Participants are slowly returning to Care Resources’ Day Center, but the pandemic altered the way the local Program of All-inclusive Care for the Elderly (PACE) organization cared for its participants — individuals who are 55 years or older and meet nursing home requirements but opt to stay home and receive at-home care.
Care Resources PACE operates on a full-risk payment model, which results in its nearly 250 participants receiving all-inclusive care. That includes primary care, home care, rehabilitation, prescription medicine, a day center and clinic, medical specialists, nutrition services, transportation and social services, all paid for by Medicare and Medicaid.
Tracey McKnight, Care Resources PACE CEO, said they have an 11-discipline model, which is led by their primary care team and includes primary care physicians, registered nurses, medical social workers, physical therapists, occupational therapists, recreational therapists, speech therapists, PCA (day center and home care aides), dietitians, pharmacists and a transportation team.
The full-risk model proved to be vital at the start of the pandemic when its Day Center closed in March. McKnight and her leadership team had to put a plan in place that would cater to all its participants at home.
“One of the things that is part of the PACE program is the Day Center,” she said. “We bring people to the Day Center for socialization, rehabilitation and educational programs, among other things, but during the pandemic, we really couldn’t do that, so we had to get innovative about ‘how do we still keep people healthy? How do we keep them moving? How do we deal with their diabetes and their CHF and all of those kind of things in a pandemic?’ We just had to get more creative and put in some more telehealth strategy.”
Although telehealth services were offered to participants prior to the pandemic, telehealth became central as Care Resources PACE staff and medical personnel had to remain in constant communication with their participants.
Between March 16 and Aug. 16, Care Resources PACE delivered 3,134 meals to participants’ homes, 4,650 activity bags were prepared and distributed to participants, 17,809 home care hours were provided, 7,277 calls were made by social workers, clinical care and medications were provided per individual treatment plans and grocery shopping was provided for participants when needed.
“During (the time our facility was closed,) we were delivering meds to the participants’ homes,” McKnight said. “Our pharmacy was working with the primary care team if medications needed to be adjusted. Occupational therapy was interesting because some of our participants are on Facebook with us so we did a video and we sent out an exercise calendar for them and then as the pandemic got longer, we knew that some of our participants were getting deconditioned so our occupational therapists and our rehab team went to the homes and did some (exercises) in their yard with them. We just had to be more innovative.”
In addition to meeting the needs of participants who stayed home during the executive order, McKnight said their payment model was financially beneficial for the state during that time.
“If we end up with a bunch of hospitalizations and a lot of high costs, we are at full risk for that, so we truly needed to manage our costs and make sure that we are taking care of the participants and keeping them healthy,” she said. “By keeping them safe and healthy in their homes, it is approximately one-third the cost of a skilled nursing facility. So, it is actually good for our participants, families and friends, but it is also good for the state budget and I would argue also for the taxpayers.”
To become a participant at Care Resources PACE, individuals must be 55 years or older, meet nursing home requirements and live in Kent County or the Ottawa County ZIP codes of 49418, 49428, 49435, 49534 or 49544.
Tom Muszynski, the chief operating officer for Care Resources PACE, said in Michigan the nursing home criteria are categorized by “doors” and there are seven doors. Muszynski said a participant needs to enter at least one door to qualify for a skilled nursing facility and, in turn, Care Resources PACE.
Some of the criteria are:
- Door one: Assistance with physical needs such as feeding or toileting, among other things.
- Door two: Dementia or moderate impairment.
- Door three: Medically unstable, frequent physician visits or multiple medication changes.
- Door four: Treatment for an open wound or an individual with tube feeding or need for IV antibiotics, dialysis or use of an oxygen tank, among other things.
- Door five: Rehabilitation such as physical therapy, occupational therapy or speech therapy.
- Door six: Behavioral problems such as those associated with advanced dementia.
- Door seven: Continuation of care.