Monday, July 14, 2014

Aging in Place with LIFE (PACE)



Numerous studies reflect that a large majority of older adults want to continue to live at home for as long as possible.
But “aging in place” can become difficult if we begin to suffer functional and cognitive losses and are no longer able to live fully independently. The burdens placed on our family caregivers can become overwhelming.
In recent years, the expansion of community-based and home care support services has allowed many seniors who would have otherwise been required to move to a nursing home to remain at home. This article is intended to alert readers to the existing of one such program that has benefited a number of my clients and their families. It is a program that I think is underappreciated.  
The LIFE program provides health-care and supportive services for older persons who are certified to need a nursing home level of care but are able to live safely at home with the program’s support. If you have limited financial resources and your income is within 300 percent of the Federal Benefit Rate ($2,163 in 2014) your participation in the LIFE program may be fully covered by a combination of Medicaid and Medicare. (And private payment may be an option for those who do not qualify for those programs).  

On a national level, this wonderful but underutilized program is referred to as PACE (Program of All-inclusive Care for the Elderly). The name was changed in Pennsylvania to avoid confusion with our state pharmaceutical assistance program. The Pennsylvania program is generally referred to as LIFE (Living Independently For Elders).

The LIFE program brings together all the medical and social services needed to provide community-based care for seniors who are frail enough to meet the Medicaid standards for nursing-home care. The program is designed to meet all of its participants health related needs. You are generally provided with transportation to and from your home to an adult day health center where you can participate in activities and medical appointments. However, services may also be given in your home, a hospital, or a long term care facility where necessary.

Because the LIFE interdisciplinary health care team authorizes and coordinates all your health care services, the program becomes a one-stop alternative that simplifies your access to health care. And increased coordination of your care can result in improved quality of that care.

The Balanced Budget Act of 1997 established the PACE model as a permanent provider type under both the Medicare and Medicaid programs. Most LIFE participants are eligible to receive services under both Medicare and Medicaid. The joint funding sources may be sufficient to provide total care for dually eligible beneficiaries.

Like another home care alternative - the Aging Waiver Program, LIFE serves individuals who are 60 years of age or older, who would otherwise qualify clinically to be in a nursing facility, but who choose instead to remain in their homes with the support of LIFE program services. (The age threshold for LIFE can be reduced to age 55 depending on the program). Clinical eligibility for participation in LIFE programs is determined through an assessment done by the local Area Agency on Aging, in cooperation with the individual’s personal physician.

To qualify for Medicaid payment for LIFE services, the individual’s available income and available resources must be at or below 300% of the federal benefit rate. The available resource ceiling is $8,000. Limited “spend down” is available since the LIFE program rules do allow individuals with income in excess of the ceiling to qualify for partial Medicaid funding by paying a monthly share of the cost of LIFE services, with Medicaid paying the monthly remainder. If an individual wishes to pay privately for participation in the LIFE program, his/her monthly premium is equal to that amount that would otherwise be paid by Medicaid.

Enrollment is voluntary. Once enrolled, PACE becomes the sole source of all Medicare and Medicaid covered services, as well as other medical, social, or rehabilitation services required by the enrollee. If an enrollee requires placement in a nursing home, the LIFE provider is responsible for the cost of care. An enrollee’s needs are determined by PACE’s team of care providers, which includes primary care physicians, nurses, therapists, social workers, personal care attendants, dieticans, and drivers.

With capitation plans like PACE, providers receive a flat monthly fee in return for covering the entire spectrum of care for enrollees from acute to long-term. The payment does not vary no matter how many services are provided. This provides a strong incentive for the LIFE program to keep its participants healthy.

Pennsylvania has one the most vigorous PACE programs in the country. People can thrive under the program. But many seniors are unaware of or don't understand the value of the LIFE alternative. And, depending on where you live, it may not be an option for you. As of July 2014, LIFE is available in many but not all geographic areas of Pennsylvania. A list of areas and providers is available on the PA Department of Public Welfare website: http://tinyurl.com/mgs33q8.  For your ease of reference I’ve reproduced the list below.

