Nurturing innovation in care for seniors

In a one-room office 50 years ago, a revolution started in San Francisco. Dr. William L. Gee and social worker Marie-Louise Ansak sought to keep seniors with chronic illnesses and disabilities out of nursing homes by serving them in their homes and communities.  

They established On Lok, and their vision resulted in the Program of All-Inclusive Care for the Elderly, known as PACE – a groundbreaking care model combining community-based health care with social services, which has been adopted by 140 organizations in 30 states.  

On average, in California, seniors enrolled in PACE are 76 years old and live with 20 medical conditions. A third have Alzheimer’s disease. This combination makes them especially vulnerable to COVID-19, but they were diagnosed with COVID-19 at one quarter the rate of nursing home residents.  

This is no small victory. California’s nursing homes accounted for 4% of the state’s COVID-19 cases but 20% of deaths – highlighting the need to provide more community-based care options like PACE, which is also over 40% less expensive. 

PACE’s low infection rates are the result of care innovations developed through operational flexibilities temporarily allowed by the state during COVID-19.  Enrollment was simplified to help seniors avoid month-long delays to getting care. Telehealth was authorized so seniors could more easily communicate with doctors. Skilled nursing staff were retrained and deployed from PACE centers to the homes of seniors to provide care.  

Assembly Bill 523 awaits action by Gov. Gavin Newsom, and it makes these practices permanent care options. The bill, introduced by Assemblymember Adrin Nazarian, a Democrat from Van Nuys, also enables PACE organizations to continue innovating their operations to more effectively and safely serve seniors how and where they need care.

By signing AB 523, Newsom can ensure California’s dedicated PACE organizations continue providing safer, better coordinated and less expensive care. 

Seniors enrolled in PACE receive individualized care from a team of doctors, nurses, therapists and aides – familiar faces who know them, their family and their home. This personal touch is why 92% of seniors enrolled in PACE recommend it.  

Seniors cared for by PACE are overwhelmingly low-income and more than 80% are from communities of color. They often do not have any home or family support, which makes PACE their only option to avoid being uprooted and placed in a nursing home. 

After Newsom’s shelter-in-place order last year, for example, one of the ​​participants could no longer receive physical therapy or take part in social activities at On Lok. His dementia caused increased hallucinations and, feeling isolated, he became depressed. His care team – including a doctor, counselor and caregivers – began a routine home care regimen. He also overcame his loneliness through prayer with On Lok’s chaplain and, by learning how to use Zoom, he began to play games, participate in a support group and sing with friends. He even received the COVID-19 vaccine at home from the care team nurse when it became available.

Nearly 90% of Californians want services like this so they can continue living at home as they age with dignity and independence. The state can meet these expectations and improve equity in aging by expanding PACE.  

California’s senior population is growing and diversifying faster than any other age group. Our nation’s population is also becoming increasingly older.  President Joe Biden has proposed meeting this challenge through a $400 billion plan to invest in home and community-based services. 

By signing AB 523, Newsom can help unleash PACE’s potential to protect the health and well-being of California’s frail seniors by preserving the best care options available. He can also ensure the nation continues looking to California for inspiration as it builds the aging infrastructure of tomorrow.