Advice From Your Advocates
Advice From Your Advocates
Staying Home Longer: How the PACE Program Supports Aging in Place
In this episode of 'Advice From Your Advocates', hosts Bob Mannor and Savannah Meksto delve into the PACE program, a transformative initiative for elder care. They discuss the eligibility criteria, financial aspects, and the comprehensive care provided under the program. The conversation emphasizes the importance of understanding Medicaid qualifications and the benefits of receiving care at home. Listeners are encouraged to explore the PACE program as a viable option for their loved ones, highlighting the supportive community and medical resources available.
Host: Attorney Bob Mannor
Co-Host: Savannah Meksto
Executive Producer: Savannah Meksto
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Mannor Law Group helps clients in all matters of estate planning and elder law including special needs planning, veterans’ benefits, Medicaid planning, estate administration, and more. We offer guidance through all stages of life.
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You're listening to Advice from your Advocates, a show where we provide elder law advice to professionals who work with the elderly and their families.
Speaker 2:Welcome to Advice from your Advocates. I'm your host, Bob Manor. I am a board-certified elder law attorney and certified dementia practitioner. Joining me, as always, is my co-host, Savannah Mexico, who is also a certified dementia practitioner. Savannah, great to have you here.
Speaker 1:Thanks, bob. I'm happy to be here Now. Today's topic is one that can truly transform how families approach elder care the PACE program in Michigan. So, bob, for those who are unfamiliar with the PACE program, can you explain that to us?
Speaker 2:Absolutely so. This is something that it's all over the country. We have the PACE program as a national program, but it's really underutilized and under unknown. So PACE, p-a-c-e what does that stand for? That stands for the Program for All-Inclusive Care for the Elderly. Now, all right, just the name sounds encouraging right, yeah, right.
Speaker 2:Yeah, so it is a Medicare and Medicaid program. So generally I mean you can private pay and it will be supplemented by Medicare for the program. But very few people are going to probably private pay for this PACE program. It's generally going to be for folks that can qualify for Medicaid Now we have Medicare and Medicaid and it is generally going to be folks that are over age 55 then qualify for Medicaid Now we have Medicare and Medicaid and it is generally going to be folks that are over age 55, then qualify for Medicaid. Now, what we do at Manor Law Group is we help people figure out how to qualify for Medicaid and still keep your money. So if this is the first time you're listening, you might not know that there's ways to qualify for Medicaid and not lose all your money. But if you've listened before, you probably should know that that's an option.
Speaker 1:So, bob, how about we dive deeper into that financial side of the PACE program? Now we know that you have to be 55 to qualify, but what other markers are they looking for? And really, how does Medicaid make this program accessible for families who really need the care?
Speaker 2:Well, first of all, I'm a little bit upset about the qualifications, because 2025, I'm going to be 55. So I will qualify for PACE based on the age ranking, and that doesn't make me really happy.
Speaker 1:We'll have fun reminding you of that every day.
Speaker 2:Exactly so okay, so right. So you have to be at least 55. That's just. You know the starting point. You can't qualify for this if you're under 55.
Speaker 2:There are other Medicaid programs that you can qualify for if you're under 55, but PACE is not one of them. So the program for all-inclusive care for the elderly is. We'll get into what you get from that. But let's talk about the qualification process first, and there is both an income and an asset limit for that. Now, assets is where Manor Law Group can come in and help you out to make sure that we can protect assets and still qualify for PACE Income. We can also potentially qualify, but that gets a little bit stickier if you're over the income limit. It's an individual income limit, meaning it doesn't matter what your spouse makes as income. It matters what you make. An income, and I want to clarify what I mean by income. Income is going to be your pension and your social security, and that's it. Any other income is something that we can work with you on, the law office can work with you on to protect, but the one thing that is just what it is is your pension and social security.
Speaker 1:So for those families who do qualify and they need help with care, what kinds of things can the PACE program help with?
