How Multisector Plans for Aging and PACE Can Work Together to Improve Care for Older Adults
Leveraging Collaborative Care Models to Enhance Outcomes for Aging Populations
February 7, 2024
Introduction
As the population of older adults in the U.S. continues to grow, delivering the services needed to support an aging population becomes increasingly important. States are seeing the impact of the predicted demographic shift across multiple domains—including increased pressure on the health system, direct care workforce, accessibility of home and community-based services, housing, and transportation. The solutions vary for those with different social, behavioral, and complex care needs, but there remains room for collaboration and coordination between the entities working to support older Americans.
Multisector Plans for Aging (MPAs) are cross-sector, government-led plans that aim to address the growing and varied needs of older adults by creating a coordinated system of high-quality care and support services. Programs of All-Inclusive Care for the Elderly (PACE) provide comprehensive health care and social support services to frail older adults with complex chronic care needs. MPAs rely on stakeholder input as they are developed, and PACE organizations have an important role in ensuring that the needs of their participants are included.
This brief provides an overview of MPAs and PACE, includes examples, and provides recommendations for consideration on how MPAs and PACE can work together to improve care for older adults. Exhibit 1. Overlap of States with PACE and MPA Activities shows the sixteen states with both PACE and MPA efforts underway (California, Colorado, Indiana, Iowa, Maryland, Massachusetts, Missouri, New York, North Carolina, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, and Washington). In these states, there is an opportunity now for collaboration. The appendices of this brief provide state-specific information on MPA and PACE resources for these states.
Note: PACE may not serve entire counties, and to reach out to the local PACE organizations for more information about exact service area
Exhibit 1: Overlap of States with PACE and MPA Activities
Background on Multisector Plans for Aging for PACE Programs
As of October 2023, more than half of U.S. states are working to either build momentum, develop, or implement Multisector Plans for Aging (MPAs). MPAs are government-led, cross-sector, whole person-focused plans that coordinate and prioritize the state’s goals and initiatives to address the needs of the growing aging population. The goal of an MPA is to create a coordinated system of high-quality care and support services that promote healthy aging, independent living, and social engagement, while also addressing intersecting issues related to healthcare, housing, transportation, and other social determinants of health.
MPAs are different from State Plans on Aging, which are required by the Older Americans Act and outline the roles and responsibilities of each state and its Area Agencies on Aging. A State Plan on Aging documents achievements and describes how the state will allocate funds and administer the Older Americans Act going forward. States are required to update this plan and submit it to the Administration for Community Living every four years. In contrast, an MPA is cross-sector and has support from the Governor or state legislature.
MPAs coordinate and elevate existing state and local efforts such as age-friendly initiatives, healthy aging, dementia care, accessible housing, transportation, disability justice, and more. MPAs also work across state agencies to engage diverse stakeholders including older adults, caregivers, industries, providers of services, researchers, advocates, and representatives from diverse communities. While MPAs vary depending on individual state priorities, they share the common purpose of serving as a blueprint for state and private efforts to improve the well-being of older adults and people with disabilities for 10 or more years. MPA development is backed by legislation or an Executive Order in ten states as of October 2023 (California, Colorado, Massachusetts, Missouri, New York, North Carolina, Pennsylvania, Texas, Utah, and Vermont). Leadership from the Governor or legislative leaders is an important step in creating buy-in and support for the development of the plan.
For more information and the latest on the MPA movement, visit multisectorplanforaging.org. This website serves as a hub for involvement opportunities, including an interactive map showing state progress on MPAs, links to helpful resources such as articles, event recordings, and toolkits, and an option to sign up for our periodic MPA newsletter.
Background on PACE for MPA Leaders and Advocates
The Program of All-Inclusive Care for the Elderly (PACE) is a unique, integrated care model that provides comprehensive health care and services to frail older adults with chronic care needs. To be eligible for PACE, an individual must be 55 or older, live in a PACE service area, certified by their state as needing nursing home level of care, and able to live safely in the community with PACE services.
