By Gordon Dritschilo STAFF WRITER - Published: April 13, 2010

Robert Graf said he came to Vermont after his wife, Bernadette Graf, was diagnosed with Alzheimer's disease.  "We moved on suggestion of a family member who feels Vermont is probably one of the best places to be when you have a sickness of that type," Graf, 82, said. "He's right."  The Grafs were already living at The Maples when PACE Vermont moved in. Their doctor recommended the program and they promptly applied and enrolled.

The nonprofit health care provider works with seniors — the name stands for Program of All-inclusive Care for the Elderly — providing medical services, home care and a day center where staff members provide a variety of services.  The program just announced a partnership with two groups with similar missions — Volunteers of America and On Lok Senior Health Services — which it hopes will expand its offerings.  "It will mean the benefit of those resources, that experience," said Kristen Carpentier, center manager of the Rutland site.

The Rutland site — PACE also operates a center in Colchester — has 14 staff members serving 36 participants. Carpentier said the center brings all their health needs under a single roof.  "With this model, because it is the primary care doctor that steers the care, the flow of information goes much smoother," she said.  There's plenty of information to manage. Four of the program's participants, seated around a table at the center one afternoon, spoke over each other rattling off a list of their symptoms, diagnoses and prescriptions.

"You don't need to make an appointment — you just see the doctor," said Norm Gilman, who alternately gave his age as 6 or 66, both drawing guffaws from his friends. "We're all in the same boat. We all have memory problems, a lot of problems that go along with that."

The center is open from 8 a.m. to 5 p.m. daily. Participants come as little as once a week to as often as daily, and some staff remain available after hours. Activities include music, crafts, classes, exercise, movies, or just taking a nap in the corner.

"We socialize, we get along together," Gilman said. "We're like a family outside of our own family."  Volunteers for spokesman Glenn Michaels said such programs also become important to the participants' actual family, who have generally become caregivers. Graf said he has to constantly watch his wife when she is away from the center, so her time there frees him up.  "Once you know she's in safe hands, she's being taken care of … it gives the quote-unquote caregivers the opportunity to lead a somewhat normal life," Graf said. "PACE provides the means of letting people who are on an almost 24-hour schedule take a break."  The program has also arranged weekend care, Graf said, enabling him to visit family.  "It's a marvelous program for someone like me," he said. "She would have to be in here in the apartment. I'd have to be with her all the time. It kind of creeps up with you. Fatigue sets in."

Gilman, on the other hand, said he did not have any nearby family, but coming to PACE helped him and others like him get by.  "Probably none of us are really capable of living on our own," he said. "We are capable of living with a little guidance, a little help. … It's better all around, us living with who we're living with than if we were living alone."

PACE Vermont is very excited to be hosting a monthly workshop series at our Colchester site, starting February 18, 2010.  The workshops are designed for families with elders that would like to continue to live home as they age.  We will look at what puts elders at risk for hospitalizations and nursing home placements, how to identify those risks, and what we can do to reduce them.  Each session will be led by a qualified professional.  The series is free and open to the public.  We hope to see you there! 

Click here to see the flyer!

Colchester, Vt. (February 1, 2010) – PACE Vermont Inc. today announced a new partnership with Volunteers of America and On Lok to operate PACE programs in Vermont . This groundbreaking partnership, effective January 29, 2010, provides a wealth of resources and expertise that will allow PACE programs in the state to grow and thrive into the future. This support will be provided directly to the current PACE Vermont organization.

The health care and other services now provided to participants will not change as a result of this new partnership, nor will the organization which provides them. The cost of the program and the means by which participants pay for services also will remain the same.

PACE Vermont opened its first PACE site in 2007 in Colchester, and added a second site in 2008 in Rutland . PACE Vermont currently serves seniors living in Rutland and Chittenden counties, and has been growing steadily.

“We are thrilled to welcome Volunteers of America and On Lok as our partners,” says Sue Watson , Executive Director of PACE Vermont .  “With the expertise and support they bring, the PACE program will enable more seniors to age in their homes and communities.”

 “We are delighted to offer our 30 years of PACE experience to help the PACE program in Vermont be even more successful in the future,” said Bob Edmondson, CEO of On Lok.

The Program of All-inclusive Care for the Elderly (PACE) model is centered on the belief that seniors with chronic care needs should be served in their home communities whenever possible. PACE serves people age 55 or older who are certified by their state to need nursing home care, are able to live safely in the community at the time of enrollment, and live in a PACE service area. If a PACE enrollee subsequently needs nursing home care, the PACE program pays for it and continues to coordinate the enrollee’s care.

