Dementia Care & Independence: The Power of PACE

In this episode of Advice From Your Advocates, Elder Law Attorney Bob Mannor sits down with Jessica Downing of Ascension Living PACE to unpack the Program for All-Inclusive Care for the Elderly, better known as PACE.

Together, they explore how PACE supports senior independence, provides comprehensive healthcare services, and removes some of the biggest barriers aging adults face, including transportation, access to Medicare/Medicaid–covered care, and reliable support for those living with dementia.

Jessica explains how PACE’s wraparound model, featuring 11 healthcare disciplines, helps older adults stay safely in their homes and communities. They also clear up common misconceptions, especially the fear of losing independence, and spotlight the critical role PACE plays in reducing caregiver burnout.

What you’ll learn in this episode:

• What PACE is and who qualifies
• How transportation empowers seniors to stay active and connected
• Why PACE is a lifeline for families caring for loved ones with dementia
• How Medicare/Medicaid interact with PACE services
• What makes the wraparound care model unique
• How PACE supports caregivers and promotes healthy aging

If you support aging loved ones or work in elder care, this is a must-listen episode.

Host: Attorney Bob Mannor, CELA, CDP

Guest: Jessica Downing, Ascencion Living PACE Michigan

Executive Producer: Savannah Meksto

Assistant Producers: Samantha Noah, Shalena Gaul, Alecia Campbell

Chapters

• 0:00 Meet Jessica And Define PACE
• 1:48 New Center Location And Capacity
• 3:13 Door-To-Door Transportation Promise
• 4:06 Who Qualifies And How Costs Work
• 5:05 Living Settings PACE Supports
• 6:04 The 11 Disciplines And Care Team
• 7:06 Unlimited Therapy Driven By Need
• 8:28 Coordinating Medicaid And Eligibility
• 9:19 Misconceptions About Independence
• 10:12 Custom Plans And Consistent Team
• 12:42 Jessica’s Path And Personal Stake
• 14:04 Dementia Support, Respite, And Socializing
• 16:23 Quality Of Life And Key Takeaways
• 17:24 How To Start And Subscribe

Transcript

SPEAKER_01: 0:00

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_00: 0:09

Welcome back to Advice from Your Advocates. I'm Bob Manner. I'm a board-certified elder law attorney in Michigan. And we have a great show today. We have Jessica Downing from Ascension Living PACE. And we've had folks from PACE before, and this is a great topic. We really want to spread the word about PACE, the program for all-inclusive care for the elderly. So, Jessica, welcome.

SPEAKER_01: 0:32

Thank you so much, Bob. I'm so happy to be here.

SPEAKER_00: 0:35

And so tell us a little bit about yourself and your job, and then we'll get into the PACE program that you work for and everything about that.

SPEAKER_01: 0:45

So my name is Jessica Downing. I am the marketing and intake director here at Ascension Living Pace, Michigan. I have actually been in my position since May of this year, but I've been with the PACE program going on three years now. I've worked for Ascension, though, for about 15 years total. So this is Wow. Yeah. So this is actually a great opportunity for me. I do have a husband and six kids. So I guess the level of care has always been up there for me. Definitely raising six kids.

SPEAKER_00: 1:12

So yeah, I've got five kids. So you got one on so uh let's specify a couple things about pace. First of all, I understand you you moved into your new digs, your new building, and I think I was a little uh short on the uptake. I had been still talking to Pay about pace and saying that you were in the old building, but you guys called me and let me know that you've moved fully moved. And so tell us about the new location and the new great uh space that you have.

SPEAKER_01: 1:42

Oh yes, I'm happy to. So we were previously behind the Flint Farm Market, which was a great location, but we had outgrown our facility, honestly. We were bursting at the scenes with bringing in participants left and right. Right. So we had to expand to accommodate. So we recently moved into our new building in the middle of May. We're actually located off of the Dorton Stewart exit off of 475 by the water plant. We actually are on a private drive just off of there. I'm not sure if you guys know where the the previous Security Federal Credit Union was.

SPEAKER_00: 2:16

Okay, right.

SPEAKER_01: 2:16

Yeah, so we're the old building. Uh, we've revamped it. We can accommodate up to 400 participants now. Previously, we were only able to accommodate about 250. Um, so this move was definitely a need for us. But we're absolutely happy to be over here. It's nice and quiet. It's a private drive. The state park across the street is always nice and well kept, and it's nice and ready for the participants.

SPEAKER_00: 2:40

And one of the things I always like to point out about PACE because sometimes, and we'll get into a lot of the details on PACE, but the thing is that the part of the deal is the for the participant, travel is part of the arrangement that I know you guys have used the term sort of indoor to indoor. In other words, they go to where they're living and help them get, you know, situated in the transportation and then get to the PACE center and then get them inside, get them situated, all of that. It's not uh the the families don't have to arrange their own transportation.

