Mary Hill (r.) eats lunch with Peggy Mitchell and other friends at the HopeWest PACE day program in Grand Junction, Colo. on March 7, 2024. Photo by Barton Glasser / Special to The Colorado Trust
Mary Hill (r.) eats lunch with Peggy Mitchell and other friends at the HopeWest PACE day program in Grand Junction, Colo. on March 7, 2024. Photo by Barton Glasser / Special to The Colorado Trust
Sandra Dee Powell is in a wheelchair. She suffers from a blood clotting problem in her legs. Cerebral palsy has twisted her right hand since birth. But the 74-year-old widow and retired daycare provider can live alone in her home thanks to a government program that accommodates her needs.
A certified nursing assistant comes to Powell’s home each morning and evening to help her get in and out of bed. An assistant prepares an evening meal for her. A helper comes regularly to clean her home. A van takes her to all medical and dental appointments.
Four days a week, a van brings Powell to an 80,000-square-foot former office building, where she is dropped off under a large sign that reads “Center for Living Your Best.” There, Powell has lunch, receives health care and help with showers, and maintains an active social life with friends she has made over the past two years.
“I can say that I enjoy every day here,” Powell said as she eagerly tucked into a grilled cheese and tomato soup lunch at the center’s dining room.
The center houses the HopeWest PACE program, which delivers wide-ranging services for older adults. HopeWest PACE is a local fulfillment of a national Centers for Medicare & Medicaid Services program known as PACE, which stands for Program of All-Inclusive Care for the Elderly.
HopeWest PACE is one of 150 programs nationwide that carry out the PACE mandate to keep qualifying older adults like Powell living in their homes by providing them with a holistic bundle of health care and social and emotional support. It includes primary and specialty medical care, prescription medications, physical and occupational therapy, recreation, dietary counseling, and mental health counseling.
For Powell, that means an interactive team of caregivers keeps tabs on her overall needs, including any chores at home. The team assigns physical and occupational therapists to keep her as mobile as possible in a PACE-supplied electric wheelchair. Caregivers interact with Powell while she is socializing with friends at the PACE day center to ensure she stays as healthy as possible and feels safe in her home and fulfilled in her life.
“Socialization is important. The majority of our people live alone,” said Jamie Renfro, manager of the HopeWest PACE day center. “A lot of them hadn’t been very social for a while before they came here.”
Powell confirmed that was true in her case. The COVID-19 pandemic was particularly tough because she barely saw anyone else. That time is just a bad memory at this point, she said.
“Every day is good now,” Powell said while piecing together jigsaw puzzles and chatting with friends.
The Grand Junction PACE program has given Medicaid-eligible seniors an alternative to nursing homes for nearly two and a half years. PACE has been operating nationally for more than a quarter of a century. It morphed from a local model of care that originated in 1971 in San Francisco when a nonprofit was formed to meet the needs of older immigrants in the Chinatown area. The program was replicated in other communities and, in 1997, was officially made a funded part of the Medicare and Medicaid systems.
Colorado now has five PACE programs. A sixth was recently approved to serve Denver County and portions of neighboring counties. The state can potentially add more as Colorado’s older adult population is projected to increase by 68% by 2030.
The PACE program uniquely appeals to older adults with an independent streak, like Powell, who want to remain at home in their later years rather than move into nursing or assisted living homes. Most Americans say they would like to age in place. More than half of Medicaid’s long-term-care spending now goes to older adults and people with physical disabilities who live in private homes or communities rather than in institutional settings.
Despite PACE’s lengthy history and the documented need, PACE is not a widely known government service. Some enrollees in the Grand Junction PACE program said they had no idea it existed or what it was until someone recommended it.
“It was a freak, one of those meant-to-be things,” said 89-year-old Mary Hill, who learned of PACE after a friend had a stroke and was enrolled by her daughter in the brand-new HopeWest PACE program. Hill researched the program, found she could qualify, and became one of the first participants.
Powell was an early enrollee after she and her daughter began shopping for a nursing home or assisted living center after Powell had struggled through pandemic-induced isolation. Powell’s primary care provider told them about the PACE option. Powell quickly decided it was perfect for her needs.
“I had lived in my house for 26 or 27 years,” Powell said. “I didn’t want to leave. I might be in this wheelchair, but I’m still very independent.”
Powell and Hill had no trouble meeting the four criteria to qualify for the program. Applicants have to pass an assessment for safety in their homes; they must be at least 55 years old; they must live in the zip codes of the service provider; and they have to be “functionally eligible,” meaning they must have limitations with the activities of daily living that qualifies them for nursing home care.