Speaker 2:So it is the program for all-inclusive care for the elderly, right. So it's all-inclusive care. So it is partially designed to be where you're staying in your home. And you know, I've been doing this for almost 30 years now. This is probably why I'm getting to the age where I qualify for PACE, but I've been doing this for almost 30 years now, and almost always I ask if you get to the point where you need help, where you can't provide all the care, you're not completely independent anymore. You need help from other people. Would you rather get that help in your house or would you rather move into someplace that provides that care? And about 99% of the time people say I'd rather get care in my home, right, and so this is one of those programs that can help with that. It is designed to keep you in your home. Now they can. If they feel like you're not safe in your home, they're probably not going to accept you into that program, Right? But if they feel like with family support and other support that they can provide, they can provide the necessary help for you, then it creates an option for you to stay in your home, get some home care options, but also go to the PACE program.
Speaker 2:You know PACE Center In Genesee County. Here we have a really really nice PACE Center right next door to the Flint Farmer's Market. So if you've ever been to the Flint Farmer's Market I know you've been there Savannah, oh yeah, it's just really nice. And then right next door is the PACE program. It used to be the International Center but it's a great building. So they've got a nice pavilion, they've got concerts there sometimes. It's just a really great place and you can go there as part of the PACE program and they will provide you with sort of your daycare and then they'll supplement that with some home care.
Speaker 1:So you and I actually had the opportunity to tour the Pace Center together, and this was like years ago that I went to this facility with you to just to check it out, and I still, to this day, just think about how cool it was there. There was so much to do.
Speaker 2:Right.
Speaker 1:Just the. You know I'm going to sound like a hippie, but the vibe I loved the vibe there. Just everyone was in such a good mood. Everyone was so friendly. The staff was just above and beyond friendly and everyone staff and PACE participant alike just seemed happy to be there.
Speaker 2:Absolutely, and so that's one of the things that I really like about PACE is that, you know, there's a lot of good care centers, places that provide 24-hour care, and you live there, but it can be very difficult in those settings to provide 24-hour care, and sometimes you walk in and it's a little bit depressing, right, I mean, and even the best places, there's going to be days where you know it's just not the most upbeat place in the world to live, and the Pace Center is. Every time I've ever been there, I think you said the right word vibe. The vibe has been very positive and one of the things I love about this, you know. I'll tell you this quick story.
Speaker 2:We have a bunch of clients that are part of, you know, participate in this Pace program, and a lot of them have some kind of memory issue, have some kind of dementia. You know they're not, they don't have complete connection to the world around them. However, they still have some skill sets, right. So, and I remember there are one of our clients was a really great seamstress. She was just a really great seamstress and could sew. We have another client that does crochet and both of them teach classes. They're participants in the program and they have a little circle of people that they'll teach them seamstress and you know sewing and they'll teach them. The other one teaches crochet, where they're actively participating in helping the other people that are part of the PACE program and make it interesting and unique and fun. That's just something you don't see very often.
Speaker 1:No, absolutely not, and just so meaningful for the people that are learning that new skill, but also for our client, who got to share that and make connections in that way. That's really cool. I hadn't heard that story yet, but I love that.
Speaker 2:It's, you know, and it does give meaning. You know we've had this in any number of settings where somebody who's not really fully understanding their surroundings and that they often there's been multiple clients that we've had that they go to the setting and they feel like they're going to work, which is great. I mean. I know you and I sometimes probably show up on Monday morning and we're like, oh, it's Monday morning and I want to go to work. But work provides meaning, right, Work provides purpose in life and to have that for somebody who might be 85 years old with memory issues, and that you're giving them some meaning, you're giving them some purpose, that really improves the quality of life of the person and the people around them.
Speaker 1:Absolutely. So we talked about how, if someone feels like they might be interested in the PACE program, they're 55, they need long-term care, but they're not quite ready for you know skilled nursing care or anything like that yet and they think this might be for me, you know how can they go about that.
Speaker 2:All right. So let's break that down. That's really a great question because we've got to say, okay, how does this fit in? So let's talk about the medical requirement, because it is a Medicaid program, so you've got to meet a medical eligibility and with Medicaid, they have these eight categories or classifications. They call them DOORS, d-o-o-r-s DOORS. It's kind of weird that they call them DOORS, but they're basically categories and you've got to be eligible based on one of those DOORS or categories, one of those eight DOORS or categories.
