A CA solution for senior health care hides in plain sight

By Janice Grandi, M.D., Special for CalMatters

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You’ve likely never heard of PACE, but for thousands of California seniors, it’s the reason they’re still living at home. 

PACE stands for Program of All Inclusive Care for the Elderly, and it is an effective option to support older adults whose goal is to safely age in their own homes. As a physician focused on the field of geriatric medicine (a specialty focused on caring for older adults), I believe in the power of PACE. Unfortunately, it remains one of the most underutilized resources in our long-term care system. Although there are several reasons for this, there also exist several attainable solutions.

Each PACE program is community-based and provides wraparound medical and social services. The goal is simple but powerful: help seniors age with dignity and independence while remaining in their communities as long as possible and simultaneously reducing hospitalizations. 

Its comprehensive services range from primary care, physical therapy, social work and dental, to transportation, meals, home care and day center activities. 

Some might think PACE seems too good to be true, that it must be available only to those with ample resources. Well, good news! PACE is funded through Medicare and Medi-Cal, making it a feasible option for a wide range of people. Participants qualify for PACE enrollment if they are 55 or older, live within a PACE program’s service area and need nursing-home-level care. 

PACE sounds nice, but does it actually work? A 2021 study by CalPACE, the state’s PACE advocacy association, found that PACE participants were hospitalized 44% less often than similar non-PACE individuals and had 26% less emergency room usage. Additionally, 98% of PACE participants continued to live in the community, and participants overall experienced lower rates of depression, better medication adherence, and higher satisfaction with care. 

PACE isn’t just the right thing to do for seniors; it’s smart public policy. With Medi-Cal costs rising and nursing home capacity strained, PACE relieves stress on the elder care system and budget. For example, PACE enrollment saved California taxpayers $369.4 million in 2024 alone.

Why then are only about 10% of eligible older adults enrolled in PACE? 

Unfortunately, PACE remains limited by geography, infrastructure and awareness. Thus far PACE serves less than half of California counties. And starting a PACE program requires significant upfront investment and navigating complex state and federal licensing processes.

Even where programs do exist, many eligible seniors, caregivers and healthcare providers don’t know about them. To improve access and use, we should consider focusing state-level funding to help new PACE programs launch — especially in underserved areas — and on streamlining the approval process for PACE centers and investing in outreach to families, caregivers and healthcare professionals.

With nearly one in four Californians projected to be over age 60 by 2030, it’s time to take action and invest in more effective and compassionate care models. 

Models like PACE hold out hope for a future where every older adult can age with the support, grace and respect they deserve.

This article was originally published on CalMatters and was republished under the Creative Commons Attribution-NonCommercial-NoDerivatives license.