There are over 150 PACE organizations serving about 70,000 individuals in 32 states plus the District of Columbia. PACE uses an interdisciplinary team approach to provide enrollees with all Medicaid and Medicare-covered services, as well as any other services to improve and maintain the participant’s overall health status. The 11-person interdisciplinary team (IDT) members include physicians, nurses, physical therapists, social workers, dietitians, and transportation drivers. They work together to meet the health needs of each person in the program – from primary care, medication management, social work, and physical and occupational therapy to home care, home modifications, transportation, dietary support, and more. PACE organizations also contract with hospitals, skilled nursing facilities, and community-based specialists for any additional healthcare needs. Each person enrolled in PACE has a personalized care plan to meet their needs. PACE organizations are responsible for providing or arranging care to meet participants’ needs 24/7 and 365 days a year.
Who Are PACE Participants
While everyone enrolled in PACE is certified as needing a nursing home level of care, about 95 percent of PACE participants live in their communities. The average PACE participant has up to six chronic conditions. 83 percent of PACE participants need assistance with at least one activity of daily living, and 33 percent need help with five or six activities of daily living.
While there is no requirement that a PACE participant be on Medicaid or Medicare, about 87 percent of participants are dually eligible for Medicaid and Medicare and 13 percent rely solely on Medicaid.
How PACE Organizations and MPAs Can Unite to Promote Shared Goals
Both MPAs and PACE have similar goals to expand and coordinate services for older adults that allow them to remain in their communities as long as possible. As part of these goals, both aim to address issues affecting older adults’ health over and beyond the healthcare system itself, including nutrition, housing, transportation, and many other social services. This intersection is therefore useful for recognizing how both entities can work together to help support older Americans. Furthermore, identifying the locations where PACE and MPAs overlap can help bridge gaps and spread awareness of how to best deliver the services being promoted through MPAs to older adults enrolled in PACE.
MPAs can use PACE expertise to meet their cross-sector aims. These include elevating and expanding existing efforts to deliver housing, community-based supports, nutrition, transportation, and many other services. PACE has experience in working with interdisciplinary teams to meet the comprehensive health needs of participants—from primary care, medication management, social work, and physical and occupational therapy to home care, home modifications, transportation, dietary support, and more. Thus, PACE can deliver key insights and experiences to the MPA planning process on how to better coordinate the broader range of services needed to promote healthy aging at the state and local level.
For example, PACE programs can be a key resource for stakeholder engagement opportunities within MPA planning. Since MPAs are often driven by Executive Orders or legislation, they are backed by government support. This governor-led or legislative-level strategic planning for aging offers a chance for a wide range of stakeholders to be at the table, including PACE programs. PACE programs are an important stakeholder because they are a key feature of the states’ care model for dually eligible individuals. Additionally, these programs have insights into the multidisciplinary care needed to address the needs of a complex population. Through their connections with community providers, PACE programs also have access to other important leaders and stakeholders who can and should be involved in MPA planning.
PACE program involvement in MPA planning has already been happening in several states. For example, in New York, a representative from the New York State PACE Alliance was part of the Long- Term Services and Supports subcommittee developing the MPA. In California, MPA development was informed by extensive public commentary. As part of their involvement with the MPA, CalPACE was able to submit a comment letter to the Department of Aging that included recommendations for how the MPA could be leveraged to expand access to PACE programs and services. Giving PACE a seat at the table not only gives voice to the experiences of PACE participants and providers, but also helps promote PACE as an important part of the continuum of care for older adults.
Final Thoughts
Given the predicted growth of our aging population, it is now more important than ever to bring together and coordinate efforts aimed at better serving and meeting the needs of older adults. This brief has identified a variety of synergies between comprehensive Multisector Plan for Aging development and the deep expertise of PACE in serving older adults. By acknowledging these synergies, PACE and MPA leaders can uncover ideological and geographic overlap between both parties that allow them to collaborate and work together to promote their shared goals. The accompanying appendices provide further resources and information for states that have both PACE and MPA activities.
