What PACE Is

The Program of All-Inclusive Care for the Elderly (PACE) is a comprehensive care model that provides all medical and support services needed by seniors who qualify for nursing home level care — while allowing them to continue living in the community rather than entering a nursing facility. PACE is jointly funded by Medicare and Medicaid and is an alternative to institutional long-term care for frail elderly individuals.

PACE organizations assume full responsibility for their enrollees' healthcare and supportive services. Rather than coordinating across many separate providers, PACE provides everything through an interdisciplinary team: physicians, nurses, social workers, physical/occupational therapists, dietitians, and home care workers — all working together under one organizational roof.

Who Qualifies

To enroll in PACE, you must: be 55 or older; live in the PACE organization's service area; be certified by your state as needing nursing home level care (requiring assistance with activities of daily living); be able to live safely in the community with PACE's support; and be enrolled in Medicare and/or Medicaid (or be willing to pay privately). PACE is designed for people who need significant care but prefer community living — it's not for seniors with mild care needs or those who are largely independent.

What PACE Includes — Comprehensive Care

PACE covers virtually all healthcare and supportive services an enrolled senior needs: primary care, specialty medical care, hospitalization (when needed), emergency care, medications, medical equipment and supplies, dental care, vision care, hearing care, physical therapy, occupational therapy, speech therapy, home health care, personal care at home, adult day health services, meals (at the day center and often home-delivered), transportation to all PACE services, social work services, and caregiver support. There are no copays or deductibles for covered services — all care is covered by the PACE capitated payment from Medicare and Medicaid.

The PACE Day Center

The PACE day center is the hub of the program. Enrollees typically attend 2–5 days per week, where they receive medical care, therapies, social activities, and meals in a supportive group setting. The day center resembles an adult day health center but with a more intensive medical component. Many seniors find the social connection at the PACE center to be one of the most valued aspects of the program — combating isolation, a significant health risk for homebound elderly.

Care at Home

PACE also provides care at home for non-day-center days — including home health aides, nurses, and home-delivered meals as needed. When a PACE enrollee has a medical crisis, PACE coordinates all hospital and specialist care. If a hospitalization results in a need for short-term skilled nursing, PACE covers that as well. The goal is 24/7 care management — PACE enrollees don't have to navigate the healthcare system on their own.

Cost of PACE

For dual-eligible seniors (enrolled in both Medicare and Medicaid), PACE is fully covered with no premiums, copays, or deductibles. Medicare and Medicaid together pay the PACE organization a monthly capitated rate. For Medicare-only enrollees, there is a monthly premium for the Medicaid portion of services (the care that would otherwise be covered by Medicaid). Self-pay enrollment is possible for those who don't qualify for Medicaid but want PACE's comprehensive care model — costs are significant but may compare favorably to combined assisted living and medical expenses.

How to Enroll

Find PACE organizations serving your area at npaonline.org (National PACE Association) or by contacting your Area Agency on Aging. The enrollment process includes: a nursing home level-of-care assessment confirming you qualify, a care needs assessment by the PACE interdisciplinary team, enrollment agreements, and coordination of the transition from current providers to PACE. PACE enrollment can take 2–4 weeks from initial contact to enrollment.

PACE vs Assisted Living

PACE and assisted living serve similar populations but with different approaches. PACE keeps seniors at home with community-based services; assisted living provides a residential care setting. PACE is fully covered by Medicare/Medicaid for eligible seniors; assisted living typically involves significant private pay. PACE provides more intensive medical oversight; some assisted living communities offer similar support services. For seniors who want to stay in their own home and qualify for PACE, it's often a better financial and care option than assisted living. For those who need 24-hour residential care, assisted living remains the more appropriate choice.