Long Term Care in the United States and Programs of All-inclusive Care for the Elderly (PACE) : Case Study of the On Lok Program

[出版社版]This paper aims to analyze the history and activity of PACE (Programs of All-inclusive Care for the Elderly) in the United States, especially the On Lok program which achieves both low medical expenses and good QOL (Quality of Life) of the elderly by all-inclusive care. As is generally known, there is no universal health insurance system in the United States. The United States has basically left long term care to the market. The medical expense control policy was strengthened after the 1980’s, and for low-income, vulnerable seniors it has become difficult to access medical treatment. Therefore, the majority of the frail elderly could do nothing but receive caregiving from their family and friends. However, PACE provides community-based care and services to people who would otherwise need a nursing home level of care. Only 7 percent of PACE participants nationally reside in a nursing home. The basic idea of PACE is that thorough preventive care can prevent more serious conditions and reduce hospitalizations. PACE provides anything and everything the elderly and their family might need, coordinated by a team of medical and social service providers, for an annual fee paid by Medicare and Medicaid. This seamless care can be delivered at home, at a PACE center, a hospital or a long term care facility. The model for PACE was developed in 1971 in San Francisco’s Chinatown/North Beach area by a community center called On Lok. After that, the On Lok approach was replicated elsewhere, and 61 PACE programs were operational in 29 states in 2008. Because of the importance of PACE activity, this paper analyzes the role of PACE, especially On Lok, in long term care