Shawn Bloom Leads PACE On the Path to Preventative Senior Care

For those of you who are not familiar with the PACE alternative of care, you will find this model very interesting.  PACE is one of the alternative models of care that is funded by Medicare and take a unique financial approach.  As you will learn in the interview with Shawn Bloom, president and CEO of the National PACE Association, PACE programs are financially motivated to following preventative paths of cafe – a unique occurrence in health care today. This incentive forces PACE Centers to take more of a 360-degree view of care than many care models available.

Shawn’s Description of the PACE Model

Programs of All-inclusive Care for the Elderly (PACE) are innovative because they provide continuous care and services offering individuals eligible for nursing home care the option of continuing to live in the community. Because these health care costs are traditionally paid for through the Medicare and Medicaid programs and out of people’s pockets, access to a comprehensive system of care that encompasses preventive, primary, acute and long term care is usually not possible. One key to the PACE model is the combining of dollars from different funding streams in order to deliver a comprehensive set of services focused on the health and well-being of the individual.

Because PACE delivers care differently from traditional long term care providers, it can be difficult to understand how all the elements of the program work together. For example, the public may be mostly aware of the PACE program’s vans that provide transportation to PACE participants.  Policy makers may view PACE as a program that integrates Medicare and long term care funding in a way that saves taxpayer dollars while providing more effective care. PACE participants and their family members might see the PACE center that they attend as the central part of the program. But it is the combination of the different components of the PACE model, including the work of the interdisciplinary team, that results in care and services that are tailored to the individual needs of each PACE participant.

What is PACE?

The ability to coordinate the care of each participant enrolled in PACE is key to the model. PACE programs coordinate and provide all needed preventive, primary, acute and long term care services so that their participants can continue living in the community. To understand how PACE works, it is important to learn about the components of PACE that enable it to respond to the unique needs of each participant enrolled in the program.

Interdisciplinary Teams: Teams comprised of physicians, nurse practitioners, nurses, social workers, therapists, van drivers, aides and others — meet regularly to exchange information and solve problems as the conditions and needs of PACE participants change. Through interdisciplinary teams, the viewpoints of different disciplines are brought together, and information gained through interaction with the PACE participants over time and in different settings is shared. This approach empowers those involved and allows more information to be available at the critical points when decisions are being made.

Capitated Payment Arrangements: PACE receives a monthly capitated payment (i.e., a lump sum from Medicare combined with Medicaid or a participant’s private pay resources that is used to pay for a variety of comprehensive services) and is responsible for the care their participants need. As such, the financial interests of the PACE program and the care needs of the persons they serve are aligned in a unique way. Regardless of whether needed services would be reimbursed under traditional fee-for-service Medicare and Medicaid, PACE provides a comprehensive set of preventive, primary, acute and long term care services that are specifically tailored to the needs of each PACE participant to help them avoid hospital or nursing home placement to the greatest extent possible. The program is designed to closely monitor participants for even subtle changes in needs, which if left unattended could lead to costly acute care episodes.

For example, a Medicare beneficiary shows up at the emergency room every month to be treated for skin infections caused by flea bites. The traditional, fragmented care delivery system would have trouble addressing the root cause of her condition and might just keep treating the patient’s flea bites. For a PACE enrollee, the team, with input from social workers, home health aides and drivers who have been in her home, may decide to fumigate her home and provide a flea dip for her pet. This flexibility can produce more cost effective solutions and a higher quality of life than prescribing costly medications or continually hospitalizing an individual.

PACE Centers: PACE participants regularly attend the PACE center on an average of three days per week. This center includes a health clinic with an on-site physician and nurse practitioner, physical and occupational therapy facilities, and at least one common room for social and recreational activities.  Unlike fee-for-service Medicare and Medicaid programs, PACE has the flexibility to provide services such as occupational and physical therapies even when the goal is to maintain or slow the decline of an ability — not to cause measurable improvement. Because PACE participants have regular contact with primary care professionals who know them well, slight changes in their health status or mood can be immediately addressed.

Transportation: Transportation for PACE participants is another covered benefit. Transportation is critical to the implementation of the care plan. It is a key way in which PACE supports families who are providing care for their loved ones. Transportation is provided not only to and from the day center, but also to other appointments. Providing transportation also places a driver, who has been trained to observe cues, in the home of the PACE participant. Drivers can then report these cues that may signal a change in health status or other changes that should be monitored.

