By Rose Hoban

Earl Smith’s voice cracked when he started describing his former life.

“It had got to the place where I was sitting at home all day long, while the wife was at work,” he said. “It was depressing, and I had got right about to the suicide stage.”

Around that time, late last summer, an outreach worker in Chatham County contacted Smith to talk to him about the local PACE program, located in Pittsboro.

PACE, short for Program of All-Inclusive Care for the Elderly, provides health care for seniors frail enough to qualify for nursing home care. Instead of winding up in a nursing home people who attend PACE programs come to the center several days per week, where they get meals, have activities, and receive all their health care. Participants also get some help at home, perhaps meals or medical equipment to make staying in their own houses easier.

shows a man in a tie-dyed shirt, sitting in a wheelchair. He is part of the PIttsboro PACE program
Walter Picard, who has multiple sclerosis, spent several months in the hospital and then another 10 in a rehabilitation facility in 2014 before joining the PACE program in 2015. “If it wasn’t for this place here, I don’t know if I’d still be here or not,” he said. Photo credit: Rose Hoban

But what really sold Smith on PACE was the chance to connect. He said he loves socializing and loves coming in every day to smiling faces.

“The ladies at the front desk, they are so polite, but what really, really amazes me, even the participants they all say, ‘Good morning,’” he said. “I’m a-tell you, coming to PACE has really brightened my life.”

Sole source of services

Smith was one of several PACE participants who spoke at an event late last year intended to help state officials put together an evaluation of North Carolina’s PACE programs. In the 2017 budget, legislators mandated a report to learn whether the program has been valuable for participants, to assess the quality of care, and to see if it’s time to allow PACE to expand in North Carolina.

“Our goal was to get people here who have participated in PACE, who work in PACE, family caregivers in PACE to really let them hear from the horse’s mouth what PACE is all about,” said Linda Shaw, who runs the North Carolina PACE Association.

Most of the people in PACE programs are seniors who receive Medicare, the federally funded health care program for seniors and some people with severe disabilities. Shaw said most participants are also poor enough to qualify for Medicaid, the state and federally funded health care program that covers nursing home care for low-income seniors.

Shows three older people singing at the PACE event, one woman, in the center, holds a microphone.
Alter Hatley (singing), Earl Smith and another friend started singing together while at the PACE program. You can listen to a snippet below.

PACE programs are required to act as the “sole source of services” for these recipients, providing everything from medications and transportation, to physician care and emergency services, to care for severe illnesses like cancer or even hospice care. In return, agencies that manage PACE programs receive a set amount each month for each person in the program.

Instead of Medicaid paying for nursing home care, which can run as much as $69,000 per year in North Carolina, the program pays for PACE.

Over time, the costs end up being somewhat lower, Shaw said, but the real payoff comes in the improved quality of life. PACE participants are able to remain in their home communities, they get intellectual and social stimulation, and their caregivers get some peace of mind to continue with their lives and work.

“I’m basically kind of blown away by the success of this program,” said Lynette Harris, one of the staff from the state Department of Health and Human Services who was collecting information and testimonies around the state for the report, which is due in March.

Physicians are also fans. Dr. Abhi Kshirsagar from the dialysis service at UNC Chapel Hill came to the Pittsboro site to testify how he believes PACE is a “wonderful thing.”


“Those patients who have enrolled in PACE, their life, their outlook in life is so much better,” Kshirsagar said. “We’re able to keep them going, we’re able to provide their life for them, but we can’t do all the other things that are meaningful for them and this is where I think PACE really complements and keeps these patients’ hope.”

Nothing but positives

Despite the glowing reviews, for the past three years, lawmakers have put the brakes on PACE expansion. Existing programs have only been permitted to add three new participants per month and no new programs have been able to get started.

Some lawmakers have noted that while PACE costs about the same as a nursing home, not every PACE participant would have ended up in an institution. This means the state spent money that could have been saved.

However, many lawmakers see the value in PACE.

“In the General Assembly, many are critical of different programs or the way things can be done better… but I’ve never heard anything but positives about the PACE program,” said Rep. Josh Dobson (R-Nebo), a member of the Joint Legislative Oversight Committee on Health and Human Services.

In particular, Dobson said he’d like to see expansion into rural counties, like the ones he represents.

“The debate is how to continue the services and… how we should expand,” he said.

Shaw pointed out that even as the state moves the Medicaid program to managed care, PACE is already providing that type of care. She argued PACE addresses the social aspects of health, like poverty, isolation and housing that health leaders are now recognizing increase health care costs.

“The rest of health care is trying to figure out what you’re already doing,” said dialysis nurse Dodie Robinson who came from UNC Chapel Hill with Kshirsagar to testify on behalf of PACE. “If we could apply the population management techniques that you all have to the rest of the country, we wouldn’t have the problems we have with health care in America.”

Creative Commons License

Republish our articles for free, online or in print, under a Creative Commons license.

Rose Hoban

Rose Hoban is the founder and editor of NC Health News, as well as being the state government reporter. Hoban has been a registered nurse since 1992, but transitioned to journalism after earning degrees...