Headquartered in Alexandria, Va. , Volunteers of America has provided services that address the needs of seniors for more than a century. The organization – which provides a spectrum of human services in 400 communities in 44 states and Puerto Rico – is the largest nonprofit provider of affordable housing, fourth-largest nonprofit provider of skilled nursing care and sixth-largest provider of assisted living in the . Its Northern New England affiliate will be supporting Volunteers of America’s involvement in PACE Vermont . Volunteers of America already operates a successful PACE program in western Colorado, and recently launched “Aging with Options,” an initiative aimed at expanding home and community-based services to all seniors.

On Lok, based in San Francisco , pioneered the PACE model more than 30 years ago. The organization started providing comprehensive health services to seniors living in the Bay Area in the early 1970s as an alternative to nursing home care. These services allow residents to remain within the community, enjoying the comforts of home and family, for as long as possible,­ inclusive of medical and personal care assistance. The model established by On Lok ultimately became the basis for PACE programs now established nationwide. On Lok operates 10 PACE centers in three counties in the San Francisco Bay Area, serving more than 1,000 seniors.  In addition On Lok operates several senior housing facilities.

Tara B. Meyer
January 2010

Study purpose: Did enrollment in Vermont’s Program for All-inclusive Care of the Elderly (PACE) decrease acute care utilization?

Significance: A major objective of PACE is to shift care from acute to preventive care.

Results: Enrollees had a significant decrease in number of hospitalizations, days of hospitalization and urgent care visits, and significantly fewer visits for Primary care-Sensitive Conditions.

Conclusions: Enrollment in PACE decreased acute care utilization.  The findings from this project indicate that PACE is effective in decreasing hospitalization and emergency room visits for its enrollees. Of note there was a decrease in acute care utilization for Primary-care Sensitive Conditions, which indicates that the services at PACE are of high quality. Similarly, enrollment in PACE led to a decrease in acute care utilization for falls, accidents and fractures.

Meyers’ review of literature includes these related findings among other PACE programs:  

According to the U.S. Department of Health and Human Services, hospitalization rates among PACE participants have been shown to be comparable with the general Medicare population, at 2046 bed days per 1000 PACE participants versus 2014 in the general Medicare population in 1998. This is significant considering PACE enrollees have a higher than average level of disability and morbidity, based on nursing home eligibility criteria and primary hospital discharge diagnoses.

          Wieland, D., Lamb, V. L., Sutton, S. R., Boland, R., Clark, M., Friedman, S., et al. (2000). Hospitalization in the Program of All-Inclusive Care for the Elderly (PACE): Rates, concomitants, and predictors. Journal of the American Geriatrics Society, 48(11), 1373-1380.

Whereas in the general population the lack of an informal caregiver is associated with a higher risk of institutionalization, in the PACE population there was no increased risk for institutionalization associated with the lack of an informal caregiver.

          Friedman, S. M., Steinwachs, D. M., Temkin-Greener, H., & Mukamel, D. B. (2006). Informal caregivers and the risk of nursing home admission among individuals enrolled in the program of all-inclusive care for the elderly. Gerontologist, 46(4), 456-463.

A study comparing the place of death for PACE enrollees with that of the general elderly population reveals that PACE enrollees are twice as likely to die at home.

          Temkin-Greener, H., & Mukamel, D. B. (2002). Predicting place of death in the program of all-inclusive care for the elderly (PACE): Participant versus program characteristics. Journal of the American Geriatrics Society, 50(1), 125-135.

A study examining the use of advanced directives in PACE showed that completion rates of advanced directives was twice as high in PACE as for the general population, and that care matched instructions on the Physician’s Order for Life-Sustaining Treatment (POLST) instructions more consistently than previously reported for advance directive instructions.

          Lee, M. A., Brummel-Smith, K., Meyer, J., Drew, N., & London, M. R. (2000). Physician orders for life-sustaining treatment (POLST): Outcomes in a PACE program. Program of All-Inclusive Care for the Elderly. Journal of the American Geriatrics Society, 48(10), 1219-1225.

February 18, 2009

In the past 4 months, PACE has seen a lot of media coverage, both locally and nationally.  On November 17th, 2008, an article appeared in USA Today that acknowledges the model’s ability to reduce hospitalizations and nursing home placements while sustaining elders’ dignity and independence.  On January 8, 2009, Jane Gross penned a blog with the New York Times.  Gross reports on her visit to a PACE program in the Bronx , and stresses individualized care, the “breadth and flexibility” of the model, and the benefit of preventive services that PACE programs offer.

Locally, PACE Vermont Inc. appeared in the Rutland Herald with a story on February 1 about our visiting therapy dogs; and in SAMS Good News to acknowledge the 99th birthday of a PACE participant.  The radio program “Health Source” with Michael McNight featured an interview with Naomi Galimidi, Director of Intake and Marketing for PACE Vermont , on February 1.  Most recently, the Burlington Free Press visited the Colchester Center to write an article for its Hometown section.  The article appeared on Wednesday, February 18th.