The Elderhaus Program of All-inclusive Care for the Elderly in North Carolina: improving functional outcomes and reducing cost of care: preliminary data.

The Program of All-inclusive Care for the Elderly (PACE) is at a crossroads in its evolution as a community-based alternative to institutionally based nursing home care. Because of their perceived value and cost savings to Medicaid and Medicare, PACE programs are under increasing pressure to expand the numbers of individuals they serve while simultaneously reducing the overall cost of care. During the first 5 years of operations, the Elderhaus PACE Program in Wilmington, North Carolina, has reduced use of acute hospital care and skilled nursing home care while demonstrating that 46% of their participants improved and 20% of participants maintained their level of functional independence. It is felt that use of a plan of care organized according to standard domains of function and the quantifiable method of documenting improvement in functional health outcomes represent a critical factor in improved outcomes despite lower use of costly hospital and institutional care. The next step will be to disseminate the plan of care process to other PACE programs and measure its effect on participant functional outcomes and cost of care. The fact that the majority of PACE programs in North Carolina are using an electronic medical record that has the standard domains and quantitative functional measures embedded in the software will facilitate this step. Benchmarks for service use data are already being collected and will be compared with service use after the implementation of the plan of care process.