Medicare home care age-in-place

This is news to me. If widely adopted, it would have tremendous Macro impact. By providing relatively low-cost assistance to enable elders to stay home safely, people would be happier and the Medicare system would save a lot of money.…

**Meet the Underdog of Senior Care**

**The Program of All-Inclusive Care for the Elderly, funded by Medicare and Medicaid, has quietly succeeded in enabling some older Americans to age in place.**


**A move to nursing home care is what PACE — the Program of All-Inclusive Care for the Elderly — was designed to prevent. <snip a lot of descriptions of home care, including nurse visits, oxygen, household chore service, social service help and much more>**

**Both the state and federal government save money. PACE programs receive a set amount monthly from Medicare and Medicaid to provide nearly everything for people over 55 whose needs qualify them for a nursing home but who don’t want to enter one. This includes doctors’ visits, tests, procedures, physical, occupational and speech therapy, social workers, home care, transportation, medication, dentistry and hearing aids. Participants typically visit a PACE center like the one in Jersey City several times a week for meals and social activities as well as therapy and health monitoring.**

**That monthly payment is 15 percent lower, on average, than Medicaid would ordinarily pay to care for what are primarily low-income seniors, the National PACE Association said....**

**The endeavor collectively serves fewer than 60,000 people although 1.6 million Medicare beneficiaries might meet PACE eligibility requirements.** [end quote]

The service is free for Medicaid patients (who can’t own more than $2,000 of assets aside from their home and car). Older adults who aren’t poor enough to qualify for Medicaid can already participate, but few do because their monthly premiums would be high — in many states, $4,000 to $5,000 a month. But that is still less than they would pay for nursing homes or assisted living in many locations.

PACE is a labor-intensive effort for the provider. There are relatively few PACE providers and many states don’t have any.…

DH and I have Long-term care insurance which covers home assistance as well as nursing home care. But the PACE people seem to be very well-organized and well-connected. That’s a better resource than trying to patch together all these needs on our own.

I think PACE is a great idea. Rolling it out on a national scale is probably too much for non-profits to handle. And getting for-profits (such as hedge funds) interested is almost a guarantee of higher prices and lower quality.



I would expect Medicare Advantage plans will begin to start covering this type of care once the volume is large enough to justify the hiring needed to do the care needed at the various private residences.

IMO, the easy way would be to bring in overseas workers who already speak reasonable English. Given the long term nature of this type of operation, it is worthwhile for the providers to hire and train non-US workers for these types of lower-skill jobs. Lower costs to start–but also highly motivated migrants who want to be in the US legally. It is also great experience for this group to be able move into being a professional health care worker and move up the health care ladder.

Of course, US citizenship is an option that can also be offered.