Speaker 2:In my experience, these DOORS or categories to be medically eligible is very subjective, meaning that whoever is making that determination can be very strict about it or be a little bit less strict about it. And in my experience, the folks that you know are eligible for PACE are probably going to be on the lower end of the scale of whether they're medically eligible. You know they don't. They're not bed bound, they're not going to be where they need somebody to. You know, lift them out of their bed, or two people to lift them out of their bed, to put them into a chair. That's not appropriate for PACE, right? And so what I'm getting at is the PACE folks that make this determination are probably going to be a little bit more lenient in whether or not you are medically eligible.
Speaker 2:But that's the first requirement. It can't just be hey, this sounds like fun, let's do that. No, that's, you know. Go visit your senior center because they have some stuff at your local senior center that can keep you entertained. But if you're not medically eligible, then you know you're not medically eligible. So there is a medical part of that. But you know, one of the medical eligibility things would be dementia, like memory issues, right? So if you're listening and you have a mom or dad that has, is you know. So if you're listening and you have a mom or dad that has, you know, short-term memory loss, frequently asking the same question over and over again, they might be eligible medically at least for this PACE program. So that's the first requirement. You have to have a medical eligibility.
Speaker 2:The second requirement is we've got to be, you know we got to get eligible for Medicaid and so fortunately, the folks over at Pace will sometimes, you know, they'll say, well, I don't see that you're eligible financially right now, but you know, maybe go see one of these lawyers that we work with and so that's what we can help people with. So if you think, oh, I'll never qualify for Medicaid. Well, that's probably wrong. You probably could qualify for Medicaid under the right circumstances, regardless of your income or assets. There's different strategies or techniques that we have that could get you eligible. So I say Medicaid versus Medicare, which, if you're over 65, you probably already have Medicare, and what our law office does is we can help you qualify for Medicaid and that would help you get eligible for PACE program.
Speaker 1:That's awesome and that must be such a huge relief for families who just feel stuck between not qualifying for Medicaid but also not being able to afford the private care that they need at home.
Speaker 2:That can be very difficult With PACE. There is a income limit and there's not a whole lot I can do about the income limit, so it's about $2,900 a month. If you individually not as a married couple, but you individually your gross income meaning your social security before deductions, your pension before deductions more than 20, about $2,900 a month, you aren't going to be eligible for this particular program. You can be eligible for other Medicaid programs, but not this PACE program. And now you know that's not great. I'd love to change that rule and we actually are working aggressively on changing that rule. So stay tuned to see if that might change next year or three years from now or whatever, because several other states have figured out a workaround so that we're not disqualifying people from the PACE program simply because they get a GM pension or something like that.
Speaker 1:Yeah, that's incredibly important. Now, if you're just tuning in, today you are listening to advice from your advocates and today we are talking about the PACE program, or the Program of All-Inclusive Care for the Elderly. Now, bob, beyond the financial relief of the PACE program, there are a lot of benefits to belonging to the program and going to the center. You know it's like you mentioned a little bit. It's not just a community center, it's not a senior center, there's actually a medical component to that. Can you tell us a little bit about what PACE covers?
Speaker 2:Yeah, perfect. So that's a great question and that's sort of the two-sided coin right. Part of it is really great and part of it is something that some people won't be thrilled about, and that is that once you're on PACE, once you accept the PACE program, you have to use the PACE doctors, you have to use the PACE specialists. That's what the program is. It's all-inclusive care, meaning that you are likely not going to continue with your existing doctor. I really want people to take a breath and not discount that they shouldn't consider this option simply because they'd have to work with a different doctor. I fully understand how important it is to have that trust and faith in your doctor and you know the people that, the professionals that you use. But it is one of those things where you're going to get all of your medical help physical therapy, occupational therapy, speech therapy, exercise, you know therapy all of those things would happen through the PACE Center and the point of it is that's kind of what is necessary to make it all inclusive, and my experience dealing with the medical industry is that it's really important that the different doctors, the different medical professionals all really work very close together, very hand in hand, to try to solve the problem. And if they're all like little islands where you have your home, you know, you have your personal doctor or your family doctor, and then you have the cardiologist, and then you have the oncologist or whatever it is, they're probably not communicating, they're probably not, all you know, coming up with a plan of care. Unfortunately, that's just the way the healthcare industry works.