Both MPAs and PACE should be interested in what the other is doing. West Health and the National PACE Association can assist in making introductions and look forward to featuring more examples for others.
Appendix of States with Both PACE and MPA Activity Underway
1. California |
2. Colorado |
3. Indiana |
4. Iowa |
5. Maryland |
6. Massachusetts |
7. Missouri |
8. New York |
9. North Carolina |
10. Oklahoma |
11. Oregon |
12. Pennsylvania |
13. South Carolina |
14. Tennessee |
15. Texas |
16. Washington |
1. PACE and MPA Resources in California
California has both PACE and MPA efforts underway. This appendix includes information about finding PACE programs across the state, as well as MPA contacts.
PACE in California
MPA Activities in California
2. PACE and MPA Resources in Colorado
Colorado has both PACE and MPA efforts underway. This appendix includes information about finding PACE programs across the state, as well as MPA contacts.
PACE in Colorado
MPA Activities in Colorado
3. PACE and MPA Resources in Indiana
Indiana has both PACE and MPA efforts underway. This appendix includes information about finding PACE programs across the state.
PACE in Indiana
4. PACE and MPA Resources in Iowa
Iowa has both PACE and MPA efforts underway. This appendix includes information about finding PACE programs across the state, as well as MPA contacts.
PACE in Iowa
MPA Activities in Iowa
5. PACE and MPA Resources in Maryland
Maryland has both PACE and MPA efforts underway. This appendix includes information about the PACE programs across the state, as well as MPA contacts.
PACE in Maryland
MPA Activities in Maryland
6. PACE and MPA Resources in Massachusetts
Massachusetts has both PACE and MPA efforts underway. This appendix includes information about finding PACE programs across the state, as well as MPA contacts.
PACE in Massachusetts
MPA Activities in Massachusetts
7. PACE and MPA Resources in Missouri
Missouri has both PACE and MPA efforts underway. This appendix includes information about finding PACE programs across the state, as well as MPA contacts.
PACE in Missouri
MPA Activities in Missouri
8. PACE and MPA Resources in New York
New York has both PACE and MPA efforts underway. This appendix includes information about finding PACE programs across the state, as well as MPA contacts.
PACE in New York
MPA Activities in New York
9. PACE and MPA Resources in North Carolina
North Carolina has both PACE and MPA efforts underway. This appendix includes information about finding PACE programs across the state, as well as MPA contacts.
PACE in North Carolina
MPA Activities in North Carolina
10. PACE and MPA Resources in Oklahoma
Oklahoma has both PACE and MPA efforts underway. This appendix includes information about finding PACE programs across the state, as well as MPA contacts.
PACE in Oklahoma
MPA Activities in Oklahoma
11. PACE and MPA Resources in Oregon
Oregon has both PACE and MPA efforts underway. This appendix includes information about finding PACE programs across the state, as well as MPA contacts.
PACE in Oregon
MPA Activities in Oregon
12. PACE and MPA Resources in Pennsylvania
Pennsylvania has both PACE (known as LIFE in Pennsylvania) and MPA efforts underway. This appendix includes information about finding LIFE programs across the commonwealth, as well as MPA contacts.
PACE in Pennsylvania
MPA Activities in Pennsylvania
13. PACE and MPA Resources in South Carolina
South Carolina has both PACE and MPA efforts underway. This appendix includes information about finding PACE programs across the state, as well as MPA contacts.
PACE in South Carolina
MPA Activities in South Carolina
14. PACE and MPA Resources in Tennessee
Tennessee has both PACE and MPA efforts underway. This appendix includes information about finding PACE programs across the state, as well as MPA contacts.
PACE in Tennessee
MPA Activities in Tennessee
15. PACE and MPA Resources in Texas
Texas has both PACE and MPA efforts underway. This appendix includes information about finding PACE programs across the state, as well as MPA contacts.
PACE in Texas
MPA Activities in Texas
16. PACE and MPA Resources in Washington
Washington has both PACE and MPA efforts underway. This appendix includes information about finding PACE programs across the state.
PACE in Washington
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