As Congress debates cuts to Medicaid, one local Medicaid-funded program is persevering: staff and participants of Providence ElderPlace PACE (Program of All-Inclusive Care for the Elderly) celebrated the Seaside location’s 10th anniversary last week as a continuing resource for older individuals seeking assistance outside of nursing homes.

PACE North Coast remains the organization’s first rural site in Oregon, an extension of nine other PACE sites in the Portland metropolitan area. The program provides people who are eligible for a nursing home level of care with medical assistance and social services so that they can continue to live either at home or in an assisted living facility.

“Everything from case management, care management, delivery of medications, help with the home — setting up a home with grab bars or maybe a hospital bed,” said PACE spokesperson Rika Bering. “…By providing all that extra care, they can continue living in the community out of a nursing home and hopefully stay put.”

The services covered by PACE range from medical assistance — primary, specialty and emergency care; medications; mental health services, nutrition and physical therapy, to enrichment — recreational and therapeutic activities, social events and shared meals. In-home care and services are also offered alongside coordinated transportation to and from medical appointments and the PACE clinic and social center.

When the Seaside location first opened in 2015, there were only six participants. This year, PACE North Coast cares for 88 participants from Clatsop and Tillamook counties, and has expanded its site next to the Lewis & Clark Bank. Carol Cutler, the first participant of PACE North Coast, is still part of the program today.

Bering said, “The actual site has expanded, but the staff has stayed super stable. That’s something that the participants have commented on, because they see PACE caregivers so often and they rely on them so much. Many of them do not have family in the area, so they become like family, and they’ve commented on how they can develop relationships, and staff has stuck around to keep those relationships going.”

Most of PACE North Coast’s participants live in assisted living facilities instead of at home, largely due to the high price tags on homes in the Seaside area.

Assisted living facilities differ from nursing homes in terms of services; an assisted living facility supports seniors who are active but need assistance with some everyday tasks, while nursing homes provide 24-hour monitoring and an intensive, more expensive level of care. PACE contracts with every assisted living facility that has a PACE participant living onsite.

“The contract rates are Medicaid rates, and the facilities agree to these rates, and then they agree to provide those services … then PACE gets paid a capitated rate from CMS and from the state for each person that’s in our care, and all that money goes into a pool,” Bering said. “We are responsible for each person’s care and that money is what we have to use to pay for the care.”

Enrollment Coordinator Anthony DeGoede, who has been with PACE North Coast since its inception, said that applicants to the program must qualify for PACE through Northwest Senior & Disability Services. Each participant has a care team made up of a social worker, activity coordinator, primary care provider, registered nurse, driver, dietitian and physical and occupational therapists.

“When they first come in here, we do the aid assessments,” he said. “Then they sign off on it, and everything in there is paid, 100%. There are no co-pays … all the bills come to us, and we are a nonprofit.

“What we try to project to people when we’re working with them is that they’re part of the community, not just a medical case. So our first step is, ‘How are we making them feel?’ It’s the very first thing, and anticipating their needs.”

Nearly all of the program’s participants are on Medicaid or Medicare, meaning PACE itself is almost entirely reliant on government funding through the Centers for Medicaid and Medicaid Services.

“By becoming PACE, we agree to offer or to provide all of the necessary medical and social care that the person needs,” Bering said. “So if there are cuts, and if the person is still eligible for our program and stays enrolled, we still have to provide the care.”

Conservatives on the U.S. House Budget Committee on Friday voted against a package of tax breaks and spending reductions because they want steeper cuts to Medicaid, according to the Associated Press.

PACE officials do have concerns about cuts to that funding — development of a planned new PACE site east of Beaverton was recently put on hold as a precaution — but Bering said PACE has not been warned or notified of any cuts and expects to continue offering the same level of care.

“Medicaid is a hot point right now, and I think there’s a lot of people that think of Medicaid and don’t truly understand who it’s serving, who it’s supporting,” she said. “These are people that had the unfortunate bad luck of getting sick, developing congestive heart failure, or dementia or or diabetes, a combination of all of many different, many different diseases.

“And you know, they’ve been working hard all their lives, but they got sick; they got old, and they just need help. And what is beautiful about PACE providing just some super-basic help is that it’s keeping them out of expensive hospitals and expensive nursing homes.”

The benefits aren’t just financial; PACE has helped cut down on calls to 911 and emergency room visits, freeing up time and space for medical professionals and first responders. And for participants, Bering said, the ability to continue living outside of a nursing home has everything to do with freedom.

“The biggest thing is staying in a less restrictive environment,” she said. “People don’t want to live their last days in a nursing home.”