‘The Program of All-Inclusive Care for the Elderly’ and The Green House model: An Innovative and Cost-Effective Partnership for Comprehensive Care

By / Posted on January 23rd, 2017

Lori Gonzalez is a PhD researcher at the Claude Pepper Center of Florida State University who studies alternatives to traditional nursing care and social inequality.

The first Green House homes included in a Program of All-Inclusive Care for the Elderly (PACE) partnership will open in early February, joining together two of the nation’s most promising long-term care models.  The Harry and Jeannette Weinberg Green House homes, located in the Thome Rivertown Neighborhood in Detroit, Michigan will serve approximately 21 lower-income older adults who are otherwise able to live safely in the community, but who are currently residing in skilled nursing facilities.  According to Capital Impact Partners, serving these older adults in Green House homes with the support of PACE, compared to providing care in a traditional nursing facility, is expected to save the state’s Medicaid system about $130,000 per year.

PACE began in California in the 1970s as an alternative to institutional long-term care.  A group of Chinese, Italian, Filipino, and other immigrants held cultural views about caring for their loved ones that departed from the larger culture of aging in nursing homes.  They formed “On Lok” meaning peaceful, happy abode.   By 1986, On Lok developed the nation’s first comprehensive model of coordinated care and by 1997, the program became a permanent provider under Medicare and a state option under Medicaid.  Today, PACE operates 116 programs in 32 states and serves over 30,000 older adults, most of whom are dually eligible for Medicare and Medicaid.  PACE operates with the belief that, “it is better for the well-being of seniors with chronic care needs and their families to be served in the community whenever possible.”  With the assistance of the PACE program, 90% of participants who might otherwise enter a nursing home are able to live in the community.

PACE provides comprehensive care to those who are eligible for the program.  PACE eligibility includes being 55 or older, certified by the state to need a nursing home level of care, residing near a PACE care center, and having the ability to live safely in the community. When an individual enrolls in PACE, they (and their family) meet with a team of care professionals including social workers, nurses, primary care physicians, and nutritionists to help craft a plan to serve an elder in the community.  PACE participants visit a PACE care center routinely where they, depending on their plan of care, might receive a flu shot, dialysis, dental care, respite care, a hot meal, physical therapy, transportation, or participate in social activities.  Family members who visit the center receive counseling or advice on how to care for their loved one.

Green House homes also provide quality care and quality of life, but in a residential setting.  In Green House homes, “elders and others enjoy excellent quality of life and quality of care; where they, their families and the staff engage in meaningful relationships…” and when licensed as ALFs, they provide a community-residential setting for elders that is expected to exceed the quality provided by other ALF models.  Green House homes are not just homelike, they are places where elders call home.

The goals and values supported by PACE and The Green House model are similar and their partnership will honor elders’ preferences to avoid a nursing home and to live in the least restrictive care setting possible. Green House homes provide high quality residential living and PACE provides the physical health, mental health, social health, and family support for both acute care needs and long-term care needs.  Furthermore, PACE and Green House value the belief that all elders should have access to quality care and a good quality of life. PACE serves mostly dual eligible, frail elders and Green House homes are meant to be available to all, regardless of income or wealth.  The Green Houses at Rivertown Neighborhood, along with PACE will support these values by serving 21 low-income elders.

Aging in place is highly desired by older adults, but sometimes financially out of reach.  The Thome Rivertown model demonstrates that creating a Continuing Care Retirement Community for lower income individuals is possible and that when PACE and Green House are integrated into that community, high quality, cost-effective care is achievable.