Responses of the Program of All-Inclusive Care of the Elderly (PACE) Organizations to COVID-19 Challenges: Effects and Lessons Learned

项目概要/摘要。PACE（老年人全方位护理计划）是一个众所周知的， 为非常具有挑战性的人群提供受人尊敬的融资和护理模式： 55岁的人需要疗养院水平的护理，其中90%的人也由医疗保险覆盖。计算机设备行动伙伴关系参与者 通常依赖至少2种日常生活活动（ADL）或需要持续监督， 认知障碍要符合PACE注册资格，参与者必须能够安全地生活在 PACE社区服务PACE模式的核心在于其全面的服务阵列， 以参与者为中心的护理计划与多学科护理团队合作构建， 停泊在PACE日间中心，定期提供医疗护理，个人护理，治疗，膳食， 社交、交通和活动。 在2019冠状病毒病大流行期间，PACE计划利用其灵活性，以社区为基础， 医疗和长期服务和支持（LTSS），以重新设计服务提供方式，并确保体弱长者的安全 尽可能在社区。向国家PACE协会（NPA）提交的初步报告表明， 这些项目迅速扩展了远程医疗，并将许多服务转移到了家中。传闻说 一些程序已经实现了显著的调整：例如，提供夜间护理（通常 PACE中允许的），为受感染的参与者租用酒店房间，使PACE中心的一部分成为隔离区 重新定义工作人员的角色，并提供这些新角色的培训， PACE中心，以避免将体弱的老年人送到养老院进行急性后停留， COVID-19感染。然而，到目前为止，研究人员还没有系统地调查，汇编， 评估了PACE计划的反应。 我们的项目将为COVID-19的三个六个月阶段提供权威信息 体验，确定新兴的最佳实践，并将PACE绩效与传统Medicare进行比较 服务，增加了2019冠状病毒病大流行期间用于指导 持续的政策和实践。我们将建立在现有的NPA数据库的基础上，并以在线调查作为补充 的PACE计划。我们将确定PACE项目报告的实质性有益的反应， 和那些尚未有效的，为以下：计算机设备行动伙伴关系参与者，他们的家庭，可用性和 地理社区中的老年人护理服务质量、医疗保健工作人员和PACE计划 财务我们将比较PACE参与者和可比Medicare的利用率和质量结果 收费服务受益人。我们将通过结构化面试深入挖掘有希望的改编。我们 我们将评估更好的实践广泛传播的潜在影响，我们将不断提供我们的见解 研究、临床实践和政策领域，以改善老年人护理安排。

Project Summary/Abstract. PACE (the Program of All-Inclusive Care for the Elderly) is a well-known and respected financing and care delivery model for a very challenging population: Medicaid-covered adults over age 55 needing a nursing home level of care, 90% of whom are also covered by Medicare. PACE participants are generally dependent in at least 2 activities of daily living (ADLs) or need constant supervision due to cognitive disability. To be eligible for PACE enrollment, participants must be able to live safely in the community with PACE services. The heart of the PACE model lies in its comprehensive service array, starting with a participant-centered care plan constructed in partnership with a multidisciplinary care team and anchored in a PACE Day Center that regularly offers medical care, personal care, therapies, meals, socialization, transportation, and activities. During the COVID-19 pandemic, PACE programs have used their flexibility as a community-based provider of medical and long-term services and supports (LTSS) to redesign service delivery and keep frail elders as safe as possible in the community. Preliminary reports to the National PACE Association (NPA) indicate that most programs quickly expanded telehealth and moved many services to the home. Anecdotal accounts indicate that some programs have implemented remarkable adaptations: e.g., providing overnight care (not typically allowed in PACE), renting hotel rooms for infected participants, making part of the PACE Center an isolation area, redefining staff roles and providing training in those new roles, and providing post-hospital therapies in the PACE Center to avoid sending frail elders to post-acute stays in nursing homes, which have had high rates of COVID-19 infection. However, to this point, researchers have not systematically investigated, compiled, and evaluated the responses of PACE programs. Our project will provide authoritative information for each of three six-month phases of the COVID-19 experience, identify emerging best practices, and compare PACE performance to traditional Medicare services, adding to the knowledge base of innovative responses used during the COVID-19 pandemic to guide ongoing policy and practice. We will build on an existing NPA database, supplementing it with an online survey of PACE programs. We will identify responses that PACE programs report as being substantially beneficial, and those that have not been effective, for the following: PACE participants, their families, the availability and quality of eldercare services in the geographic community, the healthcare workforce, and PACE program finances. We will compare the utilization and quality outcomes of PACE participants and comparable Medicare fee-for-service beneficiaries. We will dig deeper into promising adaptations through structured interviews. We will estimate the potential effects of broad spread of better practices, and we will continuously feed our insights into the research, clinical practice, and policy worlds to engender improvements in eldercare arrangements.