An innovative alternative to nursing homes that works

Covid-19 had taken the lives of 182,000 people in nursing homes, assisted living and other long-term care facilities . . . one-third of the national total. The troubles have intensified a spotlight on long-running questions about how communities can do a better job supporting people who need care but want to live outside an institutional setting. That question generates a big list of challenges for communities, health care systems and policymakers.

I wrote about this topic in a story for the New York Times several weeks ago, and I’ve been following it up with a series of conversations on the podcast.

My guest this week is Peter Fitzgerald. Peter is executive vice president for policy and strategy at the National PACE Association. PACE stands for Programs of All-Inclusive Care for the Elderly. This is a unique, innovative program that recipes its funding from both Medicaid and Medicare. 

PACE provides medical and social services that allow frail seniors to live independently. It serves about 55,000 people in 30 states around the country. Most are low income and eligible for both Medicare and Medicaid. PACE is available only in states that decide to offer it. But the program is poised for a possible dramatic expansion.

The American Rescue Act, passed by Congress in March, raises the federal share of states’ spending on home and community-based services by $12.7 billion over the coming year, and PACE is among the eligible programs. More recently, Senator Casey (D-PA) introduced legislation that aims specifically to expand PACE.

And the Biden administration’s proposed infrastructure plan includes a $400 billion expansion in Medicaid funding for home-based care. Some of that money could find its way to PACE programs. That would allow it to expand . . . not only in terms of the number of seniors served, but also beyond the primarily low-income population PACE serves now.

I asked Peter to explain how PACE works, and why it often is a superior option to institutional care. We also talked about the prospects for expansion.

If you’re interested in finding a PACE program where you live, check out the association’s online guide to programs around the country.

Listen to the podcast by clicking the player icon at the top of the newsletter. The podcast also can be found on Apple Podcasts, Spotify and Stitcher.

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Medicare smooths out much of the variation in the healthcare expenses that seniors incur -- but out-of-pocket costs can be high if you’re not careful.

Most Medicare enrollees blunt out-of-pocket risk one way or another. According to new research by the Ka