#OnTheMap – PACE

The Wyoming PACE program (Program of All-Inclusive Care for the Elderly) at Cheyenne Regional is a non-profit health and supportive services program and day center designed to assist seniors who want an alternative to long-term care placement. While these individuals are in need of some of the types of care that nursing homes offer, they are still able and desire to remain living in the community, often in their own homes.

The PACE program encompasses all aspects of primary and specialist health care, nutrition, medication management, dental care, mental health care, physical therapy, exercise, hygiene support, home-care coordination, crafts and fun activities, group social activities, basic life-skills support, and more. The program works with its participants every step of the way to determine present needs and preferences (big and small) and to anticipate future needs by getting to know each participant’s unique situation in-depth. PACE provides well-coordinated, well-managed care with its collaborative team of experts and healthcare providers.

“We truly are serving a population that, without PACE, would not have access to the level of care that they’re getting. Providing this specialized care improves the lives of both the participants and their loved ones, by decreasing their burden and stress. And for the participants themselves, we help them to become functional again—to help them to be active in the community again,” said Becky Carey, Director of PACE.

Many of the individuals that PACE serves have been independent and functional adults in the past—they have had fruitful careers, experienced rich family and social life, and participated in activities that they enjoyed. At some point, however, those individuals experienced a decline in health, and their world became smaller and smaller, until it became just the four walls around them.

Becky explained, “We help them to open up those walls to become a part of a community again—and that’s what this is, we’re a little microcosm community here at PACE.”

Laurie Wright, Administrator of Aging Services and one of the founders of PACE, elaborated on the type of population that PACE serves. “It’s important to add that we are only admitting people who want to stay in the community. We do not admit people who are ready to go into a nursing home. One of the criteria for joining PACE, is that the individual can live safely in the community at the time of enrollment. A certain level of independence or caregiver support is required,” she said.

Laurie shared an impactful story about one of PACE’s first participants. The woman had been couch-bound for many months following a hip surgery and had been relegated to sitting on the couch watching TV all day, and even sleeping on the couch. She was unable to walk on her own, and had become a shell of herself.

By the time she’d been at PACE for a few months, she’d become social, started using the sewing machine in the activity room regularly, and was even doing her hair and putting herself together before her visits to PACE. Laurie remembers, “When we went to visit her in our original home visit, she was in her nightclothes—she had no reason to get dressed, she had no reason to get up.” Since joining PACE, she had found purposeful work, and she’d become part of a community again—her health, mobility and demeanor had improved dramatically.

Several months after joining PACE, her daughter came up from Denver to visit her. Laurie recalls, “I stood in my doorway and watched her give her daughter a walking-tour of the facility. I thought, ‘Wow—how far she has come!’”

Financially, PACE operates with funding from Medicare and Medicaid. It functions as a ‘capitated’ program. Each month, the program receives a fixed amount of money for each participant (regardless of that individual’s unique medical conditions), and that collective sum is then used to provide for the medically necessary needs and care of all of the individuals enrolled in PACE. Participants enrolled in PACE must qualify for and be approved to receive Medicare or Medicaid, or be able to privately pay the same monthly stipend for the program. Participants must also be 55 years of age or older, meet the ‘functionality’ requirements in order to qualify for enrollment, and live in Laramie County.

Becky explained, “We have the ability and flexibility to look at each participant as an overall person—evaluating their unique needs—and if it’s medically necessary, we can support them in whatever way that supports keeping them healthy and functioning. We have an authorizing team that makes decisions about how we pay for and care for each participant’s needs.”

When asked about the experience of being on the PACE team, Alicia shared, “We’ve always worked in healthcare, but here at PACE we work with a team of people that truly want to work here and be a part of this because they believe in the mission of the program. The participants will even ask us, ‘Why is everyone always so happy?’”

Becky chimed in, “We believe in the mission of what we do, and we see the changes that are effected through the work that we do, and the opportunity to learn from other members of our multi-disciplinary team—it’s empowering. It truly is a learning lab and we have great resources available to us.”

She added, “We often ask ourselves, ‘How can we make our community better?’ Well, we can only make our community better if we make our individuals better.”

(March 2017)


STATS

  • PACE opened in 2013.
  • There are currently 126 active participants.
  • There are 28 staff members who work directly for PACE (33 staff members total, including those that are also shared with the larger healthcare system).
  • PACE is open to participants Monday – Friday (8 a.m. – 5 p.m.), with 3 sessions a day (all day, morning, and afternoon).
  • PACE provides transportation for each of its participants from their homes, to the center, and back to their homes–as well as any medically necessary travel during the week.