A dozen people sit around a table in a nondescript, fluorescent-lit room. A doctor, social worker, nurses, therapists and others.
They talk about Ila, 70, who, each Monday like clockwork,complains of nausea and vomiting. Catherine Perry, a nursepractitioner, explains that a barrage of tests have turned upnothing.
'We are really concerned that this somatization (of symptoms) isdepression,' she tells the group. Mental Health Counselor WesleyCowan adds: 'I definitely think we need to up the amount ofcounseling.'
Others wonder if there's something else. 'I'm really surprisedabout the depression,' said Diane Lindberg, the recreationtherapist. 'When she is in the center, she is fine.' She adds thatIla seems upbeat, dresses well and has a healthy self-esteem.
One person suggests lonely weekends at home have made herdepressed, while Dr. Joel Dickerman notes that her opiatemedications might play a role. The group pledges to look closer atboth.
This intensive team approach represents what health expertswidely regard as one of the most innovative models ever developed totake care of seniors.
Ila, whose last name is not being used to protect her privacy, ispart of the Program of All-Inclusive Care for the Elderly, or PACE.Rocky Mountain Health Care Services, a Colorado Springs nonprofit,launched a PACE program here this year.
The model for the program is about 30 years old, and PACE hasbeen eligible for Medicare and Medicaid funding since 1992. But thisis the first time El Paso County seniors have had it as an option.
Ila and 37 others attend an activity center on the west sideduring the week for social time, exercises, meals and otheractivities. Here they also have access to mental health counseling,medical appointments, physical therapy, prescriptions and otherservices.
But perhaps more importantly, they are regularly evaluated bythis team, which dissects every aspect of their lives with a goal ofimproving them.
Even the bus drivers transporting them to doctors appointmentsare trained to watch for signs that something is amiss.
At Ila's care-plan meeting on a recent Thursday, TransportationManager Daun Fleming noted how Ila always tells jokes on the bus andshows no sign of being blue, another piece of the puzzle as theyevaluate what's wrong.
Why? Because the quicker a potential problem is discovered andfixed or managed, the better shot they have of preserving a person'sindependence.
To understand PACE, it first helps to understand the traditionalway seniors in the United States get health care.
With few exceptions, the elderly rely on Medicare, Medicaid or acombination to pay for prescriptions, hospital stays, medicalequipment, nursing services and other expenses as problems surfacewith old age. It is up to the seniors or their families, though, topull all these pieces together.
Often it is when people can no longer manage their prescriptions,get to doctors appointments, or be left alone during the day thatthey land in a nursing home.
Even for the senior who has caregivers to do such tasks,sometimes health problems go undetected because no one is looking atthe case as a whole, but rather as pieces of a puzzle.
For the frail, who have complex medical histories, that sometimesmeans a treatable problem develops into something far more serious.
PACE providers, by contrast, assume complete responsibility for apatient in exchange for a roughly $5,000 monthly payment fromMedicare and Medicaid to cover them.
When someone is relatively healthy, the program thrives. But if apatient goes to the hospital or a nursing home, the program takes afinancial hit.
That incentive is a powerful one, because a $5,000 monthlypayment won't go far to pay a lengthy hospital stay or a nursinghome bill.
'When we have someone in the nursing home, we're pretty muchupside down,' said Laurie Tebo, president and chief executiveofficer of Rocky Mountain Health Care Services.
Although prevention, maintenance and the 'whole person' approachto health care are popular ideas and buzzwords in the health carereform debate, they are seldom actually practiced in currentmedicine.
Dickerman, a family practice and geriatric physician, said healthcare is a 'victim of its own success' because it has become so goodat fixing problems that there's little motivation to avoid them inthe first place.
PACE tries the opposite. It is quick to send someone to thedentist, for example, because bad teeth can lead to poor nutrition,and poor nutrition can lead to a host of complications.
Some patients might receive physical therapy indefinitely simplybecause that might keep them mobile longer. The program also paysfor certain things that typically aren't covered, such as cataractssurgery.
There appear to be no outspoken critics of PACE, but providersand others concede it has its limitations:
- It's risky. For these seniors, a major medical bill is just afall or diagnosis away even with the most attentive health care.Although no PACE program has gone under financially, a patient whotakes a turn for the worse can trigger a need to use capitalreserves or catastrophic insurance.
- It's highly regulated. Reporting requirements and rules forPACE are exhaustive. Rocky Mountain Health Care Services spent fiveyears putting together its program.
- It's expensive. An entire health care staff and center must bein place before the first patient enrolls, and a hefty reserveaccount is required for patients who fall seriously ill.
Rocky Mountain, helped by a number of grants, spent about $3million in start-up costs.
These reasons partly explain why the program cares for only about15,000 seniors nationwide.
Tebo said Rocky Mountain's goal is to break even in 18 months. Itwill be at capacity with 220 patients.
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Call Newsome at 636-0198. Visit the Pikes Peak Health blog atpikespeakhealth.freedomblogging.com and the Gazette's Health page atgazette.com/health.