SPEAKER_01: 3:15

Yes, that's correct. So that seems to be a really big aspect of the PACE organization, I have to say. Transportation, you know, is a very integral part of our community because a lot of seniors do not get the privilege of being able to drive much anymore, if at all. So we provide those services to and from our PACE facility and to and from outside appointments as well. And like you had mentioned, they are a door-to-door service. So we'll go right to the door to pick up your loved one, take them to our bus. We have lift systems for any kind of assistance medical devices that your loved one might have, whether it be a walker, cane, or wheelchair. So our buses can assist just about an array of anything you can think of to be able to get them safely to and from our pace center and to and from their appointments.

SPEAKER_00: 3:58

Now, it sounds like with the numbers that is about double or more than double the the uh volume that you're allowed that you can get that as many that many people now that you can serve.

SPEAKER_01: 4:08

We're almost double. We were at about 250, we're at 400 now that we can potentially bring in. Yeah, but after we get closer to 400, we get to be reevaluated, so we might even be able to bring in more as we reach that cap as well.

SPEAKER_00: 4:21

Okay. Yeah. So for those that don't really know about PACE, I'd like you to kind of give an explanation of how PACE works, how people, you know, the the participants' contribution towards it, if they as far as what insurances they need and things like that. So if you can uh just kind of give us a background on how PACE works.

SPEAKER_01: 4:42

Absolutely. So it's kind of an extensive process to kind of go from start to finish. So to start up, to get an individual into our program, they do need to have Medicare and Medicaid to be in our program completely free of charge. We do have out-of-pocket costs for those that cannot qualify for Medicaid. So that is an option. But we are an all-inclusive care program. Pay stands for program of all-inclusive care for the elderly. Um, so we service those 55 and older who are struggling to remain independent in their homes and in the community. We just offer that little bit of assistance to keep them living independently in the community with, you know, safeguards in place that we are helping them with and their caregivers with. So that way they can remain independent in their homes and in the community.

SPEAKER_00: 5:23

And that's what it seems like most people would really want, you know, that they want to stay independent as much as possible. They'd like to stay home or in the community. And so I understand that pace could work with someone who's at home, maybe living at their daughter's home. They could be an independent living. And then there's other situations that can be advanced to later. But basically, where you live is your home. And so it doesn't have to be, you know, in your own home. It could be your daughter's home, it could be independent living.

SPEAKER_01: 5:54

Yes, that's correct. So we service a bunch of different living situations for participants in our program. Absolutely.

SPEAKER_00: 6:00

Now tell me about, and this is something I've always found fascinating. The 11 different, I don't know if you want to call them specialties, there are 11 different areas where they come up with the plan of care for the participant.

SPEAKER_01: 6:14

So there are 11 different disciplines that come into play. It's kind of a wraparound care program, is how we like to describe it. So the wraparound is the 11 different disciplines come in to kind of cater to each individual's health care needs to assist them in living independently and safely in the community. So they each play an integral role in each participant's health care needs. It could be your social worker that's just kind of reaching out to make sure that your Medicaid redetermination is taken care of as it's coming up. And that takes a little burden off of those potential participants or caregivers to try to scramble and figure that out. Or it could be, you know, simply just our receptionist answering the phone to take a referral from you regarding your neighbor. So it's all kinds of aspects just kind of coming together to help with their healthcare needs.

SPEAKER_00: 7:00

One of the things that I think is unique about PACE, so for our clients, we often have clients that really it's really important that the fan to the family that their loved one continue to get physical therapy, occupational therapy. Well, under Medicare and traditional insurance, that usually is for a set period of time. But if you're part of the PACE program, they're not going to put a limit on that. If if it's part of the plan of care. And if, you know, so for example, we have families that have a loved one with a stroke, and they feel like, boy, they made such great progress when they were getting therapies, physical therapy, occupational therapy, maybe even speech therapy. And the idea that, you know, it gets cut off after a set period of time based on the insurances, and that's one of the unique things about PACE is that you don't have those types of limitations because you've got the physical therapists and all that right there at the PACE Center.

SPEAKER_01: 7:56

Yes, that's correct. We do have physical therapy and occupational therapy on site here. So we actually have expanded our footprint for our services with our therapy department from our previous building. We've actually tripled that department by three times. So we're able to accommodate more participants with the need of therapy services by having that extra room here in this new building. But they also do, you know, go into the homes to help people who are more bedbound or housebound, those that can't come into our center, they do go in there just to make sure that everybody is getting the care that they need.