About Shawn Bloom

Shawn Bloom is the President and CEO of the National PACE Association (NPA), an organization that represents 71 operating PACE sites and approximately 40 additional health care organizations in various stages of PACE site development.  Since joining NPA in (1999), the number of PACE locations has grown to serve over 17,000 participants around the Nation. Shawn has served as the Principal Investigator for many PACE-related grant supported efforts and his leadership has played an instrumental role in not only the growth of PACE, but health care policy reform in general. Shawn frequently speaks on behalf of PACE and health care policy topics at aging forums and numerous federal, state and local provider conferences.  With over 25 years in the elder and health care industries, Shawn is a well-known expert with National and local media and frequently is called to testify before state and federal policymakers.

Prior to assuming the role of President and CEO with NPA, Shawn spent 5 years as the Executive Director of the Missouri Association of Homes for the Aging (MoAHA), which represented over 100 not-for-profit long-term health care and housing facilities in the state of Missouri.  Shawn previously worked in the Policy and Governmental Affairs Division of the American Association of Homes and Services for the Aging (AAHSA), a Washington, D.C.-based trade association that represents approximately 6000 providers of long-term health and housing services for the aging.

Shawn received his B.S. in biochemistry and gerontology from Kansas State University and completed his M.S. coursework in long term care at the University of North Texas, Center for Studies in Aging.  Shawn began his career in the elder and health care industries early in life, working as a nursing home Certified Nurse Aide in high school and college.

Contact Information

PACE Information for Consumers

National PACE Association
801 N. Fairfax Street, Suite 309
Alexandria, VA 22314
info@npaonline.org
Phone 703/535-1565
Fax 703/535-1566

Seven Ways to Talk to Your Parents About Getting Help at Home

It can be difficult to acknowledge the fact that your parent needs some help with day-to-day activities, let alone introducing to them the idea of hiring a professional caregiver for help. Your parent is likely to react to this decision with some resistance. Approaching the subject requires patience and tact. However, there are certain considerations to keep in mind that can help you approach this conversation with your parent with greater success.

Below are some ideas to consider, based on our years of experience with families facing these struggles:

1. List advantages. Make quality home care provided by a hired caregiver desirable to your loved one. Some benefits for hiring in-home care for your parent may be: rather than having to move to an assisted living facility or nursing home, they can remain at home; in-home care is often less costly; they will be given one-on-one attention when their caregiver is there.

2. Focus on independence. Explain why hiring a caregiver is a way for your parent to maintain their independence in their own home. Of course, this is easier said than done. Perhaps paint a visual picture for them. Have they already fallen once or twice? Explain what could happen if they fall again – how it could lead to broken bones, surgery and hospitalization, followed by a lengthy recovery period. The same method could be used if they frequently forget to take their medications, or often miss doctor appointments.

3. Try a different approach. If your parents are still living together, try suggesting that in-home care would benefit their spouse. They may be more willing to accept the care for the sake of their loved one, even if in reality, it is equally beneficial for both parents. If they live alone, focus on concerns or activities that are important to them.  For example, your parent may deny needing help, but may be amenable to someone helping with housekeeping and preparing some meals. They may acknowledge that they don’t like to drive at night but still want to attend their weekly bridge game.

4. Make it about you. Explain to your parent how much you worry about them. Or if you have been acting as primary caregiver explain that it has become too much on top of career or parenthood responsibilities. According to a recent study by Genworth, 55 percent of Americans say being a burden on their family is their biggest concern regarding long term care issues. Take this into consideration when approaching your parent about accepting in-home help. You might say, “Mom, I worry about you…and even if you tell me I shouldn’t, it keeps me up at night. Would you try having someone come in once a week for me?”

5. Mitigate fear. An elderly person can act hostile towards a hired caregiver at times, but this action is most likely out of fear. Prior to attempting to alleviate this fear, it is important to understand it. Common fears include loss of independence, losing control and dignity and financial worries. The presence of an outsider is likely to leave the elder feeling vulnerable. Take this into consideration when communicating with them, and respond with empathy rather than with frustration. Realize how your own emotions may be impacting the conversation and increasing resistance. It is important to choose an appropriate time and place for these discussions and set aside time for them.