PACE is not more widespread because not every community has the resources to host a program. PACE stands out for being incredibly complicated, even by government bureaucracy standards.
“It is super highly regulated. You must have a clinic and day center and every little thing required in those facilities, from pull cords in the bathrooms to handrails in many places,” said Mandy DeCino, director of enrollment and engagement at HopeWest PACE.
It took nearly a decade of effort to put all the pieces in place for HopeWest to qualify as a PACE provider, even though HopeWest has operated a well-known network of hospice, palliative care and grief support programs on the Western Slope for over three decades.
“We basically started an adult day care center, a clinic, a transportation company, a home care company and an insurance company all at the same time,” DeCino said.
In October 2021, state and federal agencies approved HopeWest’s application for a PACE program. HopeWest PACE now has around 150 participants. That number fluctuates with new enrollments, disenrollments and deaths.
When participants must leave their homes and go into nursing home care because of deteriorating health, PACE care doesn’t end. It simply shifts to a new living space. PACE participants can remain in the program until the end of life.
DeCino said some participants drop out of the program because they move out of the service area. Some choose to disenroll because they want more choices with their primary care providers (PACE requires participants to receive their primary care from PACE providers at the center or in their living spaces).
The PACE program contracts with 1,600 specialized care providers in the community who provide care in areas like cardiology, dentistry and dialysis. The program utilizes about 100 of those specialists regularly.
About 40 employees now work in the HopeWest PACE day center and the upstairs medical clinic where primary care and some medical tests are delivered. An 11-person team, including some of those caregivers, meets each weekday morning to assess the coordination of all the pieces of care for each participant. DeCino said the team considers information that has come via what they call “touch points”—information gleaned from clients through daily interaction with PACE employees.
That team includes a primary care provider, a nurse, a certified nursing assistant, a dietician, a social worker, a home care provider, a worker in the activities and daycare division of the program, an occupational therapist, a physical therapist, a translator and a day center manager.
Hill said she recently suffered a twisted bowel and ended up in the hospital and a rehabilitation center for six weeks after surgery to remove a section of her colon. She said the PACE team guided her care throughout the ordeal.
The PACE caregivers “handled everything for me,” she said. “I never even saw a bill.”
When some of the 11 PACE vans pull up to the doors of the HopeWest PACE center each morning and afternoon, quite a few PACE participants roll out in wheelchairs. Some use walkers or canes; others walk in unaided; and others drive themselves to the center.
When they come through the doors, they are all greeted by name by a front desk volunteer. They each pick up a badge as they pass through an entry room. Those badges, which dangle on lanyards while they are in the center, are meant to be more than identifiers. They are designed to be conversation starters.
Powell’s badge notes a point of pride for her: “I was a child care provider for 30 years.”
“I love to laugh,” reads Margaret’s badge. Kathy’s badge has a sure-fire conversation starter: “I used to take photos of famous rock stars.”
Hill’s badge message is “resourceful, recycle, reuse.” She points at her red walker that matches her red shoes to explain what that means: she has sewn a bag out of recycled fabric, decorated it with old buttons and bits of castoff jewelry, and added straps that fit snugly on her walker. She reuses everything, she said.
“I’m a tough old bird. I can’t be idle,” Hill said.
She joins a table with Powell and Pualeilani Emerson. Emerson, whom everyone at PACE calls by her nickname Pinky, is at PACE because she suffered a stroke that affected her speech and required her to use a walker. Her husband left her, she said, so she now lives alone. She receives at-home care similar to Powell’s and relies on the center for social time.
Around this trio, the PACE activity room buzzes and hums with participants focused on games or crafts. Three tables are devoted to the most popular activity: jigsaw puzzles. A woman rapidly works a crochet needle on a lacy yellow blanket at one table. Others shuffle decks and chat over card games. Several bend over crossword puzzles.
One man works out on exercise machines in the adjacent gym and physical therapy room. One PACE participant is ensconced in a recliner in “the quiet room.” It has low lights, bookshelves, a TV and virtual flames in a fireplace. It is set aside for PACE members needing private time or a nap. Outside, a putting green and patio surrounded by flower gardens draw participants in nice weather.
“We didn’t want this to be a place where people feel like they have to come,” DeCino said. “We wanted it to be a place where they want to come.”
Powell said for her, it is both a need and a want.
“Without this,” she said, “life for me would be tough.”
Related story: This Free Program Matches Older Adults with Various Experts to Help Them Age in Place
