PACE is an acronym for Program of All-inclusive Care for the Elderly. PACE coordinates the care of each participant enrolled in the program based on his or her individual needs. PACE helps individuals continue to live in the community through comprehensive services and support. The PACE Center (adult day health, medical and rehabilitation services) is open, Monday through Friday 8am to 5pm.

Services include, but are not limited to:
 

• Primary Care (including physician and nursing services)

• Hospital Care, Emergency Services and Outpatient Services

• Medical Specialty Services, Dentistry and Surgical

• Prescription Drugs, Over-the-Counter Medicines and Medical Supplies

• Medical Equipment (wheelchairs, walkers, etc.)

• Home Care Services and Caregiver Support

• Physical, Occupational and Speech Therapies

• Adult Day Health Center

• Recreational Therapy, Activities and Exercise

• Nutritional Counseling

• Social Work Counseling and Mental Health Services

• Social Services

• Transportation to PACE Center and Medical Appointments

• End-of-Life Services

Note: Most services occur at the PACE Center, however, some are provided through PACE’s provider network and other services occur at the participant’s home.

A person is eligible for enrollment if he or she:
 

• Is 55 years of age or older

• Lives in Randolph, Montgomery, and parts of Moore counties. The following zip codes are included:
  27203, 27205, 27208, 27209, 27229, 27233, 27239, 27242, 27248, 27260, 27263, 27281, 27283, 27292, 27298, 27306, 27313, 27316, 27317, 27325, 27341, 27344, 27350, 27355, 27356, 27360, 27370, 27371, 27376, 28127, 28327, 28350, 28374, 28387, 28394

• Meets the nursing home level of care requirement as determined by the NC Division of Medical Assistance

• Is able to live safely in the community at the time of enrollment

Yes. PACE accepts Medicaid, Medicare or private payment for care. If a person does not qualify for Medicare, a monthly premium will be charged to cover services. There is no out-of-pocket cost for Medicaid-eligible participants. If the individual wants Medicaid to assist with coverage, the Department of Social Services determines the cost during the Medicaid application process. Other insurance plans are contracted on a case by case basis. Coverage is determined by the insurer. Once an individual is enrolled, StayWell becomes the primary care provider and covers all healthcare services. Participants with Medicaid and Medicare may receive services at no cost if dually eligible for Medicaid and Medicare. With the exception of life threatening emergency services, all services delivered must be approved in advance by StayWell. You can get emergency care anywhere in the United States.

No. Anyone can refer to PACE including the individual who needs the service. A referral from a doctor is not necessary. Anyone can refer a person by phone or by completing a referral form and sending to PACE via fax or email.

When a person enrolls in PACE, he or she is assigned a primary care provider who is part of a care team skilled in treating seniors. This primary care provider works with the team to coordinate all services a participant receives.

PACE has a broad network of specialists and dentists familiar with the PACE program and participant needs. All services (except emergency) must be approved by StayWell Senior Care. A participant may be personally liable for the cost of unauthorized or out-of-network services.

PACE participants use the after-hours phone number to speak directly to a PACE Nurse/Provider who is familiar with his or her care needs. In the event of an emergency, an ambulance will be dispatched to the participant’s home. In non-emergency situations, the participant will be transported to the PACE Center the following day for treatment.

Attendance is based on individual needs and allows PACE staff to closely monitor health concerns, prevent emergency room visits and hospitalizations. Attendance ranges from once a week to several days a week and as needed.

Yes, as long as the individual meets PACE safety criteria.

• Once a person is referred to PACE or contacts PACE directly, a home visit is scheduled with an Intake Coordinator to fully explain the program, assess needs and complete forms. A Homecare Coordinator will also visit the home to assess home care needs, if any. If necessary, a social worker may visit as well.

• If the person meets the basic guidelines (challenged with ADLs, medical condition, etc.) and is medically appropriate for PACE, the potential participant and caregiver attend PACE Center assessment (10-2:30). During this time, he or she meets members of the PACE team (primary care provider, physical and occupational therapists, recreational therapist, social worker, nurses and registered dietitian) for an assessment to help the team determine the needs and care required. Also, the provider completes and submits the necessary forms to the NC Division of Health Benefits for approval.

• An enrollment meeting is scheduled with the potential participant and caregiver to review the plan of care (in which family input with regard to the participant’s individualized plan is considered) and enrollment agreement. Adult day center attendance and transportation are also scheduled at this time.

• Once the enrollment agreement is signed, participant care will begin on the first day of the following month.

Since individuals with Medicaid are likely to receive PACE services at no cost or at a reduced cost, it is recommended that those interested in PACE apply for Medicaid. The Medicaid process can take up to 45 days for approval.

No, currently there is not a waiting list.

Yes, a participant can leave the PACE program for any reason and resume the benefits of traditional Medicaid and Medicare programs. The effective date of discharge is the last day of the month because PACE is financially responsible for participants until the end of the month.

No. PACE covers all medically necessary expenses including hospitalization. The PACE provider will work closely with hospital providers to ensure continuity of care for the participant. After discharge, PACE will coordinate home health or rehab services as necessary.

No. PACE will continue to provide medical services and support. If a skilled nursing facility is needed, the skilled nursing facility must have a contract with PACE.

StayWell Senior Care supports individuals in the following counties: Randolph, Montgomery, and parts of Moore counties. The following zip codes are included: 27203, 27205, 27208, 27209, 27229, 27233, 27239, 27242, 27248, 27260, 27263, 27281, 27283, 27292, 27298, 27306, 27313, 27316, 27317, 27325, 27341, 27344, 27350, 27355, 27356, 27360, 27370, 27371, 27376, 28127, 28327, 28350, 28374, 28387, 28394. Other NC PACE programs are based in Greensboro, Asheville, Burlington, Charlotte, Durham/Raleigh, Fayetteville, Gastonia, Hickory, Lexington and Wilmington.