Speaker 2:With PACE they are. They're coordinating all of it together and so, yes, you might be giving up your existing doctor to participate in the PACE program, but the advantage of it is they come up with a plan of care. They've got 11 different specialties that they put as part of your plan of care team, including making sure that you have the proper transportation, so you don't have to get back and forth to the PACE center. They will pick you up. And when I say they pick you up, that doesn't mean they get to your driveway and honk the horn.
Speaker 2:They're supposed to come into your house, get you situated, help you out, get you into the van, drive you to the Pace Center, get you inside the Pace Center, get by them, but then there's going to be a doctor, a social worker, a nurse, you know, a physical therapist One of the things about PACE that I really really like is that you don't have to rely on your insurance company to decide how much care you get or how much physical therapy you get or how much occupational therapy you get. So they've got the caregivers there. You could continue physical therapy for years, whereas under Medicare and Blue Cross or whatever insurance, they're probably going to cut that off after about seven weeks. With PACE, you might meet with your physical therapist for multiple years and there's no cutoff because it's part of that all-inclusive care program.
Speaker 1:And that's just amazing and I remember during our tour they talked about it was just an interdisciplinary team and they all work together. And one of the things that stuck out to me, you mentioned the driver. Even the driver they consider a part of that interdisciplinary team and I just thought that that was so cool. It really is all-inclusive care.
Speaker 2:Yeah, and I really do like so we're. You know we're broadcasting here in Genesee County and there's PACE programs all over the country and all over Michigan. But I really do appreciate the Genesee County PACE program which is through. I guess it's Henry Ford now, but it's the you know the Genesis PACE through. I guess Henry Ford took over that. But yeah, I think they do a great job. I really do. I think that they have contracts with different assisted livings, they have contracts with different doctors and things like that, and I do think that they make really good decisions. Sometimes I think people worry about if you get on one of these programs, you're going to get the lowest quality, you're going to get the least doctor.
Speaker 1:I don't feel like that's the issue with Pace at all. No, I completely disagree with that myth, especially after just doing the tour. I mean just that in itself and I think they're really cool and we'll talk about this in a minute. But if you're interested in Pace, they're really open about stuff like that. They want you to call, they want to talk to you and answer your questions.
Speaker 2:One thing I want to point out and you ask about. You know what are the benefits of PACE? They're probably not going to admit you to the program, and I know that this isn't 100% true, because I've seen some examples where they were able to do a placement in a memory care from the very beginning, in a memory care from the very beginning. But for the most part, we want to start PACE before it gets to the point where you can't live at home anymore or you can't live with your daughter anymore. That is the better situation. And if it advances to the point where that you can't stay home or you can't stay with your daughter, it's just too much of a burden. Pace will cover that cost. Now, at that point, the one thing I want to point out about PACE is that there's actually no cost to it. There's no copay. You get eligible and it's $0. Now if PACE decides, if that team of 11, your specialty comes up with a plan of care and they say, well, you know, it's really not safe for you to be home anymore, or it's really not safe for you to live with your daughter anymore because she works, you know, 40 hours a week or whatever it is, then they will provide placement and the placement places that they've chosen for placement they have contracts with, I think are good places I would independently recommend outside of PACE and so. But typically they're not going to and there's exceptions to this rule but typically they're not going to and there's exceptions to this rule, but typically they're not going to want to accept you into the PACE program if you already need to be admitted into memory care or assisted living.
Speaker 2:If you are admitted into memory care, assisted living as part of the PACE program, you could be subject to a copay based on your income. But that's OK. Yeah, absolutely. You know, if these places cost $6,000 or $7,000 a month and the biggest obligation you would have is based on your Social Security check, that's fair, right and so there's no cost to it if you're living at home or living with your daughter or son or whatever. But there could be a copay based on the fact that you are placed now in a living setting and the maximum copay would be based on the fact that you are placed now in a living setting and the maximum copay would be based on your monthly income.
