Chapter 7: Implementation: Start with PACE


Do you want your community to be a MediCaring Community? Of course you do. Virtually everyone agrees that this is what they want for themselves and for their loved ones. But nearly everyone then says, “But what about X?” They fill in the blank with some element of reform that seems to be overwhelmingly unlikely to change. What about the power of the hospitals, doctors, drug companies, and insurance companies that would risk losing income and influence if supportive community services were taken to be important? What about the increased investment in personal care, housing, and food—won’t that take away from medical providers? Aren’t these social services a “black hole” of need that has no boundaries and will swallow up budgets? What about generating that new layer of governance that watches over the elder care system and makes strategic investments—who will allow that to happen?

One would not undertake a major reform like this if there were easy and appealing options, or if things were working out fairly well as they are. Lewis and Clark would not have headed to the Pacific if there had been an armchair way to figure out what the territory west of the Mississippi held. As a society, we are in the same position regarding elder care. We know that there will be a very large number of frail elderly persons needing a great deal of personal care and a substantial array of services, with the largest increase being in the 2030’s. We know that our current temporary illusion of sufficiency already entails a great deal of unnecessary suffering on the part of elders and their caregivers and that the costs already greatly stress families and the national economy. If we do nothing much to improve the situation, we will have to learn to turn a blind eye to an abandonment of many elderly people or to endure a set of serious harms to the economy. We must find a way to care for one another more reliably and with fewer burdens on families and society generally. MediCaring Communities offers the way to do just that. But it won’t be easy; it will require the spirit of exploration from the tradition of Lewis and Clark.

Starting with expanding PACE programs offers a very appealing way to establish the first MediCaring Communities, and this chapter will characterize that path. PACE is one of the improvement models we included in Table 3.1 on pages 57-66.

This chapter deals with many of the issues attending a practical implementation of MediCaring Communities, specifically:

7.1 How should we start implementing a MediCaring Communities model? Answer: PACE!

7.2 Which communities should become the first MediCaring Communities?

7.3 What will CMS leadership need to do to make it possible to implement MediCaring Communities?

7.4 What strategies other than PACE can generate a MediCaring Community?

7.5 What could other stakeholders do to help a demonstration of MediCaring Communities to succeed?

7.6 Could social impact bonds or “pay for success” models help with the initial financing?

7.7 After the first set of PACE expansion initiatives, how might MediCaring Communities develop?

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