By Mahlon Meyer
Northwest Asian Weekly
Sitting in the lobby, a man with two amputated legs and steel bars where his ankles should be, sits waiting. An hour later, he is still sitting there, perhaps having just finished lunch. His driver, a short Filipino man, saunters up.
“Ready to go?”
The man grunts.
At the PACE center on Martin Luther King Jr. Way in South Seattle, a relatively new model of caring for the elderly has been underway for two decades. Pooling all the resources of patients—participants, they are called—the program provides onsite medical and dental care, activities, food, and a host of spiritual and social guidance. PACE—which stands for Program of All-Inclusive Care for the Elderly and was designed by the federal government—absorbs all Medicare and Medicaid payments owing to an individual and then provides its own team of health practitioners to that individual.
The participants, however, do not live onsite, but are shuttled by a fleet of busses to and from the PACE center every day.
“Our drivers are actually integral members of the team,” said operations manager Brian Osborn. “They often spend a lot of time with patients so they know them really well.”
“And if they notice anything different, they can report it to the doctor,” he added.
As a national health crisis looms, operators of health care facilities that have traditionally tried to embody models that are more akin to familial living—with elders living together cared for by a staff of young people—are now turning to the PACE model.
“It’s like day care,” said a prominent health care advocate speaking off the record because of potential repercussions from the community.
So far, all four of the PACE centers in the Seattle area are operated by Providence Health and Services. But recently Kin On, the traditionally Chinese and Asian Pacific Islander (API) nursing home, has announced it will join the International Community Health Services (ICHS) in opening up their own PACE center—called AiPACE (Aging in PACE).
The announcement comes at the same time that Keiro Northwest announced its closure due to an inability to uphold its traditions and standards of care in a changing fiscal and social environment.
“In American society, we shun and isolate old people, because they remind us that death is coming,” said the national health advocate, who has worked in nursing homes and assisted living communities nationwide, and visited Keiro hundreds of times.
“But in Japanese and Chinese culture, they revere life as a process, they revere elders,” the advocate added. “We have lost a piece of that culture, it will now be extinct.”
An attention to detail
At Kin On, the staff and leaders don’t see it that way.
“I believe AiPACE can change the world with the right level of community and government support because the model is fundamentally sound and can be replicated quickly,” said Nigel Lo, the CEO of Kin On.
Heidi Wong, who is tasked with raising $20 million for the construction of the new AiPACE center, a building that will be surrounded by low-cost housing and backed by the mammoth former Amazon headquarters, sees it as a way to keep a dream alive.
Just before she took the job, her grandmother died, and she decided this was a way to provide care for an untold number of grandmothers—called “popo” in Chinese.
“My relatives and I, who are not healthcare professionals, did whatever we could the best way we know how to keep popo at home where she wanted to be,” said Wong. “Can you imagine if we were healthcare professionals, how many more popos can live independently and age at home?”
Lo, a former manager of the military sector in Boeing, and a longtime board member of Kin On and former board president, came out of retirement to oversee the development of the AiPACE center.
As he walks around the new assisted living center at Kin On, another recent expansion, he proudly shows off details that will make life better for the future residents.
A staff member slides a window open that abuts the parking lot, but affords a view of a deep canopy of tree leaves moving in the wind.
“Show all the different ways the window opens,” he asks the staff member.
Lo goes over to help. The two of them turn a lever on the window that opens it from the top so that air can vent into the room without any fear of anyone entering.
The rooms are small but comfortable with mini refrigerators. The exterior, among the swaying trees, even has a resort-like feel.
They show a mahjong table that rises pneumatically to the proper playing height, solving a problem that has plagued other retirement communities that seek to cater to an Asian crowd.
If their attention to detail is any indication of the future, they may find ways to stave off the kind of dissolution of cultural veneration for the elderly that the advocate worried about.
“We know our clientele,” said Lo.
Kin On currently has the highest rating—five stars—on the government’s Medicare website, considered “much above average.” Such a top rating also includes “quality of resident care.”
Poster boards throughout the community show cultural activities. Staff members speak multiple Asian languages and dialects.
Meanwhile, Wong, the fundraiser, attests that her grandmother attended daily activities at a community center for Chinese in the International District, while living at the homes of her different daughters. She contends that other “popos” will have the same experience at the AiPACE center they are building.
Challenges of the PACE model
Implementing the PACE model, for Kin On and ICHS, will not be without its challenges.
Scholars that study the PACE model contend that it has many advantages, including an emphasis on preventative care.
The longer PACE administrators keep their participants out of the hospital, the more money they save—money that is necessary for them to keep running. PACE programs across the nation survive by enrolling greater number of enrollees, adults over the age of 55 that are eligible for nursing home care, but choose to travel to the center for team care and activities.
Down a long hallway at the PACE center on Martin Luther King Jr. Way, a row of offices reveal social workers, nurses, a doctor, and others working over their computers. A spiritual adviser comes in, carrying a takeout bag of lunch.
In a physical therapy room, an older woman is monitored and encouraged on a recumbent bicycle by a young trainer with long hair.
Given the widespread closing of nursing homes across the country, and the massively low reimbursement rates the remaining homes receive from the government, putting them in constant financial jeopardy, PACE is a “fabulous option,” said the advocate.
“We just want to make sure that individuals understand what they are signing up for,” the advocate added.
PACE provides an array of medical and even dental services as determined by the doctor in charge.
“But if you need to go for neurosurgery and want to see the top specialist, will you be able to? I don’t think so,” said the advocate.
“Or if you do need to go to a skilled nursing facility, you have to choose from the ones that PACE contracts with,” the advocate added.
A concern of researchers is that while PACE programs tend to focus on preventative medicine to keep the elderly out of the hospital, they may not necessarily be aimed at preserving longevity.
“Researchers suggest that resources and services within the program are more focused on functional status, and less focused on services to limit mortality,” said Jerome A. Dugan, a professor in the University of Washington School of Health.
“This may represent one of the most important limitations of PACE—a lack of alignment of the program’s aims to lower mortality risks,” he added.
At the Martin Luther King Jr. PACE center, general manager Brian Osborn refutes such allegations. He claims that in their program, 86 percent of participants die at home while only 14 percent die in the hospital or a skilled nursing facility.
Such figures represent a shift away from an institutional model in which 60 percent of people (within the Medicare eligible range) die in nursing homes or the hospital, he said.
Most of their participants, he said, have filled out end of life plans.
“Some people don’t want interventions,” he said.
Mahlon can be reached at email@example.com.