Maggie McKay (Host): As we age, there are things we never knew we needed to know. So today, we'll talk with Dr. Mandeep Walia and Heidi Wong about PACE, a program dedicated to healthy aging and wellness.

Welcome to Together We Rise, a podcast from International Community Health Services. ICHS advocates for health as a human right and welcomes all in need of care, regardless of health, immigration status, or ability to pay. I'm your host, Maggie McKay. Thank you both so much for being here today. Would you please introduce yourselves? Let's start with you, doctor.

Mandeep Walia, MD: Yes, thank you for having us. I am Dr. Mandeep Walia. I am the HAWP PACE Medical Director and a board-certified Internal Medicine physician.

Host: And Heidi?

Heidi Wong: Hi, I'm Heidi Wong, currently the Program Director of Healthy Aging and Wellness at ICHS. Thanks for having us.

Host: Absolutely. I can't wait to hear about this. So, let's start with you, Dr. Walia. Can you explain what PACE stands for?

Mandeep Walia, MD: PACE stands for Program for All-Inclusive Care for the Elderly. PACE is a Medicare and Medicaid program that helps people meet their healthcare needs in the community instead of going to a nursing home or other care facility. So, it allows participants to remain as independent as possible in their current living situation for as long as possible.

Host: And Heidi, what are the goals of the program?

Heidi Wong: Yeah. As Dr. Walia said, the model of care for PACE is really centered around the belief that it's better for the well-being for frail elders, especially those with chronic care needs and their families, to be served in the community, where they're most familiar with whenever possible. So, the goal is to really provide individualized wraparound care so elders can age in place and remain as independent as possible, preventing or delaying the need to move into an institutional care setting like nursing homes. Ultimately, we want to really honor the wants and wishes of our elders and their families to be cared for and remain in their familiar surroundings, to maintain their autonomy of care, have a say in their care, and to maintain a maximum level of physical, social, and cognitive function with the help of our team.

Host: And are there specific requirements to join?

Heidi Wong: Yeah. So since this is a Medicaid Medicare program, there's very specific eligibility requirements. To be eligible for PACE, one would have to be age 55 or above, live in the service area of that PACE organization and, for us, it would be King County; be certified by the state in which you live in as meeting the need for a nursing home level of care, and be able to live safely in the community with the help of the PACE team at the time that you enroll.

Host: And Dr. Walia, what kind of services are available?

Mandeep Walia, MD: There are many services, thank you for asking. One is that PACE covers all Medicare Parts A, B, and D benefits. They also cover Medicaid-covered benefits and any other services or supports that are medically necessary to maintain or improve the participant's health. So when you look at the whole model for PACE, we function in a PACE Center at home, and in the community. So, for instance, at the PACE Center, participants will receive their primary care, so they'll see their physician. They also receive mental health services, so behavioral health services, which will help with their overall mental well-being; nutrition education, physical and occupational therapy. We provide meals, we provide activities and recreation, socialization and personal care, even things like bathing. Our schedulers will also help to make any patient appointments, and then assist them with getting durable medical equipment, so things like walkers, canes, et cetera. We also function in the home. So, PACE offers skilled nursing care in the home, our occupational and physical therapy services, personal care, so help with daily living, such as like cooking, bathing, overall chores in the home. And then, in the community, our PACE Program offers specialists and other providers. We also offer transportation to and from appointments, whether it be imaging, blood draws, primary care appointments, specialist appointments, and to and from the day center. So essentially, providing this holistic, overall approach to patient care, and removing the obstacles that many elderly face when it comes to care management and care coordination. We also have an interdisciplinary team, which has 11 disciplines, that keep a close eye on each of the participants' psychosocial, functional, mental, and physical well-being.

Host: It sounds like you guys have thought of everything and covered every base. That is amazing. Heidi, are there any costs to participate?

Heidi Wong: The cost to participate really depends on the eligibility for Medicaid and Medicare. for those who are dually eligible for both Medicaid and Medicare, participation in the PACE Program is actually fully covered with no out-of-pocket expenses for all authorized services. These have to be medically necessary and approved by the team. There's no deductible copayment for drug services or care your health care team approves. Now, some Washington State Medicaid enrollees may be subject to a cost of care amount if they are receiving long-term services and support and that portion will remain the same as part of the participant's responsibility.

For those who don't qualify for Medicaid, but have Medicare, you'll pay a monthly premium to cover the long-term care portion of the PACE benefit and a premium for the Medicare Part D drugs. I know that every participant situation may be different and unique, so we do recommend that for those who are interested to reach out to us, and our team will be happy to help you figure out what cost applies to you and based on your eligibility.

Host: Dr. Walia, what are some positive outcomes current members have experienced by being in the program?

