The latest entry onto the menu of choices for frail older people who want to continue to live in their own homes opened for business this month. PACE Vermont, now serving Chittenden and southern Grand Isle counties through its new center in Colchester, offers participants all-inclusive care – including primary and preventive health care, home and adult day services, pharmacy, related transportation, and specialty health care, nursing home and hospital care when needed

Another PACE Vermont center is due to open later this year in Rutland, serving Rutland County.

"Forget everything that you know about Medicaid and Medicare," says PACE director Sue Watson. "After you enroll, PACE is responsible for all of your health needs – from prevention, primary care, and rehabilitation to acute hospital care." Watson comes to PACE after a 27- year career with the Visiting Nurse Association of Chittenden and Grand Isle Counties, most recently as director of long term care services.

Twenty years ago, "long term care" meant nursing homes. Today, "long term care" still includes nursing homes and other residential facilities, but increasingly it also means choices among an array of services to help people stay at home, such as: personal care, house-keeping, meals programs, adult day care, and respite for the care-giver. Recognizing that most people choose to live at home as they become frail and responding to the ballooning public expense for care in residential facilities, Vermont state administrations over the past two decades have promoted the growth of home and community-based services, both for frail older people and for younger people with disabilities.

In spite of the growing focus on care at home, however, the services still are often expensive, not reimbursed by most insurances, not readily accessible, and difficult to coordinate. PACE addresses these difficulties with a "wrap-around" service. It provides, coordinates, and pays for all health and home care through an interdisciplinary care team assigned to the individual. Each PACE team is composed of a physician, nurses, social worker, rehabilitation therapists, dietician, pharmacist, aides, and van drivers. Participants give up their current primary care provider and use the PACE physician. The team follows and coordinates your care whether you are at home, or must enter a hospital or nursing home. You do not have to worry about Medicare D or other pharmaceutical insurance because PACE is an approved Part D provider with a pharmacy on site, and costs for medications are included in the program.

Also, PACE has contracts for services, when needed, with existing providers: including Fletcher Allen Health Care, local nursing homes, specialty physician practices, the Visiting Nurse Association, home health agencies, transportation providers, Champlain Valley Agency on Aging, and the Howard Center for Human Services.

"This community collaboration in forming the care teams makes our Vermont program unique among PACE providers around the country," says Janice Clements, president of the PACE board of directors and facilitator of the Champlain Long Term Care Coalition.

To be eligible for PACE, you must be 55 years old or older, certified by Vermont to need nursing home level of care, live in Chittenden, southern Grand Isle, or Rutland counties, desire to live at home, and can do so safely. PACE may be for you if you have a chronic condition, like heart disease, Parkinson's, or lung disease; if you need daily help with personal care, like getting your food or bathing; if you take many medications; if your family caregivers work. PACE may be your answer if you would need a nursing home in lieu of the care you are now getting at home.

After you are deemed eligible and accepted into PACE, you are assigned a service team, and you take part in the development of your care plan. The plan usually includes home services and attendance at the PACE center, including transportation, for physician visits, rehabilitation appointments, personal care like bathing, and recreation. The plan may also include referrals to outside specialists, depending on need

The PACE center on the Fanny Allen campus in Colchester, is housed in a newly renovated building which once served as the convent for the Religious Hospitallers of St. Joseph. On three floors, it includes spacious activity, dining, and therapy rooms, laundry, barber shop and salon, pharmacy, and personal care suites where participants can be bathed and get other care.

To many people who struggle to find and coordinate care, PACE can sound too good to be true. How does it work? PACE Vermont receives monthly payments from Medicare and Medicaid for each eligible participant. If you are on Medicaid or dual-eligible for both Medicaid and Medicare, you pay no fees, no deductibles, and no co-payments for any of the comprehensive services. Medicare beneficiaries who are not Medicaid eligible can enroll by paying the Medicaid monthly payment and the Part D premium.

"PACE functions like an insurance pool," says Watson. "But we are both the insurer and the service provider."

PACE or Program of All-Inclusive Care of the Elderly, started out in San Francisco's China Town in the 1980's. Since then, PACE has become a part of Medicare and Medicaid, and programs have been developed all across the United States - mainly in urban areas because a certain density of population is necessary to assure sufficient funding. The idea for PACE Vermont was born in 2002, when Vermont was awarded a grant from the John E. Hartford Foundation and the National PACE Association to encourage the development of a program in a rural state. It took five years of planning, fund-raising, and dealing with federal and state requirements and regulations to bring PACE to its opening date, says Clements.

She credits PACE Vermont's success to the support and collaboration of state officials, key legislative committees, the founding board, and many community partners, particularly the Sisters of the Religious Hospitallers of St. Joseph, the Fanny Allen Corporation, and former Senator Jim Jeffords.

"It's not very often that you get a chance to participate in real system change," says Clements. "I've stayed with this project through the mountains of state and federal regulations because I think that this model of care can work for all populations. Everyone is struggling to navigate our broken medical system. PACE offers a glimpse of a truly integrated and responsive health care system."

For more information about PACE Vermont, contact Sue Watson, 802-655-6700 or toll-free 888-655-6706 or visit their website.

Barbara Leitenberg writes on senior issues for the Champlain Valley Agency on Aging. This article originally appeared in the Burlington Free Press.