My mom is 68, and she still lives alone two streets from the gym where I coach. That feels normal to me. But ask most people how their parents’ care would work in a crisis, and the answers get shaky fast: a patchwork of clinics, ER visits, and phone tag with insurance companies.
Last month I sat down with Dr. Anthony Zizza, medical director of Element Care, to talk about a model that fixes that mess: PACE, the Program of All-Inclusive Care for the Elderly. Here’s what stuck with me.
The Why: A Care Model That Wraps Around the Person
Most U.S. healthcare is piecemeal. You go to one doctor, then another, and the system makes you do the chasing. PACE flips that. The system wraps around the older adult instead.
Participants get 14 different services under one roof: transportation, therapy, social work, physicians, nurse practitioners, medication support, dietitians, an adult day health center, home-based services, palliative care, and urgent care. One team coordinates it all.
The How: An Air Conditioner That Beat a Ventilator
Dr. Zizza’s story that I keep thinking about: a PACE participant with COPD, a lung disease that usually strikes longtime smokers. Every summer he’d have 4 or 5 exacerbations — bad flare-ups that often end in a hospital stay, sometimes on a ventilator. Winter? He was fine.
So the team bought him an air conditioner. It did the trick. The flares stopped. That’s not a small thing when you’ve spent a career treating big, scary diseases. Sometimes the fix is an appliance instead of a long hospital stay. One summer, the pattern broke.
Here’s the eligibility check, because it trips people up:
Step 1: You’re 55 or older and would qualify for a nursing home — meaning you need help with at least one activity of daily living (bathing, dressing, feeding) and can’t safely live alone without it.
Step 2: You have both Medicare and Medicaid (in Massachusetts that’s MassHealth).
Step 3: You agree to receive all your care through the PACE program. That’s the trade: one team owns your care, end to end.
Why does the money work? Medicare and Medicaid pay the program a fixed amount per participant. So the program has a financial incentive to keep you healthy and living in your own home. Preventing an ER visit, an inpatient stay, or a move into long-term care saves the system real money.
The Numbers: What PACE Looks Like Today
Coach’s Math: PACE has existed since 1971, but it stayed a small thing — a couple of dozen programs nationwide — until 1997, when it became a permanently recognized provider type under Medicare and Medicaid. After that, it scaled. By 2023: 151 programs, 68,000 participants, 32 states plus the District of Columbia.
Not everywhere. Some states have no PACE programs at all, and even where they exist, coverage is ZIP-code by ZIP-code. Setting up a new program means applications to CMS and the state Medicaid agency. Dr. Zizza’s one wish for the model: cut the red tape.
Your Move:
Step 1 (5 minutes): Write down who would coordinate care if your parent needed help with bathing or dressing this month. If the answer is ‘no one,’ that’s the gap PACE exists to close.
Step 2: Check whether your state has PACE programs and which ZIP codes they cover. Start with your local Area Agency on Aging.
Step 3: If your parent qualifies, book the eligibility assessment. The worst it can do is give you a real plan.
We all want the people we love to age in their own homes, not in a waiting room. Sometimes the model that gets us there already exists. It’s just waiting for us to find it. You can listen to my full conversation with Dr. Zizza here.