Mandeep Walia, MD: There are actually a lot of positive outcomes. So, I'm going to throw a little bit of data out there to just demonstrate this. According to the National PACE Association, studies have shown that PACE participants have better outcomes in reduced hospital admissions. So, 24% lower hospitalization rate than duly eligible beneficiaries who receive Medicaid nursing home services. So, that's one. Decreased rehospitalizations, which is a huge plus. So if somebody's admitted to the hospital, we want to make sure they don't get readmitted. So, 16% less than the national rehospitalization rate of 22.9%, reduced emergency room visits because we should be intervening sooner, so less than one emergency room visit per member per year, which is outstanding.

For fewer nursing home admissions, I think we all know that, as you age, many times you do end up in a skilled nursing facility. So, we despite the fact that our patients require skilled nursing level home care, we are able to keep them at home and have a low risk of being admitted to a nursing home. PACE participants also receive better preventative care, which again prevents the hospitalizations and the nursing home, the ER visits, especially with respect to hearing and vision, screenings, flu shots, and pneumococcal vaccines. And our PACE program itself here at ICHS has had numerous examples of positive outcomes. We have had patients who are unable to walk, who come to our program and into our therapy program and now can walk, which for them is a huge achievement. We've had patients with advanced Alzheimer's who was living in the community independently, but with the support of PACE is now able to live much more independently without caregivers. And really, from an overall cognitive standpoint, because we have activities and recreation services that help maintain your cognition longer, so many examples of positive outcomes while joining the PACE Program.

Host: Heidi, let's talk about the immigrant and refugee communities that you serve. Why is PACE so important to them?

Heidi Wong: So, seniors and families, especially from immigrant and refugee communities really face a lot of difficulties navigating the healthcare system. We know how confusing it is even when you're not from those communities. But when language barriers or cultural barriers are there, it's difficult for them to navigate. So, PACE provides much needed wraparound support to help navigate and coordinate care every step of the way. This is especially critical with the elder's health condition changes and more services or higher level care is needed, we really kind of come alongside the family to help them to figure out what's needed, what's the next step.

At ICHS PACE, making sure that our care is provided in a culturally and linguistically appropriate manner is very important to us as a large proportion of our participants do come from these immigrant families where English is not their first language. So, we really make sure to hire the bilingual staff as well as dedicated interpreters to assist our participants and their families so that they can really be part of the decision-making and get the help that they need.

Host: Dr. Walia, what inspires you about working with seniors in the PACE Program?

Mandeep Walia, MD: Well, as a physician, I have to say one of the most rewarding things is to see a patient thrive under our care. I think I mentioned that patients who were unable to walk can now walk. Patients who were depressed and weren't coming out of their home and socially isolated are just thriving under our care. And some of them will say, "I love to sing with the therapist. I love to dance with the therapist." So, to see somebody go from being socially isolated or unable to walk, and now to do all those things is probably the most rewarding thing I can say.

I also have a father who's 92 years old and, as a physician, have been having difficulty just managing the healthcare system. And with all my background, I have difficulty. So, I can only imagine what our patients go through every day. So, we remove those barriers that every single one of us face every day. Things like I cannot get caregivers where we live or home health services. And family, they suffer burnout because of this, because they have to take care of their family members. They have to drive them to appointments and they work. Sometimes they're up all night with our participants. And so, being able to help families so that they can not burn out, being able to help patients so they don't have to juggle our difficult healthcare system is extremely inspiring and rewarding and makes me want to do this every day.

Host: That's awesome. Heidi, what about you? What inspires you about working with seniors in the PACE Program?

Heidi Wong: Yeah, I do echo everything Dr. Walia shared. For me, when I first was considering joining this program, I was really struck by my own experience with my grandmother. We call her Popo. At the time, she really needed 24/7 care, but she really wanted to stay with family and prefer to live with us and not have to move out. So, our extended family of aunts and uncles and cousins really rallied around her, each serving our different roles, whether it's my kids playing with her, my cousins driving her to appointments, my mom helping her with paperwork. We each kind of serve our role to take care of her and make sure we keep her wishes of staying with family. And ultimately, she only spent maybe a couple of weeks total in the hospital for just emergency situations. But otherwise, she spent her latter years at home with family. So, recognizing that not every elder has access to this type of family support from their own families or their own community, and so I wanted to help be part of the team to create that for others, especially elders who are in that situation, families in that situation, so that they do have access to a professional care team to help them as they age.

Host: That's so nice. Heidi, how can someone find out information to determine if joining is right for them?

Heidi Wong: We definitely welcome you to reach out to us. You can learn more on our website, ichspace.org. That's I-C-H-S-P-A-C-E dot O-R-G. You can also contact us at our hotline 206-462-7100, or make an appointment with our facility. We would love to show you around and answer any of your questions, to see if this is the right fit for you.

Host: Well, thank you both so much for sharing your expertise on this very important topic. We appreciate your time.

Heidi Wong: Thank you.

Mandeep Walia, MD: Thank you so much.

Host: Again, that's Dr. Mandeep Walia and Heidi Wong. If you'd like to find out more again about PACE at ICHS, check out our website at ichspace.org. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. I'm Maggie McKay. Thanks for listening to Together We Rise, a podcast from International Community Health Services.