Medical director of PACE CNY explains how his program helps people age in place. “If you join our program, we basically take care of you,” he says
By Chris Motola
Q: What does “all-inclusive” mean in the context of elderly care?
A: PACE [Program of All-inclusive Care for the Elderly] is a program that’s been in effect since the early ‘80s. And the concept began in San Francisco in the 1960s. What we do is provide a series of comprehensive healthcare services for the elderly. Elderly is defined here as 55 and older. The program is largely sponsored by the federal government through Medicare and Medicaid. What we provide is primary care, clinic nursing, home care nursing as needed, physical therapy, occupational therapy, recreational therapy, dietitians and transportation appropriate to healthcare, i.e., to our clinics, specialists or labs. We also cover dentistry and podiatry within our own system. And we have consultants in the community as well if our clinics are full. We also have social workers. So if you join our program, we basically take care of you.
Q: What’s not covered?
A: We don’t take care of housing you. We don’t pay your rent. We don’t necessarily take care of feeding you, although you will be given a meal at our day centers if you come. And we won’t clothe you, per se. We are a full spectrum healthcare delivery system designed for older folks who need that kind of comprehensive service.
Q: So it’s mainly to support people still out in the community?
A: That’s a great question. We’re designed to essentially help people age in place. So this service is largely designed for patients who are in their own home, in their family home or in senior living. But we do also take care of people in facilities, including skilled nursing facilities if necessary. But the bulk of our patients and the focus of our program is to help folks stay in their homes or with their family members and to avoid having to move into facilities.
Q: On that note, you recently published a piece in In Good Health on helping families make the decision to seek senior services for their elder family members. What are some of the considerations families should make, and why are they so difficult?
A: If you look at the cycle of life, when people are young, you see growth and the promise of the future, even when you’re cleaning up after them. Towards the end of life, when people become more frail and need assistance, it’s not as charming. It’s not as hopeful. It’s depressing and sad at times. So as we deal with our loved ones aging and needing more support, we work through those difficult decisions to help people meet those needs throughout the remainder of their loved ones’ lives. You might have someone who is relatively healthy, relatively independent, but can’t do all their cooking and cleaning. We may be able to set them up in their own home with support, and they can live the rest of their lives there very happily. On the other hand, you may have a more extreme situation where someone isn’t able to self-toilet, feed themselves or do anything like that at all. And if they don’t have a family support network, they might end up in a skilled nursing facility. So we deal with that full spectrum. Each individual person needs a very comprehensive assessment to see what they have, what resources they bring to the table, what family support they have, and to work through that process to help them come up with a decision that best suits them. Sometimes there have to be compromises. Sometimes wish and need align, and sometimes they don’t. When I talk about the extreme of someone having to enter a nursing home, when we talk about safety and stability and good medical care. If someone is home alone with no support and wanders, turns on the oven, or falls or burns themselves, we have to think about supervision. On the other hand, if the person just can’t buy their own groceries, can’t mow their lawn or needs a reminder to take their medication, those people can be great candidates for living in the community with support.
Q: How far ahead should people plan for this kind of thing?
A: Plan ahead. Most of us will age. Most of us will require some support as we age. The better families plan ahead, the better things generally turn out to be.
Q: You mentioned the services can kick in as young as 55. How do you do with the broad range of ages you serve?
A: PACE and Loretto look at the individual. The people joining our programs at 55 are generally people who have multiple medical problems and need significant support. Many people at 55 are healthy, working and do not need PACE services. For that matter there are people who are 85, working and don’t need us. So the program was initially designed by the government to use 55 as the early cut-off point. That number’s up for debate. It could one day be lowered to a younger age. The patients that we see are not healthy in general. So it’s not so much the diversity of age, but people who are older by illness. So we try to provide help in a more universal way. Do you need help paying your bills? Do you need help remembering to take your medication? Do you need transportation? Do you get bored alone? Those are the sorts of things we provide in a PACE program.
Q: We’re coming off of a period of extreme isolation on a societal level. How do you help seniors who are struggling from having been isolated?
A: During normal times we have active day centers where people can socialize, see their physician, social worker, get a shower, a meal, have their clothes washed. When COVID-19 struck, we started doing a lot more telehealth, including recreational therapy. Or we’d use mobile care units rather than having people congregate in a central location. That will get better, hopefully very soon. Then we’ll start bringing people back to our day centers and the resocialization can begin.
Name: David G. Heisig, M.D.
Position: Medical director of PACE CNY
Hometown: Quaker Street (Schenectady County)
Education: Albany Medical College (1979–1983); resident in medicine, SUNY Health Science Center (1984-1986); fellowship in gastroenterology, SUNY Health Science Center (1989–1991)
Organizations: American College of Physicians; Onondaga Medical Society; Medical Society of the State of New York