Setting the PACE in East Boston and Beyond

By Manny Lopes

America is rapidly going gray.  Some 45 million Americans are 65 or older.  By 2030, that figure will leap to 72 million as Baby Boomers swell the ranks of retirees.

That means millions more becoming eligible for Medicare and Medicaid.  To uphold the promises implicit in those programs we will need to help seniors remain independent longer, to reduce hospital admissions, and to make the last years of life as productive and joyful as possible.

One answer has been around for more than 40 years.  In 1973, a new model of care opened in San Francisco.  “On Lok” – “Happy Home” in Cantonese – met the medical and social needs of immigrant elders remarkably well.  By 1990, the program had been copied in 10 places across the country and – now known as Program of All-Inclusive Care for the Elderly (PACE) – was being funded through Medicare and Medicaid.

According to the National PACE Association, there are now 115 programs in 32 states, serving 34,000 seniors.  Massachusetts has eight PACE programs, including East Boston Neighborhood Health Center’s Elder Service Plan, which recently celebrated its 25th anniversary with the opening of its Wellness Center.

PACE offers seniors 55 or older who are medically eligible for nursing home care a comprehensive program of medical, social, and rehabilitative services designed to preserve their independence.  As a capitated program, Medicare and Medicaid pay a fixed price for the service, providing an incentive for efficient management of the care that is delivered.

EBNHC’s ESP serves nearly 450 seniors from East Boston, Chelsea, Winthrop, Revere and Everett through three PACE Centers – in East Boston and Winthrop – where participants receive care from physicians, nurses, social workers, rehabilitation therapists, nutritionists, and others while enjoying therapeutic recreation.

In addition to the care they receive at the PACE Center, ESP participants can attend programs at the Wellness Center to improve management of chronic conditions such as diabetes, chronic obstructive pulmonary disease, and congestive heart failure.  They can learn about pain management, attend healthy diet cooking demonstrations in an accessible kitchen, exercise, and try alternative therapies, including yoga, massage, and Feldenkrais to improve motion and function while reducing pain.

The Wellness Center’s fitness room has state-of-the-art equipment, including training and weight machines and balance balls – reflecting the growing emphasis on physical fitness and prevention, even among a population long viewed as the frailest elderly.

But the secret to PACE’s success lies in people – such as, in our case, medical director Dr. James F. Pedulla, who has been with EBNHC since 1988.  Several other key clinic staff have been with the program for more than a decade.

That longevity builds trust, as does the fact that many staff live in the communities we serve, and are thus motivated both by their professional calling and their desire to help neighbors.  Just as EBNHC was created to serve residents who found it hard to reach medical resources clustered in downtown Boston, a tunnel trip away, so our program is a local solution for a local need.

We know that PACE works.  Remarkably, while every individual enrolled in a PACE program is eligible for a nursing home, statewide only 10 percent of program participants reside in a long-term care facility, and PACE participants are hospitalized at far lower rates than the general nursing home population.

PACE is not for everyone.  Some elders want to stay with long-time primary care physicians, even though PACE offers longer and more frequent visits than are typical in most primary care offices.  Others don’t want the enhanced level of social contact the program provides.  And seniors are always free to leave the program.

Nor is PACE right for every provider.  Starting a program means spending millions of dollars on construction, assembling an interdisciplinary care team, building the right culture, and meeting voluminous reporting requirements.

But once in place, PACE programs tend to thrive.  Seniors report high levels of satisfaction, and their families enjoy better life balance, knowing their loved one is getting the right care.

PACE isn’t the only solution to the needs of America’s seniors, but we believe it is a national model that can and should grow, provided that growth is guided by what’s best for individuals and their communities.

Those clichés about “60 being the new 40” reflect more than wishful thinking.  Many older Americans today are indeed more fit than previous generations.  But millions of us will still need some help in our later years.  Aging as gracefully as possible – and in the community one calls home – are important parts of building a compassionate and just society.

Manny Lopes is President and Chief Executive Officer of the East Boston Neighborhood Health Center.

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