ulcers, preventable hospitalizations, and emergency room visits among members (LIFE, 2010).
LIFE is one of 72 programs in 31 states that are part of the Program for All-Inclusive Care for Elders (PACE)—a model of care begun in San Francisco in the 1970s that is now a national network offering services to elderly Medicare and Medicaid beneficiaries—and it is the only PACE program to be affiliated with a school of nursing, the University of Pennsylvania’s. (See the websites of LIFE [www.lifeupenn.org] and PACE [www.npaonline.org] for more information.) And because PACE programs receive capitated payments—per member, rather than per service provided—from government and private insurers, LIFE is both provider and payer for specific services, said Mary Austin, MSN, RN, NHA, LIFE’s chief nursing officer and chief operating officer. “If members go to the hospital or a nursing home, we pay for all of that care as well,” she said. The team makes all care decisions, including some that might seem unconventional, such as buying an air conditioner for a member with asthma.
Despite potential financial barriers—some might deem the $2 million required to start a PACE program prohibitive, and some private insurers do not cover PACE services—LIFE is fiscally sound. “We operate on a shoestring, to a degree. But we operate responsibly, and we get the money we need to run the program,” said Eileen M. Sullivan-Marx, PhD, RN, FAAN, associate dean for practice and community affairs at the University of Pennsylvania School of Nursing. She also said that the state saves 15 cents on every dollar spent on LIFE members who would otherwise be in nursing homes. The program makes up about 41 percent of the nursing school’s operating budget (Sullivan-Marx et al., 2009).
Ms. Mashore is quite clear that the program has strengthened her ability to care for herself. When a nurse suggested that she not use her electric wheelchair because using a manual one would strengthen her arms, Ms. Mashore was angry at first. “But I see what she’s saying,” Ms. Mashore said. “My arms are very strong. I pull my own self up in the bed. I can do things that I couldn’t do when I was in the nursing home.”