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

项目摘要/摘要。PACE(全包式老年护理计划)是一项著名的 为极具挑战性的人群提供受人尊敬的融资和护理服务模式：医疗补助覆盖的成年人超过 55岁需要疗养院级别的护理，其中90%也在医疗保险范围内。PACE参与者 通常至少依赖2项日常生活活动(ADL)，或由于以下原因需要持续监督 认知障碍。要获得PACE注册资格，参与者必须能够安全地生活在 提供PACE服务的社区。Pace模式的核心在于其全面的服务阵列，从 与多学科护理团队合作构建以参与者为中心的护理计划，以及 停靠在佩斯日间中心，该中心定期提供医疗、个人护理、治疗、饮食、 社交、交通和活动。 在新冠肺炎大流行期间，佩斯项目利用了它们作为社区提供者的灵活性 医疗和长期服务和支持(LTSS)，以重新设计服务提供并确保体弱老年人的安全 在社区中尽可能多地使用。提交给全国佩斯协会(NPA)的初步报告表明，大多数 这些计划迅速扩大了远程医疗，并将许多服务转移到了家庭。坊间传闻表明 一些方案已经实施了显著的适应：例如，提供过夜护理(通常 允许进入佩斯)，为受感染的参与者租用酒店房间，使佩斯中心的部分区域成为孤立的区域 重新定义工作人员的角色，提供这些新角色的培训，并在以下方面提供医院后治疗 佩斯中心避免将体弱多病的老年人送到疗养院，这些疗养院的发病率很高 新冠肺炎感染的可能性。然而，到目前为止，研究人员还没有系统地调查、汇编和 评估PACE计划的反应。 我们的项目将为三个为期六个月的新冠肺炎阶段的每一个阶段提供权威信息 体验、确定新兴的最佳实践，并将PACE绩效与传统医疗保险进行比较 服务，增加了新冠肺炎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，并以在线调查为补充 佩斯计划。我们将确定PACE计划报告为实质性有益的反应， 以及那些没有有效的，对于以下方面：PACE参与者，他们的家人，可用性和 地理社区、医疗保健劳动力和PACE计划中的老年护理服务质量 财务方面。我们将比较PACE参与者和类似的医疗保险的利用率和质量结果 按服务收费受益人。我们将通过结构化采访更深入地挖掘有前景的适应。我们 将评估广泛传播更好的实践的潜在影响，我们将不断提供我们的见解 进入研究、临床实践和政策世界，以改善老年护理安排。

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.