Discovering the All Care PACE Program: A Comprehensive Guide to Elderly Care

The All Care Pace Program, also known as the Program of All-Inclusive Care for the Elderly, is a unique healthcare model designed to provide comprehensive support for older adults. This innovative program offers an alternative to traditional nursing home care, allowing eligible seniors to live independently in their communities while receiving the medical and social services they need. Sponsored by Medicare, Medicaid, and private funds, PACE delivers a spectrum of care coordinated by an Interdisciplinary Team, ensuring that participants receive holistic and personalized support at home, at the PACE center, and when hospitalized.

Understanding the All-Inclusive Care PACE Program

The All Care PACE Program stands out as a comprehensive long-term care solution specifically tailored for senior citizens who require nursing facility-level care but wish to remain in their homes and communities. It’s a tri-partnership between the Commonwealth of Virginia, the Federal government, and organizations like the Appalachian Agency for Senior Citizens (AASC), ensuring a robust and reliable support system. The core mission of the All Care PACE Program is to empower older adults to maintain their independence and quality of life for as long as medically possible.

Participants in the All Care PACE Program benefit from a structured schedule that often includes transportation to a dedicated PACE center. These centers serve as hubs for a variety of services, including medical appointments, therapeutic sessions, and engaging social activities. A crucial aspect of the center experience is the provision of nutritious meals and snacks, fostering both health and social interaction among participants. Furthermore, the program ensures that participants have access to specialist medical appointments, with transportation provided at no additional cost, all coordinated and authorized by the PACE Interdisciplinary Team. It’s important to note that while emergency care is readily available when needed, all other services within the All Care PACE Program are carefully authorized by this team to ensure appropriate and effective care management. The AASC PACE health care team is committed to providing continuous support, offering 24/7 availability to address the diverse care needs of its participants.

Benefits of the All Care PACE Program

Choosing the All Care PACE Program offers numerous advantages for older adults seeking comprehensive and community-focused care. The program’s design prioritizes keeping participants in their homes and communities, avoiding or delaying the need for nursing home placement. The Interdisciplinary Team approach ensures that each participant’s care plan is highly individualized, addressing their specific medical, social, and emotional needs.

Beyond medical care, the All Care PACE Program enriches the lives of participants through social engagement and activities at the PACE center. This fosters a sense of community and combats social isolation, which is crucial for the well-being of seniors. The program’s all-inclusive nature simplifies healthcare management for participants and their families, as PACE coordinates and manages all necessary services, from doctor’s appointments to medications and transportation. This holistic approach not only addresses the health needs of older adults but also enhances their overall quality of life.

Eligibility for the All Care PACE Program

To be eligible for the All Care PACE Program through AASC, prospective participants must meet specific criteria. These programs, namely AllCARE for Seniors and Mount Rogers PACE, are designed for adults aged 55 years or older who, at the time of enrollment:

Qualify for nursing facility level of care as determined by the state’s criteria.
Are able to live safely at home and in the community with the support services provided by PACE.
Reside within a designated PACE service area.

Currently, AllCARE for Seniors serves individuals living in Buchanan, Dickenson, Russell, and Tazewell counties in Virginia. Mount Rogers PACE extends its services to residents of Bland, Smyth, Wythe, and Washington counties, as well as the city of Bristol, Virginia. It is essential to verify that your residence falls within these service areas to determine eligibility for the All Care PACE Program.

Cost and Funding of PACE

Understanding the costs associated with the All Care PACE Program is important for prospective participants. As a non-profit program, PACE is primarily funded through contracts with Medicare and Medicaid. For individuals who are dually eligible for both Medicare and Medicaid, PACE services are often fully covered, potentially with a set monthly premium to maintain Medicaid eligibility. It’s important to note that participants with both Medicare and Medicaid typically have no deductibles or co-payments for PACE services.

Participants who are only eligible for Medicare will need to pay a monthly premium to enroll in the All Care PACE Program. Individuals who do not qualify for either Medicaid or Medicare are also eligible to participate in PACE by paying the full monthly premium privately, provided they meet all other eligibility requirements. Regardless of the funding source, all participants must meet the program’s health and residential criteria. Transparency regarding costs is a priority, and participants will always receive advance notice if any premium payments are required.

