Many families reach a point where a parent needs a lot of help, but nobody wants a nursing home. Mom needs her medicines managed, a ride to the doctor, help bathing and someone to check on her during the day. Juggling a dozen providers on top of your own job can feel impossible.
The Program of All-inclusive Care for the Elderly, known as PACE, was built for exactly this situation. It is a Medicare and Medicaid program that helps older adults who need nursing home-level care meet their health care needs in the community, with coordinated care from one team1. This guide explains how the PACE program works for the elderly, who qualifies, what it covers, and the questions to ask before your parent joins.
What is the PACE program?
PACE is a comprehensive medical and social services program offered through Medicare and Medicaid in some states1. A local PACE organization runs a PACE center, usually a day center with a clinic, and is responsible for nearly all of a participant's care, at the center, at home and in the hospital or nursing home when needed.
The core idea is coordination. Instead of separate doctors, home care agencies and transportation services that don't talk to one another, a single interdisciplinary team plans and delivers care. Federal rules require that team to include, among others, a primary care provider, a registered nurse, a social worker, physical and occupational therapists, a recreational therapist or activity coordinator, a dietitian, a home care coordinator, personal care attendants and drivers3. For ride options outside PACE, see transportation for seniors.
PACE is paid a set amount each month by Medicare and Medicaid for each participant4. Because the program takes on the full cost of care, it has a strong reason to keep your parent healthy and out of the hospital.
Who qualifies for PACE?
Federal rules set four basic requirements21:
- Age 55 or older. PACE is open to adults 55 and up, not only those over 65.
- Lives in a PACE service area. Each PACE organization serves specific ZIP codes or counties.
- Needs nursing home-level care. Your state must certify that your parent's needs meet its level of care for nursing facility services.
- Can live safely in the community with help. At enrollment, your parent must be able to live at home or in another community setting without risk to health or safety, with PACE support.
Your parent does not have to have Medicare or Medicaid to join PACE, though most participants have one or both2. Some PACE programs also add their own conditions, which can't change the four basic requirements.
What does PACE cover?
PACE covers all Medicare- and Medicaid-covered care and services, including prescription drugs, plus anything else the PACE team decides your parent needs to improve and maintain their health1. Services may include:
- Primary and specialty care. Doctor and nursing visits, specialists, lab work and x-rays.
- Adult day care. Time at the PACE center with meals, activities and recreational therapy. See our adult day care guide.
- Home care and personal care. Help with bathing, dressing and other daily tasks at home.
- Therapy. Physical, occupational and speech therapy.
- Hospital and nursing home care. When medically necessary, arranged and covered by PACE.
- Dental, vision and hearing. Including dentistry and related care.
- Prescription drugs. All necessary medicines come through PACE.
- Transportation. Rides to and from the PACE center and medical appointments.
- Social services and counseling. Including mental health counseling and caregiver support1.
Care is delivered at the PACE center, in your parent's home and in contracted hospitals and other facilities. The program must provide services around the clock, every day of the year5.
What does PACE cost families?
Costs depend on your parent's coverage1:
- With Medicaid. Your parent won't pay a monthly premium for PACE.
- With Medicare but not Medicaid. Your parent pays a monthly premium for the long-term care part of PACE, plus a premium for Part D drugs.
- With neither. Your parent can pay the PACE premium privately.
Whatever your parent's financial situation, there is no deductible, copayment or coinsurance for any drug, service or care the PACE team approves1. If your parent qualifies for Medicaid, PACE may be one of the most complete long-term care options available. Our guide to Medicare vs. Medicaid for long-term care and the Medicaid spend-down explain how Medicaid eligibility works.
PACE pros and cons to weigh
PACE works very well for many families, but it isn't right for everyone. Consider both sides:
Why families choose PACE
- One phone number. The team coordinates doctors, medicines, home help and rides.
- Staying at home. Your parent can often delay or avoid a move to a nursing home.
- Caregiver relief. Day center time gives family caregivers regular breaks, which can ease caregiver burnout.
- No surprise bills. Approved care has no copays.
What to think about first
- Provider network. Your parent must receive services through the PACE organization and its contracted providers3. A longtime doctor may not be part of it.
- The team decides. The interdisciplinary team approves services. You can ask for services and appeal decisions you disagree with3.
- Drug plan rules. Joining a separate Medicare drug plan while in PACE ends enrollment1.
- Limited areas. PACE is only available in some states and service areas.
Your parent can leave PACE voluntarily at any time3. If they do, Medicare and Medicaid coverage is reinstated, so ask the program to explain the steps and timing so care doesn't lapse. It also helps to write down why your parent joined, so you can check each year whether PACE is still meeting those goals.
How to find and join a PACE program
- Check for a program. Search for PACE plans in your parent's area on Medicare.gov, or call your state Medicaid office1.
- Call the PACE organization. Ask whether your parent's address is in the service area and request an intake visit.
- Tour the center. Bring your parent. Watch activities, meet staff, and ask how home care and rides work.
- Complete the assessments. The team assesses your parent's needs, and the state certifies the level of care.
- Review the enrollment agreement. Read it with your parent and whoever holds their power of attorney. Ask about providers, hospitals and after-hours care.
- Plan the transition. Confirm the start date, medication transfer and any changes to doctors.
Our guide to touring senior care has more questions you can adapt for a PACE center visit.
PACE for a parent with dementia
Many PACE participants live with memory loss. For families caring for a parent with dementia, PACE can offer structure that is hard to build alone: a predictable day at the center, supervised activities, meals, help with medicines and a team that notices changes early. Staff see your parent often, so a new infection, a fall risk or a change in mood is more likely to be caught before it turns into a hospital visit.
Ask the program how it supports people with dementia specifically. Useful questions include how staff handle confusion or agitation, whether there is a quieter space at the center, how they manage wandering, and how they involve family in care planning. If your parent's dementia is advancing, ask what happens if they can no longer live safely at home, since PACE can arrange and cover nursing home care when it is medically necessary1. Our guides to dementia care needs by stage and dementia wandering can help you prepare those questions.
Helping your parent adjust to PACE
Change can be hard, especially for a parent who has seen the same doctor for decades or who dislikes the idea of a day program. Introduce PACE as a way to keep living at home, not as a step toward a facility. Visit the center together, and let your parent try a meal or an activity before deciding.
Expect an adjustment period. Some people need a few weeks to feel comfortable with new faces and a new routine. Stay in touch with the social worker and tell the team about your parent's history, interests and daily habits, so care feels personal. Keep attending care planning meetings, and speak up if something isn't working. You know your parent best, and the team relies on family input to get the plan right. If your parent resists, our guide for when an elderly parent refuses help has ideas for gentle conversations.
PACE compared with other options
PACE sits between home care and a nursing home. Compared with hiring private home care, PACE adds medical care and coordination. Compared with a nursing home, your parent stays in their own home and community. If your parent already lives in assisted living, some PACE programs can serve them there; ask the program. For a wider view, read assisted living vs. home care and aging in place.
