Nurse helping older African American woman

Racial and ethnic minorities could hold the key to expanding Programs of All-Inclusive Care for the Elderly (PACE). A new study led by Jasmine Travers, RN, Ph.D., from New York University’s Rory Meyers College of Nursing, found Blacks and Hispanics are using nursing homes more, but would prefer to remain in their homes and communities.

Travers told McKnight’s Home Care Daily Pulse there needs to be much better communication to this population about the benefits of PACE.

Jasmine Travers
Jasmine Travers, RN, Ph.D.

“There needs to be education, so providers can say there is this other option,” Travers said. “You want to have as many options at your disposal.”

PACE is a Medicare and Medicaid program that allows patients, who qualify for skilled nursing, to remain in their homes. Patients receive some in-home services, as well as center-based services for medical exams, meals and social programs. PACE is currently available in 31 states and covers approximately 50,000 people.

Demographic push

Travers said demographics point to the need to increase minority access to PACE and other home- and community-based services. Ethnic or racial minorities will make up approximately 40% of people over the age of 65 by 2050. This cohort has greater functional daily living limitations than their white counterparts, according to the Joint Center for Housing Studies. Although Travers found this group could provide good candidates for PACE, there are barriers to getting them enrolled in the program when it is offered in their communities.

Travers said communication is one of the barriers, particularly in the Hispanic community. She said marketing materials sometimes aren’t in Spanish and staff don’t speak the language. Requiring patients to only use  PACE services is another potential challenge. 

“What can be detrimental is older people having to give up their primary care provider when entering the PACE program,” Travers explained. “That has been a significant barrier for some older adults when deciding if they want to take on PACE services.”

PACE growth

The Biden administration has singled out PACE for expansion as it continues to push for $150 billion in HCBS funding in its Build Back Better plan. Although Build Back Better remains in limbo, two bills introduced to Congress that would expand PACE — the PACE Extended Care Act and the PACE Plus Act — have received bipartisan support. 

With additional funding and some tweaks, Travers thinks PACE could help provide care to thousands more seniors in their homes. Currently, seniors who qualify for both Medicaid and Medicare pay nothing for the long-term care portion of the benefit. Medicare only recipients pay a monthly premium to cover for long-term care and for prescriptions. Travers thinks there should be a way to better serve Medicare beneficiaries through PACE without making it too costly.

“What does that buy-in look like? Is it going to be something that is financially reasonable for older adults who are middle income?” Travers asked. “Can you use retirement funds? Can you use long-term care insurance?”