Individuals With Disabilities Receiving Care From a Program of All-Inclusive Care for the Elderly

To evaluate outcomes for the youngest eligible patients with disabilities enrolled in a Program of All-Inclusive Care for the Elderly (PACE). We hypothesized that health (as defined by validated measures of function, mood, quality of life, and community engagement) and care satisfaction (as defined by perceptions of care delivery) would improve after 1 year compared with baseline, and health care use would be similar to benchmarks from the National PACE Association.

Prospective cohort study.

PACE.

N=51 individuals with disabilities aged 56-68 years.

Enrollment in Community Living Independence for the Elderly (LIFE) (a PACE program).

Health and care experience outcomes were collected at baseline and then every 3 months for 1 year (4 data points). Cost and utilization outcomes were reported for the Community LIFE program.

Participants had high physical and cognitive independence, low depression symptoms, a moderately high quality of life, and high care experience scores (>80%) throughout the study. Mobility out of bed and outside the home declined (Friedman test, p<.001; Page's L test, p>.99). Community engagement declined but was not statistically significant. Both were likely due to the COVID-19 (COrona VIrus Disease-2019) pandemic. However, Occupation scores significantly improved overall (monotonically) (Friedman p=.037; Page's L test, p=.019). Only 3 participants were admitted to skilled nursing facilities (SNFs) and spent fewer total days in these facilities than benchmarks from other PACE populations. However, they also had more emergency department (ED) visits, more hospitalizations, longer hospital lengths of stay, and fewer outpatient visits than benchmarks, likely impacted by a small number of outliers overusing care.

Participants were satisfied with PACE care. Three participants were admitted to an SNF, with fewer total stays than benchmarks. Despite the effects of the pandemic, participation in occupational activities increased. Further interventions are needed to shift care from the ED and hospital to outpatient settings.