In 25 Years, PACE Has Had Positive Impact and Shows Great Promise for the Future

December 15, 2022

December 15, 2022
Contact: Ellen Mullally

The Program of All-Inclusive Care for the Elderly (PACE), which the Centers for Medicare & Medicaid Services (CMS) recognized with “permanent provider status,” is marking its 25th year of service. PACE has been an important force in care for the nation’s older adults and is likely to lead state efforts to “rebalance” long-term care strategies and budgets toward community-based models. An article in the December issue of JAMDA talks in detail about PACE’s history and its role in health care moving forward.

In The Program of All-Inclusive Care for the Elderly (PACE): An Update after 25 Years of Permanent Provider Status, the authors talked about the significance of these programs. “With the surge in total numbers of older adults comes an increasing prevalence of functional dependence and cognitive impairment, as well as greater complexity of medical care needs,” they said. Additionally, they noted, “In the next 30 years, there will be a significant increase in people needing long-term care with a threefold rise in the number of people over age 85. This reality places greater stress and burden on any attempts at community-based care alternatives.”

Over the years, PACE programs have established close relationships with community housing settings such as assisted living facilities and foster care and have co-located services in traditional senior housing. In doing so, the authors said, “They fill in the care gaps that all too often are the determining factor in the necessity for nursing home placement.

While there is wide variation among PACE programs and a lack of evidence from randomized trials, there is some data demonstrating the benefits of such efforts. At least one study showed that PACE enrollees had significantly lower mortality, though by a smaller magnitude of 5-6 percentage points after the first year through month 48 after enrollment. Program characteristics associated with lower mortality include higher concentration of services and having more professionals than para-professionals involved.

PACE also is linked to reduced in-hospital time, a delay in long-term nursing home placement, and a reduced long-term use of nursing facilities. During the pandemic, PACE participants also were at lower risk of contracting COVID.

Looking ahead, the authors said, “The recent context of PACE’s response to the COVID-19 pandemic, which highlighted its strengths, has created new opportunities for PACE growth including heightened consumer and provider interest. How PACE responds to these opportunities will be framed by state and federal policy actions with the potential to expedite its growth and broaden its reach, as well as PACE organizations’ ability to expand their capacity to serve more people.” Taking these factors into consideration, the authors concluded, “PACE’s future can be considered in terms of its ability to scale the capacity of its current providers, to spread its availability into unserved [areas], and to broaden the scope of the PACE population.”

The study was conducted by researchers at the Hopkins ElderPlus and Johns Hopkins University, Baltimore, MD; National PACE Association, Alexandria, VA; Neighborhood PACE, East Boston Neighborhood Health Center, East Boston, MA; National PACE Association, Alexandria, VA; Providence ElderPlace, Portland, OR; and University of Pennsylvania, Philadelphia, PA.

Get more information on the findings above and more details about the study. To contact the researchers or JAMDA editor for an interview, please email





JAMDA is the official journal of AMDA – The Society for Post-Acute and Long-Term Care Medicine. JAMDA publishes peer-reviewed articles including original studies, reviews, clinical experience articles, case reports, and more, on all topics more important to post-acute and long-term care medicine. Visit for more information.


About AMDA – The Society for Post-Acute and Long-Term Care Medicine
AMDA – The Society for Post-Acute and Long-Term Care Medicine is the only medical specialty society representing the community of over 50,000 medical directors, physicians, nurse practitioners, physician assistants, and other practitioners working in the various post-acute and long-term care (PALTC) settings. Dedicated to defining and improving quality, we advance our mission through timely professional development, evidence-based clinical guidance, and tireless advocacy on behalf of members, patients, families, and staff. Visit for more information.