6. Test it out on a trial-basis. Try hiring an outside caregiver for in-home help on a short-term basis for respite, or recovery care, after being discharged from the hospital or after a fall. This provides an opportunity to show your parent that having a caregiver is not something to fear and often leads to them being open to receiving ongoing care. If they currently rely on you, another family member or friend as their primary caregiver or source of help, try using vacation as an excuse to bring in a professional caregiver while gone. Explain that it is for your own peace of mind.

7. Get advice from a professional. Try discussing the situation with your parent’s primary care physician (this is most likely someone they have known for years and trust). If they share your concern for your parent, they are likely to help by talking to them, explaining why in-home care is the best option for them. Another option is to consult a geriatric care manager, a professional with special expertise in making these assessments. They will be able to provide you with further advice on how to prevent resistance when introducing the new living arrangements with your loved one.

Photo Credit:  Eggybird

About the authors: Alex Chamberlain is executive director at EasyLiving, Inc., a fully licensed, private duty home health care company serving individuals and families in Pinellas and Pasco counties in Florida.

Shannon Martin, M.S.W., CMC, serves as Director of Communications for EasyLiving, Inc. and Aging Wisely, LLC. Shannon has worked for Aging Wisely, a professional geriatric care management and consultation firm, for over 8 years.

Chuck Gould and Volunteers of America Push the Envelope on Senior Care Models

In this Leaders in Elder Care interview, I spoke to Chuck Gould, president and CEO of Volunteers of America.  I first ran into the folks from VOA when one of their marketing people, David Burch, solicited questions for their panel with Newt Gingrich and Tom Daschle.

Upon researching Volunteers of America, I was surprised (and impressed) to find that they are:

  • The largest not-for-profit provider for elders and individuals with disability
  • The 4th largest non-profit skilled nursing provider
  • The 6th largest non-profit assisted living provider

I really enjoyed the discussion with Chuck for a couple of reasons.  First, I could really sense the commitment and passion in his work – you could feel it from the conversation.  Second, they are really pushing the envelope in terms of changing the way they think about and provide senior care.  The organization has many communities throughout the country, providing them an opportunity to experiment with different levels of care and alternative care models.  Because they are not tied to a single model of care, they are free to pick and choose the components of each that work.

Enjoy the interview!

About Chuck Gould and Volunteers of America

Charles W. (Chuck) Gould serves as national president and chief executive officer of Volunteers of America. He provides leadership to one of America’s largest and most comprehensive nonprofit, faith-based organizations.

Gould oversees the organization and its more than 16,000 employees and 90,000 volunteers. With combined revenues of almost $900 million, and programs that help more than 2 million people in more than 400 communities, the organization continues to grow.

Before his selection as national president in 1995, Gould was president of Volunteers of America Health Services, a division of the organization that provides skilled nursing care and other health services. Previously he was an attorney with Arnold & Porter law firm in Washington, D.C.

Gould is a graduate of the University of Minnesota Law School and a member of the Minnesota, District of Columbia and Colorado State bars.  He serves as chairman of the ASAE Key Philanthropic Organization Committee; as a member of the board of directors and previous chairman of the National Human Services Assembly; and is a member of the board of directors of the National Affordable Housing Trust (NAHT) and the American Association of Home and Services for the Aging (AAHSA).

Volunteers of America is a national, nonprofit, faith-based organization dedicated to helping those in need live healthy, safe and productive lives. We offer a variety of services for older Americans that allow them to maintain their independence and quality of life – everything from an occasional helping hand to full-time, around-the-clock care. Since 1896, our ministry of service has supported and empowered America’s most vulnerable groups, including the frail elderly, those with disabilities or requiring specialized nursing care, and many others. Our work touches the mind, body, heart-and ultimately the spirit-of those we serve, integrating our deep compassion with highly effective programs and services.

Contact Information

For more information about Volunteers of America:

Volunteers of America
1660 Duke Street
Alexandria, VA 22314
(800) 899-0089

www.VolunteersofAmerica.org

Paula Panchuck Redefines Independent Living with Lasell Village at Lasell College

In this Leaders in Elder Care interview, I had the pleasure to interview Dr. Paula Panchuck, vice president of Lasell Village at Lasell College.  Lasell Village epitomizes the meaning of creativity in elder care.  Combining senior independent living and continuing education within the campus of a four-year university, Lasell Village at Lasell College serves as an inspiration for what can happen when people think “what if….”