Navigating Grievances and Appeals within PACE

The All Care PACE Program is committed to ensuring participant satisfaction and provides clear processes for addressing concerns. Should a participant have any issues or dissatisfaction with any aspect of the program, AASC PACE encourages immediate communication through various channels. Concerns can be raised orally to any PACE employee or by contacting the specific program numbers: 276-964-7176 for AllCARE for Seniors or 276-781-9050 for Mount Rogers PACE. Written grievances can be submitted via fax or mail to the respective program locations.

Filing a grievance or appeal will never negatively impact a participant’s care within the All Care PACE Program. Upon receiving a grievance, the PACE team will engage in a dialogue with the participant or their representative to outline the resolution process, including timeframes for response, and will provide written confirmation of this process. Crucially, PACE services will continue uninterrupted during the grievance process, maintaining the participant’s current plan of care. If a participant remains unsatisfied with the proposed resolution, they will receive further information, both verbally and in writing, regarding additional actions they can take. Participants also have the right to appeal decisions regarding service denials, reductions, or payment refusals, which must be initiated within thirty days of the PACE decision.

Disenrollment from PACE

Participants in the All Care PACE Program have the flexibility to disenroll at any time, for any reason. It is recommended that participants considering disenrollment discuss their decision with a PACE team member to ensure a smooth transition. While verbal disenrollment is accepted, a signed disenrollment form is required to finalize the process. Upon disenrolling from PACE, individuals can resume their benefits under traditional Medicare and Medicaid programs, typically at the beginning of the following month.

Involuntary disenrollment from the All Care PACE Program is also possible under specific circumstances, such as moving outside the program’s service area or non-compliance with the agreed-upon plan of care. PACE prioritizes participant well-being and adherence to care plans, so involuntary disenrollment is considered only when necessary to ensure the safety and health of the participant or the integrity of the program.

Key Services Offered Under PACE

The All Care PACE Program is distinguished by its comprehensive suite of services, all centered around the participant’s needs. An Interdisciplinary Team (IDT) of healthcare and social service professionals collaborates to develop and implement individualized care plans. This team-based approach ensures that all aspects of a participant’s well-being are considered and addressed. Services offered are extensive and tailored to enable participants to live safely at home for as long as possible. These services include, but are not limited to:

Medically Necessary Transportation: Wheelchair-accessible transportation to and from the PACE center and medical appointments.
Hospital Care: Coordinated and managed by the PACE IDT when hospitalization is needed.
Outpatient Medical Services: Including lab work, X-rays, and diagnostic tests, scheduled as required.
Specialty Medical Care: Access to specialists in cardiology, ophthalmology, dermatology, orthopedics, wound care, surgery, podiatry, audiology, and more.
Adult Day Care: Engaging and supportive day programs at the PACE center.
Rehabilitation and Therapy Services: Physical, occupational, and speech therapy to improve or maintain function.
Durable Medical Equipment: Provision of necessary medical equipment such as walkers, wheelchairs, and hospital beds.
Prescription Medications: All necessary prescription medications are covered and managed.
Nutritional Services: Dietary counseling and meal planning to meet specific nutritional needs.
Respite Services: Temporary relief for family caregivers.
Meals: Nutritious meals provided at the PACE center and home-delivered meals when appropriate.
Personal Emergency Response Systems: For immediate help in case of emergencies at home.
Personal and Home Care Services: Assistance with daily living activities and home care support.

The All Care PACE Program partners with a broad network of providers, including specialists and therapists, ensuring participants have timely access to all required medical services. By managing appointment scheduling and coordinating care, PACE significantly reduces the administrative burden on participants and their caregivers. Beyond physical health, the program also addresses the emotional and social challenges that older adults may encounter, striving to enhance their overall quality of life through a holistic and participant-centered approach.

Important Resources for PACE Information

For further information about PACE and related resources, please refer to the following links:

Contact AASC PACE Programs

AllCARE for Seniors

Physical Address: 216 College Ridge Road, Cedar Bluff, VA 24609

Phone: 276-964-7176

Toll Free: 866-828-7723

TDD/TTY: 276-964-5765

Fax: 276-964-7157

Mount Rogers PACE

Physical Address: 555 South Main Street, Marion, VA 24354

Phone: 276-781-9050

Toll Free: 888-500-0130