ABSTRACT
OBJECTIVES: Program of All-Inclusive Care (PACE) organizations faced unique challenges during the COVID-19 pandemic, particularly given PACE participants are frail older adults who often live with multiple disabilities and chronic conditions. This study describes how PACE programs leveraged their unique program flexibilities and adapted services to manage this crisis. DESIGN: Mixed methods. SETTING AND PARTICIPANTS: This study leveraged 2 national surveys of PACE directors (with response rates of 71.2% and 67.8%) and 6 qualitative interviews. METHODS: Descriptive and univariate analyses of survey response data and thematic analyses of qualitative data from interviews and open-ended survey questions were conducted. RESULTS: Results indicated that PACE organizations responded rapidly to the COVID-19 pandemic, implementing a range of adaptations that shifted the PACE model from primarily center-based to a home-based model of care. Most PACE organizations reported increasing the in-home services they provided, often accomplishing this through the redeployment of center-based staff. PACE organizations likewise leveraged telehealth and remote monitoring to increase support to beneficiaries in their home, implemented various COVID-19 vaccine and infection prevention efforts, increased food and nutrition services provided in the home, and took steps to address social isolation and boredom, among other initiatives. Most PACE organizations indicated they plan to continue delivering more services in the home, consistent with participant preferences. CONCLUSIONS AND IMPLICATIONS: The findings from this study indicate that PACE organizations continued to keep participants at the forefront as they transitioned to a home-based model during the COVID-19 pandemic. Key characteristics of PACE, including its strong emphasis on person-centered team-based care, its fully integrated service model, and its flexible capitated payment structure, contributed to the resilience of the program. These findings highlight PACE organizations' ability to empower nursing home-eligible older adults to remain living in their preferred residential setting and have implications for how best to serve this population.