I hope everyone enjoys my interview with Paula as much as I did.

How Paula Describes Lasell Village

Lasell Village is a unique Continuing Care Retirement Community located on the campus of Lasell College in Auburndale, Massachusetts, a village of Newton and a residential suburb bordering Boston.  Open since May 2000, the Village combines the elements of lifelong learning, retirement housing, support services, short-term rehabilitation and long-term care on its thirteen-acre site.

A focus on living and learning is the defining characteristic of Lasell Village and one that makes it distinctive among retirement communities.  Although it is one of a growing number of college-affiliated retirement communities in the country, it is the only one to feature a formal, individualized, required continuing education program for its residents. In addition to courses and other learning opportunities at Lasell College, Village residents enjoy hundreds of on-site courses, lectures, cultural events and physical fitness classes each year. A College-appointed Dean oversees this unique living and learning program at Lasell Village and encourages intergenerational activities for residents, faculty and college students.

The physical environment of the Village is designed to support its educational mission and to integrate the intellectual growth, creative development, and physical wellness of its residents.  Each of its sixteen apartment buildings includes a classroom, studio, library or fitness facility and indoor linkways interconnect all buildings, providing Villagers with easy access to educational offerings taking place throughout the community.  The architectural model at Lasell Village was selected for a Project in Progress Design award by Nursing Homes/Long Term Care Management and the Society for the Advancement of Gerontological Environments (SAGE).  The community’s innovative combination of lifelong learning and retirement housing was featured in the Urban Land Institute’s Housing for Niche Markets: Capitalizing on Changing Demographics.

About Paula Panchuck

Paula Panchuck is Vice President for Lasell Village at Lasell College and the founding Dean of its innovative living and learning program.   She holds a PhD in Educational Studies and Public Policy from Lesley University in the area of adult development and aging and recently completed the Certified Aging Services Professional program sponsored by the University of North Texas and the American Association for Housing and Services to the Aging (AAHSA).   Paula is the recipient of the American Society on Aging and the MetLife Foundation Mind Alert Award for Outstanding Older Adult Learning Programs.  Her primary research interests include the impact of intergenerational exchange on older adults and college students’ attitudes toward older adults.  She is a frequent conference, workshop and webinar speaker on the topics of lifelong learning, campus-affiliated retirement communities, and intergenerational programs and has hosted the cable television’s Through Our Eyes which explored on issues in aging.

Contact Information

Dr. Paula Panchuck
Vice President for Lasell Village at Lasell College
ppanchuck@lasell.edu

617-663-7054

You can reach Lasell Village at www.lasellvillage.com.

Leaders in Elder Care: Shawn Bloom, the PACE Alternative

For those of you who are not familiar with the PACE alternative of care, you will find this model very interesting.  PACE is one of the alternative models of care that is funded by Medicare and take a unique financial approach.  As you will learn in the interview with Shawn Bloom, president and CEO of the National PACE Association, PACE programs are financially motivated to following preventative paths of cafe – a unique occurrence in health care today. This incentive forces PACE Centers to take more of a 360-degree view of care than many care models available.

Shawn’s Description of the PACE Model

Programs of All-inclusive Care for the Elderly (PACE) are innovative because they provide continuous care and services offering individuals eligible for nursing home care the option of continuing to live in the community. Because these health care costs are traditionally paid for through the Medicare and Medicaid programs and out of people’s pockets, access to a comprehensive system of care that encompasses preventive, primary, acute and long term care is usually not possible. One key to the PACE model is the combining of dollars from different funding streams in order to deliver a comprehensive set of services focused on the health and well-being of the individual.

Because PACE delivers care differently from traditional long term care providers, it can be difficult to understand how all the elements of the program work together. For example, the public may be mostly aware of the PACE program’s vans that provide transportation to PACE participants.  Policy makers may view PACE as a program that integrates Medicare and long term care funding in a way that saves taxpayer dollars while providing more effective care. PACE participants and their family members might see the PACE center that they attend as the central part of the program. But it is the combination of the different components of the PACE model, including the work of the interdisciplinary team, that results in care and services that are tailored to the individual needs of each PACE participant.

What is PACE?

The ability to coordinate the care of each participant enrolled in PACE is key to the model. PACE programs coordinate and provide all needed preventive, primary, acute and long term care services so that their participants can continue living in the community. To understand how PACE works, it is important to learn about the components of PACE that enable it to respond to the unique needs of each participant enrolled in the program.

