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What is PACE

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Developing PACE

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Elder Care Resources

What is PACE?


The Program of All-inclusive Care for the Elderly (PACE) model is centered around the belief that it is better for the well-being of seniors with chronic care needs and their families to be served in the community whenever possible.

PACE serves individuals who are aged 55 or older, certified by their state to need nursing home care, able to live safely in the community at the time of enrollment, and live in a PACE service area. Although all PACE participants must be certified to need nursing home care to enroll in PACE, only about seven percent of PACE participants reside in a nursing home nationally. If a PACE enrollee does need nursing home care, the PACE program pays for it and continues to coordinate his or her care.


Delivering all needed medical and supportive services, the program is able to provide the entire continuum of care and services to seniors with chronic care needs while maintaining their independence in their homes for as long as possible. Care and services include:

  • Adult day care that offers nursing; physical, occupational and recreational therapies; meals; nutritional counseling; social work and personal care
  • Medical care provided by a PACE physician familiar with the history, needs and preferences of each participant
  • Home health care and personal care
  • All necessary prescription drugs
  • Social services
  • Medical specialists such as audiology, dentistry, optometry, podiatry, and speech therapy
  • Respite care
  • Hospital and nursing home care when necessary


The PACE model of care can be traced to the early 1970s, when the Chinatown-North Beach community of San Francisco saw the pressing needs of families whose elders had immigrated from Italy, China and the Philippines for long term care services. Dr. William L. Gee, a public health dentist, headed the committee that hired Marie-Louise Ansak in 1971 to investigate solutions. They, along with other community leaders, formed a nonprofit corporation, On Lok Senior Health Services, to create a community based system of care. On Lok is Cantonese for "peaceful, happy abode."


William Gee, DDS, and two others execute articles of incorporation for the nonprofit Chinatown-North Beach Health Care Planning and Development Corporation (later renamed On Lok Senior Health Services) and retain Marie-Louise Ansak to study the feasibility of building a nursing home in the community. She finds a nursing home would be both infeasible financially and culturally inappropriate. Instead she obtains funding to train health care workers, in cooperation with University of California San Francisco. She also outlines a comprehensive system of care combining housing and all necessary medical and social services, based on the British day hospital model.


On Lok opens one of the nation’s first adult day centers in San Francisco.


On Lok begins receiving Medicaid reimbursement for adult day health services.


On Lok adds a social day care center and includes in-home care, home-delivered meals and housing assistance in its program.


On Lok’s model of care expands to include complete medical care and social support of nursing home-eligible older individuals.


On Lok receives a four-year Department of Health and Human Services grant to develop a consolidated model of delivering care to persons with long term care needs.


On Lok is allowed to test a new financing system that pays the program a fixed amount each month for each person in the program.


Federal legislation extends On Lok’s new financing system and allows 10 additional organizations to replicate On Lok’s service delivery and funding model in other parts of the country.


The Robert Wood Johnson Foundation, the John A. Hartford Foundation and the Retirement Research Foundation provide funding to On Lok and the first replication sites to support their efforts.


The first Programs of All-inclusive Care for the Elderly (PACE) receive Medicare and Medicaid waivers to operate the program.


The National PACE Association is formed.


The Balanced Budget Act of 1997 establishes the PACE model as a permanently recognized provider type under both the Medicare and Medicaid programs.


The Robert Wood Johnson Foundation and the John A. Hartford Foundation fund the PACE Expansion Initiative to assist the National PACE Association in expanding the benefits of the PACE model of care to more families in need.


Alexian Brothers Community Services in St. Louis becomes the first PACE provider to become a full, permanently recognized part of the Medicare and Medicaid programs.


 Copyright 2002 National PACE Association.  All Rights Reserved.