For decades, when people aged and developed chronic medical conditions, they were moved from their homes into a nursing home setting. The advent of the Program of All-inclusive Care for the Elderly (PACE) in 1971 marked a change in that process, allowing many people to age in the comfort of their own home. Today, the ability to obtain comprehensive PACE care, including medications, and remain at home is further evolving long term care.
PACE: The Future of Long term CareWhile the implementation of PACE has been a gradual process over the last several decades, PACE centers represent the future of health care. Several factors will likely continue to drive an increase in PACE utilization:
- An aging Baby Boomer population will increase overall demand for long term care services. Estimates from the United States Census indicate that there will be 69.4 million American seniors by 2030. This nearly doubles the 35.5 million seniors in the year 2000.
- Baby Boomers largely desire maintaining some level of independence, making PACE centers a preferred method of long term care.
- Since the inception of the Affordable Care Act in 2010, health care as a whole is moving toward a “medical home” model, where patients receive collaborative care that’s focused on quality and safety. PACE centers align with this model of care.
PACE Medications at HomeThe average PACE participant has eight acute or chronic medical conditions and needs assistance with at least three activities of daily living. Because of the sheer number of health conditions experienced by this population, medications play a significant role in PACE. The role of the geriatric pharmacist in delivering PACE medications at home is complex. Before medications are dispensed, pharmacists implement a number of quality assurance and safety processes, including:
- elimination/prevention of duplicate medications
- monitoring of associated labs
- enforcement of Beers criteria from the American Geriatric Society
- dose adjustments
- identification of drug interactions