Speaker 1:So the point there, I think, is don't wait.
Speaker 2:Exactly, don't wait.
Speaker 1:So, before we wrap up today, bob, what advice do you have for families who are exploring the PACE program but might feel intimidated by the whole Medicaid process?
Speaker 2:Yeah, absolutely. That's a great, great, great question. So the first thing is check it out. Go and visit. You know I've visited Pace many times, often where it's a scheduled thing and I'm meeting with people. But I've also just stopped by and my experience has been the same both when they knew I was coming and when they didn't know I was coming. I've got the same vibe as far as the quality of care that they're providing. But that's the first thing Check it out, because you know, whenever I'm talking to a client about this, maybe they knew about PACE. A lot of times they didn't know about PACE. I never have them commit to the process in my office before they go and at least you know, get the tour.
Speaker 1:That's smart.
Speaker 2:Yeah, exactly, we need to have them check it out, make sure they're comfortable with it, and then the next step is, if it appears that you're not financially eligible, come see us at Manor Law Group. And what we do is we work very closely with PACE we will you know if you are eligible, if you basically don't have any assets and have you know minimal income are eligible. If you basically don't have any assets and have you know minimal income, then they will submit the application for you. You don't need a lawyer for that. What you need the lawyer for and particularly a lawyer that does Medicaid, which is there's very few of those in this area is making sure that we can get approved for Medicaid without having to spend down all of the assets. And so that's what I recommend is that first check it out. Once you think this is probably a good idea and that you should do this, then come see us and we will help you with the financial part of it to get you financially eligible for Medicaid.
Speaker 1:So for families who are listening right now, who maybe have already applied for the PACE program and were told no or they were denied, what should they do? Should they try again?
Speaker 2:Absolutely Come see us. So a lot of times if it's a financial eligibility issue, you know, sometimes the people at PACE will say, hey, you know, go see a lawyer.
Speaker 1:We know a guy. Yeah, we know a guy.
Speaker 2:So come see us, we can help you out. And you know, the other thing that we always think about is OK, maybe PACE isn't the answer, Maybe it's Veterans Benefits, Maybe it's other Medicaid programs, Maybe there's other you know options for you. We're certainly going to look at PACE as one of the strong options.
Speaker 1:So if you are listening today and you have questions about Medicaid or you have questions about the PACE program, we strongly encourage you to reach out to our team. You can call us at 1-800-990-6030. You can also call us at our local number, which is 810-694-9000. You can even visit us on our website, which is wwwmannerlawgroupcom, and there's two N's in Manner M-A-N-N-O-R-L-A-W groupcom, and we'd love to answer those questions for you. Bob, is there anything that you just feel is really important, any lasting words about the PACE program that you just wish people would know?
Speaker 2:I just wish that they would consider it more often. You know, when I bring this up to families, sometimes when I tell them that they aren't going to be able to continue with their doctor, they'll just say, oh, absolutely not. And I think sometimes we have to make hard decisions, especially when there's dementia involved or things like that. We've got to get the best care that we can for our parents, for our spouse, for our loved ones, and sometimes that means we have to make hard decisions and don't reject it out of hand just because of one issue or another issue. I think that we have to really kind of look at the big picture.
Speaker 1:Yeah, absolutely, and in that case you could be trading one doctor for a whole team of 11 or 12 specialists, so I think that's a pretty good tradeoff, in my opinion. Well, bob, thank you so much for another informative episode of Advice from your Advocates, and thank you to our listeners for joining us. I would love to talk to you next month when we're back again on 103.9 the Fox, but if you don't want to wait a whole nother month to listen to us, you can find us wherever you get your podcasts, so you can actually just look for Advice From your Advocates. We are on Apple Podcasts, spotify, literally anywhere you get your podcasts, and you can even watch videos on YouTube. We interview guests from all over the country and actually the world who are experts in leading the way in elder advocacy and elder care, so we hope that you find us there, and thanks again for listening. Thanks for listening. To learn more, visit ManorLawGroupcom.