SPEAKER_00: 8:28

Now we've worked with the pace, especially Ascension Living PACE, a lot because, you know, ideally the participant has Medicare and Medicaid, and that's something that we help people with. And so often they might not be, you know, currently eligible for Medicaid. And we can look at their circumstances and see, you know, what would be necessary to get them eligible. So that's one of the ways that we've worked pretty closely with PACE, especially Ascension, a Living PACE. And it's we've just had real good experiences there. Our clients uh report back, you know, very positive. One of the things I've always noticed about the PACE Center is the positive attitude of the folks there, the caregivers and everybody else that works there. I've, you know, I'll stop by unannounced sometimes, and it seems everybody has a very positive attitude, which is really nice.

SPEAKER_01: 9:18

We're very proud of this.

SPEAKER_00: 9:19

Well, talk to me about some of the common misconceptions that people have about PACE, because I think there are quite a few.

SPEAKER_01: 9:25

Some of the common misconceptions, I'd say the first one off bat is going to be losing their independence. They really think they're going to lose their independence by reaching out to us, thinking that, you know, we're going to take over their everyday healthcare needs as well as, you know, everything else they do from day to day. And that's not the case at all. This is, you know, a program where every healthcare aspect comes in to try to formulate the best plan for each participant. So that way, you know, they're actually gaining more independence and potentially getting better in the long run to be able to care for themselves independently.

SPEAKER_00: 9:58

And so getting back to the 11 disciplines, from what I understand, that they come up with a plan of care and then, of course, review for that plan of care from time to time. So there really is, like you say, wraparound coverage to the extent of you have advocates, which is really difficult to get in the healthcare industry, to have a social worker, to have the advocates of the different disciplines that you have, where they're creating a plan of care and then providing that plan of care. So talk a little bit about just the customization of the care services.

SPEAKER_01: 10:30

Absolutely. So, like I had said previously, you know, we, and you had also mentioned, we do assign caseworkers or social workers, we call them here, to each individual to kind of, I guess, help them navigate once they get into the program. So that's kind of their their touch base. They can reach out to them for any kind of questions, concerns, comments, anything that is bothering them. If they need to reach out to another department and they're not sure who to reach out to, that's a good point of contact to start with. Some other disciplines in there. We do have our physical therapist and occupational therapists are listed in there. We have home care nurses that do also go into the home to check on potential participants and family members for any issues that they might be having. But just checking in for those that don't come out to our center. I mean, we have so many different disciplines. I mean, even just our marketing director. I mean, I'm a part of it as well. My intake team, we help you get into the program. I mean, we're your first point of contact when you give us a call to say, my loved one's having a hard time. I need help. So we help you get into the program. And then we have people that, you know, are in our clinic area and they're gonna be helping you along the way, making sure your appointments are set up and that you're coming in for those scheduled appointments with your new primary care physician, which is another thing that we provide, primary care provider. So we become your primary care provider, you know, have all those services provided to you right here at the Pay Center. You're welcome to meet with that provider prior to enrollment. They talk with you directly so that way you're not getting put on the back burner talking with a nurse practitioner or a nurse or a nurse assistant. You'll get to talk one-on-one with your provider. So there's definitely a lot of different disciplines on your side, and they really don't change. Honestly, if you're coming into the program, you're designated a team. So that team member for each discipline is gonna stay the same. So you're not wondering, you know, well, where is Nancy, you know, my physical therapist that came in, you know, last week when it's now Rob that's coming in to take care of me when I discussed everything with Nancy last week.

SPEAKER_00: 12:28

Right.

SPEAKER_01: 12:29

So your care team members remain the same from the day that you come into the program, which is nice. It it stays the same across the board. So that way we know exactly who we need to go to for each individual patient as well.

SPEAKER_00: 12:40

Well, Jessica, tell us a little bit more about your journey. You said you've been with Ascension for 15 years. So tell us about your journey in and caring for seniors.

SPEAKER_01: 12:49

Senior care is actually fairly new to me through Ascension. This job kind of landed in my lap unexpectedly, and it was kind of at a perfect time. And the reason I say that is because I had, you know, outgrown my roots at my previous doctor's office that I was working at, and I felt like I was just butting my head. So I started to branch out a little bit in the Ascension community, and pace just popped up. So I got interested in what they were doing, and it seemed like a great program. It almost seemed too good to be true, and that seems to be something that a lot of people bring to the table every time we mention it as well. But it landed in my lap unexpectedly, like I said. But I've actually grown pretty fond of the elderly community since I've gotten here because not only, you know, is it close to my heart and a work aspect, it's also close to me as a caregiver aspect. I have a grandmother in the program who's current. Yeah. And she was diagnosed with dementia just a couple of years ago. So Pace stepped in and they've been able to, you know, give her that wraparound care to keep her living safely in the community still while her dementia advances. So it's definitely, you know, very close to my heart in a couple of different ways now.

