PACE- Piedmont- aging Hyun Namkoong


Piedmont Health SeniorCare meets the many needs of seniors and – most important – allows them to remain in their homes and community.

By Hyun Namkoong

More than 2 million baby boomers in North Carolina have begun to approach the golden age of retirement. In 2010, the state ranked ninth in the country for the largest population of people aged 65 and older. Within the next five years, North Carolina’s population is projected to have more seniors than teenagers.

Many of those people will need care as they age; most prefer not to live out their years in a nursing home.

But the health needs of the aging population are complicated and costly. The frail elderly often have several chronic conditions or disabilities and limited income to pay for health care costs. Many rely on family members for help with daily tasks and are often at risk of social isolation.

maps show the changing number of people over 65 in each county.
More than half of the state’s counties are already experiencing population aging – a demographic shift in which the median age of the population increases significantly due to improved life expectancy and a drastic decline in birth rate. Map progression shows the changing number of people over 65 in each county.

Now a health care center in Chatham County is helping local seniors live the lives they want, by taking a creative approach to addressing their needs. And they’re using a model of care that’s gaining traction across the country.

Piedmont Health SeniorCare, which has locations in both Pittsboro and Burlington, offers the PACE model of integrated and holistic care. The location in Pittsboro currently serves 13 seniors. Eventually, the program will serve 90 people each day and a total of 150 seniors in the area.

The Program of All-Inclusive Care for the Elderly (PACE) model is an adult day health care program that provides seniors with access to services from 11 disciplines such as social work and recreational therapy. This approach to care allows seniors to maintain their independence and remain in their homes and communities.

“[Piedmont Health SeniorCare] is wonderful; it’s a great place,” said Stella Chester. She’s been a participant since the Pittsboro location opened its doors in January.

Everything included

The PACE model was designed in San Francisco’s Chinatown in the 1970s with a $2,000 federal grant to develop an alternative to nursing home care for immigrant communities in which institutionalization is culturally unacceptable.

That original program has evolved into PACE, a model of care in which health care plans are tailored for the individual needs of each participant. The PACE model provides a continuum of prevention, primary care and specialist care for when participants need more.

The PACE model also anticipates the needs of seniors that go beyond health care, services such as transportation. Piedmont Health SeniorCare has a van – donated by the Carolina Meadows retirement community – that picks up participants from their homes. They also receive breakfast and a hot meal for lunch.

“Everything is included here,” said Sylvia Clark, a participant, while eating a lunch of baked chicken, green beans and rice.

“Most of our participants are dual eligible for Medicare and Medicaid,” said Jane Hollingsworth, a primary care physician and medical director at Piedmont. Funding for PACE is provided by set monthly payments from both programs.

To be eligible for PACE, participants must be 55 or older, eligible for nursing home-level of care and be safely cared for in a community setting at the time they enroll in the program. Participants must also designate the PACE program as their sole source of medical services. That last requirement can be difficult for some seniors, who may have had the same doctor for years and may be reluctant to give up that familiarity in exchange for more comprehensive care.

Challenges in start-up

PACE programs face several challenges in the start-up process. Jeff Sumpter, site director of the Pittsboro location, explained that because the PACE model of care requires an interdisciplinary team, it takes significant capital to get a program up and running.

It took more than $4 million to get the Pittsboro center open, according to Brian Toomey, head of Piedmont Health Services, the parent organization for the center. Toomey said the only way they could do it was through grants from the Kate B. Reynolds Foundation and Duke Endowment. Those came after a BCBSNC Foundation grant paid for a feasibility study in Chatham County.

Participants at the Pittsboro PACE program enjoy a hot lunch on a snowy afternoon.
Participants at the Pittsboro PACE program enjoy a hot lunch on a snowy afternoon. Photo credit: Hyun Namkoong

Piedmont Health Services also got a low-interest loan from the SECU Foundation to build the 20,000-square-foot facility in Pittsboro.

“We went to SECU for a grant, and they said we can’t do that, but we can do this,” Toomey said. “It kept us from having to look for a commercial loan that would have demanded a higher rate.”

PACE programs must include a primary care clinic, areas for therapeutic recreation, restorative therapies, socialization, personal care, dining and transportation vehicles.

Most PACE programs don’t break even the first year, Hollingsworth said. “We have to purchase equipment for the clinic, lab, kitchen and physical therapy,” she said.

But several studies have shown that even while PACE programs have high start-up costs, in the long run they are on average 15 percent more cost effective than traditional fee-for-service care.

“[My family] didn’t understand how we were doing so much stuff and not paying money,” said PACE participant Marie Byers.

Reduce caregivers burden

The goal of PACE programs is to avoid institutionalization for as long as possible and improve overall quality of life. Family support is a key factor for seniors to remain in their homes. An estimated 61.6 million Americans provide care to family members who have limited daily functioning.

“We really try to create a partnership with the families and reduce caregiver’s burden,” Sumpter said.
The PACE model offers caregivers a program that develops an individualized plan of care and provides easy access to all of the required health care services, including medication.

Piedmont Health SeniorCare also has a pharmacy, though Hollingsworth said that’s not required in the PACE model.

Keeping seniors engaged

Apart from the care and meals participants receive at Piedmont Health SeniorCare, they also have a jam-packed day of activities that promote socialization and physical activities, like chair exercises with a recreational therapist.

Donatello Pugliese
Donato Pugliesse comes to Piedmont Health’s PACE program two days per week. Photo credit: Hyun Namkoong

“Socialization is really important, especially as people get older,” Sumpter said.

The risk of social isolation and depression increases as people age and they have reduced abilities in performing daily tasks like cooking or bathing, and as they face chronic illnesses.

Donato Pugliesse is originally from Colombia and has been at Piedmont Health for about five weeks. He’s had three heart attacks and open heart surgery. He comes to the center on Tuesdays and Thursdays.

“We play cards, we paint and we make arts and crafts projects,” he said in Spanish. “Even though I don’t speak English, I am still friends with everybody.”

“They keep us busy and have something to do each hour,” Byers said. “It’s all interesting.”

“This is where everybody should be,” she said.

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Hyun graduated from the UNC-Chapel Hill Gillings Global School of Public Health in the health behavior department and she worked as the NC Health News intern from Jan-Aug 2014.