National information about PACE and a list of programs in each state is available on the Pace4You website at http://tinyurl.com/nlxxlgp.   
Here is a list of the 23 LIFE programs currently operating in Pennsylvania:

Albright LIFE Williamsport
901 Memorial Avenue
Williamsport, PA 17701
Ph: 570-322-5433
URL: click here to visit website 

NewCourtland LIFE
5457 Wayne Avenue
Philadelphia, PA 19144
Ph: 267-335-1500
URL: click here to visit website 

LIFE Lutheran Services, Inc.
840 Fifth Avenue
Chambersburg, PA 17201
Ph: 717-264-5433
E-mail: info@lifelutheranservices.org
URL: click here to visit website 

LIFE Butler County
231 West Diamond Street
Butler, PA 16001
Ph: 724-287-5433
URL: click here to visit website 

LIFE St. Mary
Attention: Erin Williams
2500 Northgate Road
Trevose, PA 19053
Ph: 267-991-7600
E-mail: ewilliams@stmaryhealthcare.org
URL: click here to visit website 

LIFE Geisinger - IHM Center
Attention: Maria Maletta Hastie
2300 Adams Avenue
Scranton, PA 18509
Ph: (800) 395-8759
Fax: (570) 558-6161
E-mail: mchastie@geisinger.edu
URL: click here to visit website 

Senior LIFE Johnstown
401 Broad Street
Johnstown, PA 15906
Ph: 877-998-LIFE
E-mail: info@seniorLIFEpa.com
URL: click here to visit website 

LIFE Lawrence County
PA 16101
Ph: 724-657-8800
URL: click here to visit website 

Senior LIFE Uniontown
89 W. Fayette Street
Uniontown, PA 15401
Ph: 877-998-LIFE
E-mail: info@seniorlifepa.com
URL: click here to visit website 

Senior LIFE Washington
2114 N. Franklin Drive
Washington, PA 15301
Ph: 877-998-LIFE
E-mail: info@seniorlifepa.com
URL: click here to visit website 

Albright LIFE Lancaster
417 W. Frederick Street
Lancaster, PA 17603
Ph: 717-381-4320
URL: click here to visit website 

LIFE - Pittsburgh
One - Parkway Center - 875 Greentree Road
Suite 200
Pittsburgh, PA 15220-
Ph: (412) 388-8042
URL: click here to visit website 

SeniorLIFE Lehigh Valley
2045 Westgate Drive, Suite 100
Bethlehem, PA 18017
Ph: 484-895-4302

Community LIFE
2400 Ardmore Boulevard
Suite 700
Pittsburgh, PA 15221-
Ph: (412) 436-1320
URL: click here to visit website 

Mercy LIFE
1900 South Broad Street
Philadelphia, PA 19145
Ph: (215) 339-4747
URL: click here to visit website 

LIFE - University of Pennsylvania School of Nursing
4508 Chestnut Street
Philadelphia, PA 19139
Ph: (215) 573-7200
URL: click here to visit website 

LIFE Beaver County
131 Pleasant Drive, Suite 1
Aliquippa, PA 15001
Ph: (724) 378-5400
URL: click here to visit website 

LIFE - NWPA
149 West 22nd St.
Erie, PA 16502
URL: click here to visit website 

SeniorLIFE Greensburg
123 Triangle Drive
Greensburg, PA 15601
Ph: 724-838-8300
E-mail: info@seniorlifepa.com
URL: click here to visit website 

LIFE Geisinger - Roosevelt Court Center
Attention: Marc Varano
1100 Spruce St., Suite 100
Kulpmont, PA 17834
Ph: 866-230-6465
Fax: 570-373-2101
E-mail: mavarano@geisinger.edu
URL: click here to visit website 

Senior LIFE York
1500 Memory Lane Ext.
York, PA 17402
Ph: 877-998-LIFE
E-mail: info@seniorlifepa.com
URL: click here to visit website 

Albright LIFE Lebanon
113 South 9th Street
Lebanon, PA 17042
Ph: 717-376-1133
URL: click here to visit website 

Senior LIFE Ebensburg
429 Manor Drive
Edensburg, PA 15931
Ph: 877-998-LIFE
E-mail: info@seniorlifepa.com
URL: click here to visit website 

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