SPEAKER_00: 13:59

Yeah, you mentioned dementia, and that's something, you know, we we realized a few years ago that a good percentage of our clients that we help with long-term care have some form of memory loss or dementia. Not all of them. Certainly, we have plenty of clients that don't have any memory loss or cognitive issues. But we try to always talk a little bit about that. So talk about how the PACE can be a particularly good option for those, especially in sort of the beginning stages of dementia or even further along with if they have family support and things like that.

SPEAKER_01: 14:31

So we've actually come into a lot of cognitive deficits over the years, and it's very common. It's more common than what people realize. And, you know, it's just something that we really have to focus on because it is such an integral part of our community. So, really, our program is meant to be a big support system to any caregivers experiencing any burnout because it's very hard. I mean, dealing with any kind of dementia or cognitive deficit for from a loved one is already very hard. You're not sure how to navigate it. You don't know what they're gonna be like from one day to the next. So we just kind of step in and offer that little bit of extra help to keep them from feeling that burnout by taking care of their loved one, offering respite for them at our day center where they can come out and socialize and know that their loved ones being taken care of by their medical staff and that they'll be safely returned home at the end of the day after the caregivers had some respite. But respite, you know, kind of goes a long way with dementia patients. I mean, it's not just daily that they need respite. Sometimes it's weekends, it could be a week at a time. And we do offer that assistance as well. We partner with neighboring assisted living facilities and memory care facilities that will house our participants in the event that, you know, family members go out of town. If there's a surgery that one of our participants has and they need that 24-7 recovery, I mean, those are absolutely options for our caregivers just to kind of ease the burden. And, you know, we're there to help them out in every other aspect of their health care needs as well.

SPEAKER_00: 15:59

I think that's particularly important for dementia. We've been talking of this with a lot of our guests that, you know, some families when they get the diagnosis of dementia, there's some families that just kind of, you know, hide in the home, they cocoon and they don't really interact with others. Well, that's likely to only make it worse. And there's all kinds of research that says, you know, if we start experiencing some cognitive ability, you know, deficits or memory loss, that one of the things that can slow that down is social interaction, socialization, activities, keeping active. And that's one of the things that pace can really participate in to have a very active life with uh someone with dementia and really kind of stall off that progression of the disease.

SPEAKER_01: 16:41

That's absolutely right, Bob. We have a lot of, like I said, Alzheimer's, you name it, we've had to deal with it. And we've gone through a lot of different processes to help each individual as they're progressing. And, you know, those activities, the respite, all of it really co goes hand in hand with making sure that, you know, everybody's taken care of in this picture.

SPEAKER_00: 17:00

And, you know, not only does it kind of slow the slow the progression, but it's better quality of life during that period of time, too. So it can be better quality of life not only for the participant, for the person with dementia, but also for their loved ones. They get to experience more of the you know fullness of life. So I want to ask you, I really appreciate you coming on the podcast. I want to see if you have any, you know, general key takeaways that you want to leave our audience with about the PACE program.

SPEAKER_01: 17:29

The biggest thing for me is when I start talking to people about the PACE program, they do say that it is too good to be true, like I previously mentioned. So I just want people to know that, you know, we are here for any questions, comments, concerns. We always try to address any kind of situation that might arise with potential participants and their caregivers. So it's not it's not taking away their independence. We're not trying to take over anything in anybody's life. We're just here to offer that extra support for both the participant and the caregivers out there. So I hope that kind of clears things up for some people just to know that you know we're a wraparound care team for not just the participant, but for families and caregivers as well. So we're all here for you.

SPEAKER_00: 18:12

Well, again, I appreciate you coming on. Jessica Downing from Ascension Living PACE. And so, what is the best way for that anybody that's interested to start that intake process or just learn more?

SPEAKER_01: 18:26

So you can actually look for us online, ascensionliving.com. So if you actually go right to the website, we talk about, you know, a lot of things that we have going on here at PACE, or you're welcome to give us a call and we can talk with you directly. We could even set up a face-to-face session where we can go over all of the potential participants' healthcare needs and see what we can do to better assist. You can call us at 810-236-7500.

SPEAKER_00: 18:52

Thanks, Jessica. And for the listeners, if you've enjoyed this presentation and you want to make sure that you know when we drop a new podcast, which we do every other week, feel free to subscribe at any place that you listen to podcasts. So you can do Apple Podcasts or Spotify or any of those. And if you want, you can watch us if you just want to see the podcast condition to listen to it on YouTube and on our website, which is manorlawgroup.com. So don't forget to subscribe and we'll see you next time.

SPEAKER_01: 19:29

Thanks for listening. To learn more, visit manorlawgroup.com.