Interdisciplinary Teams: Teams comprised of physicians, nurse practitioners, nurses, social workers, therapists, van drivers, aides and others — meet regularly to exchange information and solve problems as the conditions and needs of PACE participants change. Through interdisciplinary teams, the viewpoints of different disciplines are brought together, and information gained through interaction with the PACE participants over time and in different settings is shared. This approach empowers those involved and allows more information to be available at the critical points when decisions are being made.

Capitated Payment Arrangements: PACE receives a monthly capitated payment (i.e., a lump sum from Medicare combined with Medicaid or a participant’s private pay resources that is used to pay for a variety of comprehensive services) and is responsible for the care their participants need. As such, the financial interests of the PACE program and the care needs of the persons they serve are aligned in a unique way. Regardless of whether needed services would be reimbursed under traditional fee-for-service Medicare and Medicaid, PACE provides a comprehensive set of preventive, primary, acute and long term care services that are specifically tailored to the needs of each PACE participant to help them avoid hospital or nursing home placement to the greatest extent possible. The program is designed to closely monitor participants for even subtle changes in needs, which if left unattended could lead to costly acute care episodes.

For example, a Medicare beneficiary shows up at the emergency room every month to be treated for skin infections caused by flea bites. The traditional, fragmented care delivery system would have trouble addressing the root cause of her condition and might just keep treating the patient’s flea bites. For a PACE enrollee, the team, with input from social workers, home health aides and drivers who have been in her home, may decide to fumigate her home and provide a flea dip for her pet. This flexibility can produce more cost effective solutions and a higher quality of life than prescribing costly medications or continually hospitalizing an individual.

PACE Centers: PACE participants regularly attend the PACE center on an average of three days per week. This center includes a health clinic with an on-site physician and nurse practitioner, physical and occupational therapy facilities, and at least one common room for social and recreational activities.  Unlike fee-for-service Medicare and Medicaid programs, PACE has the flexibility to provide services such as occupational and physical therapies even when the goal is to maintain or slow the decline of an ability — not to cause measurable improvement. Because PACE participants have regular contact with primary care professionals who know them well, slight changes in their health status or mood can be immediately addressed.

Transportation: Transportation for PACE participants is another covered benefit. Transportation is critical to the implementation of the care plan. It is a key way in which PACE supports families who are providing care for their loved ones. Transportation is provided not only to and from the day center, but also to other appointments. Providing transportation also places a driver, who has been trained to observe cues, in the home of the PACE participant. Drivers can then report these cues that may signal a change in health status or other changes that should be monitored.

About Shawn Bloom

Shawn Bloom is the President and CEO of the National PACE Association (NPA), an organization that represents 71 operating PACE sites and approximately 40 additional health care organizations in various stages of PACE site development.  Since joining NPA in (1999), the number of PACE locations has grown to serve over 17,000 participants around the Nation. Shawn has served as the Principal Investigator for many PACE-related grant supported efforts and his leadership has played an instrumental role in not only the growth of PACE, but health care policy reform in general. Shawn frequently speaks on behalf of PACE and health care policy topics at aging forums and numerous federal, state and local provider conferences.  With over 25 years in the elder and health care industries, Shawn is a well-known expert with National and local media and frequently is called to testify before state and federal policymakers.

Prior to assuming the role of President and CEO with NPA, Shawn spent 5 years as the Executive Director of the Missouri Association of Homes for the Aging (MoAHA), which represented over 100 not-for-profit long-term health care and housing facilities in the state of Missouri.  Shawn previously worked in the Policy and Governmental Affairs Division of the American Association of Homes and Services for the Aging (AAHSA), a Washington, D.C.-based trade association that represents approximately 6000 providers of long-term health and housing services for the aging.

Shawn received his B.S. in biochemistry and gerontology from Kansas State University and completed his M.S. coursework in long term care at the University of North Texas, Center for Studies in Aging.  Shawn began his career in the elder and health care industries early in life, working as a nursing home Certified Nurse Aide in high school and college.

Contact Information

PACE Information for Consumers

National PACE Association
801 N. Fairfax Street, Suite 309
Alexandria, VA 22314
info@npaonline.org
Phone 703/535-1565
Fax 703/535-1566