Individuals with Disabilities Receiving Care from a Program of All-Inclusive Care for the Elderly

To evaluate outcomes of the youngest eligible patients with disabilities enrolled in a Program of All Inclusive Care for the Elderly (PACE).

health (as defined by validated measures of function, mood, quality of life, and community engagement) and care-satisfaction (as defined by perception of care delivery) would improve after one year compared to baseline, and healthcare utilization would be similar to benchmarks from the National PACE Association.

prospective cohort study SETTING: PACE PARTICIPANTS: 51 individuals with disabilities aged 56-68 INTERVENTIONS: Enrollment in Community LIFE (a PACE program) MAIN OUTCOME MEASURES: Health and care experience of care outcomes were collected at baseline and every three months for 1 year (4 data points). Cost and utilization outcomes were reported by the Community LIFE program.

Participants had high physical and cognitive independence, low depression symptoms, moderately high quality of life, and high care-experience scores (>80%) throughout the study. Mobility out of bed and outside the home declined (Friedman p < .001, Page's L p > .99). Community engagement declined but was not statistically significant. Both were likely due to the COVID-19 pandemic. However, occupation scores significantly improved overall (monotonically) (Friedman p= 0.037, Page's L p=0.019). Only 3 participants were admitted to skilled nursing facilities (SNF) and spent fewer total days in SNF compared to benchmarks from other PACE populations. However, they also had more ER visits, more hospitalizations, higher hospital lengths of stay, and fewer outpatient visits compared to benchmarks, likely impacted by a small number of outliers overutilizing care.

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