereexpanding across the country, I
bet somebody said, is thisreally scalable?
how are you gonna build theseenormous buildings, have them
(35:37):
everywhere and, have peopleliving in the, all these little
rooms.
I.
Impossible.
like such a big, and now there'sfour or five in every community.
they're all over the state.
They're all over the country.
so I think we need to use thatsame mindset with pace.
Of course, it's scalable,Absolutely.
It's scalable to be able to dothat.
(35:59):
If you could do it with theseginormous buildings as our
nursing homes, you can do itwith a PACE program.
So sometimes I think we, we tendto look at the challenges,
understanding that there aredefinite ways around them.
and yes, I think pace isabsolutely,
Erin (36:19):
who doesn't wanna work in an environment where you give,
when you're almost a hero everyday.
Donna (36:27):
Yeah.
Yeah.
Erin (36:28):
You feel that way inside senior living to some extent,
but I feel like in, in a pacestandpoint, like it's very
different.
It could be senior, it's very
Donna (36:40):
different as I've done both, and it's very, it is
different.
there's a level of, appreciationand gratitude that may be a, a
little higher.
but, you.
Lived in the world.
but it's, it's a program worthsaving.
It's a program worth growing.
Ah,
Erin (36:57):
love it.
That's great.
And I think that's the end rightthere.
It is a program worth saving.
And it is a program worth lovingand it is scalable and it needs
to be mandatory.
Donna (37:09):
Yes, definitely love it.
Erin (37:11):
I'm fired up.
I would go and help advocate onpace advocacy days.
You just let me know.
Yeah, I'll be there.
yeah, for sure.
if that's a thing because I knowsenior living does it.
I saw Alzheimer's awareness,people going to advocate for it,
the state.
And I'm like, okay.
So once I get my, we just
Donna (37:29):
on the hill in March doing that very thing, and I'll
be back in just a few weeks totalk about.
It's very same subject.
So yes,
Erin (37:37):
so good.
So good.
Thank you Donna for being here.
Thank you for educating me andother people on pace and what we
need to do to support, thisprogram.
It's very important.
Thanks for having
Donna (37:49):
me.
Super to see you again.
And go pace.
Erin (37:52):
That's right.
Go pace.
And as always, for my listeners,aspire for more for you and
Pace.
And.
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