PACE stands for Program of All-Inclusive Care for the Elderly. It’s a healthcare model that combines medical, social, and long-term care services for older adults who qualify for nursing home care but want to keep living at home. As of April 2025, about 83,500 people are enrolled in PACE across 33 states and the District of Columbia, served by 190 PACE organizations.
Who PACE Is Designed For
PACE serves people who are frail enough to need nursing home-level care but are still able to live safely in the community with support. To enroll, you need to meet four criteria: be 55 or older, live in the service area of a PACE organization, be certified as eligible for nursing home care by your state, and be able to live safely in the community at the time you join.
Most participants are dually eligible for both Medicare and Medicaid, which together fund the program. People who don’t qualify for Medicaid can still enroll by paying privately, though the cost reflects the comprehensive nature of the services.
How the Care Model Works
The core of PACE is an interdisciplinary team that manages every aspect of a participant’s health. This team includes at minimum a primary care physician, registered nurse, social worker, physical therapist, occupational therapist, recreational therapist, dietitian, home care coordinator, personal care attendant, and even a transportation representative. Together, they assess each participant’s medical, functional, emotional, social, and cognitive needs and build a single care plan around them.
That care plan is specific. For every need identified, the team documents the problem, the interventions they’ll use, measurable goals, a timeline, and which staff member is responsible. The assessment itself is thorough, covering physical and cognitive function, medication use, nutritional status, home environment (including whether a participant can safely enter and exit their home), psychosocial health, dental status, caregiver availability, and cultural and language needs.
Most care happens at a PACE center, which functions as a combination medical clinic, rehabilitation facility, and social hub. Participants typically attend several days a week, where they receive primary care, therapy, meals, and social activities in one location. The team monitors changes continuously, with every member responsible for flagging shifts in a participant’s condition.
Services Included in PACE
PACE covers essentially everything a participant needs, which is what “all-inclusive” refers to in the name. This includes primary and specialty medical care, prescription drugs, physical and occupational therapy, social work services, meals and nutritional counseling, personal care assistance, and adult day services at the PACE center.
Transportation is built directly into the model. PACE organizations are required to provide safe, accessible transportation to and from the center and to medical appointments. Drivers are trained to manage the special needs of participants, handle emergencies, and communicate observations about changes in a participant’s condition back to the care team. Vehicles must be equipped to communicate with the PACE center at all times. This might sound like a minor detail, but for a population that often can’t drive, reliable transportation is what makes the entire program functional.
Home care is also part of the package. The home care coordinator on the interdisciplinary team arranges personal care attendants and other support so participants can manage daily life at home between visits to the center.
How Enrollment Works
Enrolling in PACE starts with an initial assessment to determine whether you meet the nursing home-level care threshold. Depending on your state, this assessment may be conducted by the PACE organization itself or by an independent assessment program. The PACE team evaluates your health status, functional abilities, and living situation. If you’re found eligible, enrollment can proceed through your state’s Medicaid managed care enrollment process.
In states with a direct eligibility option, the PACE organization conducts the assessment and can enroll you relatively quickly, though a verification review follows within 30 calendar days. If you’re found not to meet the criteria, the PACE plan must notify you within three business days.
Outcomes Compared to Nursing Home Care
A major CMS evaluation found that PACE participants had significantly better outcomes than comparable individuals who received traditional care. In the first six months, PACE enrollees were 50 percent less likely to be hospitalized, averaging 1.9 hospital nights compared to 6.1 for the comparison group. They also spent far less time in nursing facilities: an average of 6.5 nursing home nights versus 22.7 for non-PACE individuals over the same period.
At 12 months, PACE participants had spent an average of 15 days in a nursing home compared to 38 days for the comparison group. They spent more days living in the community in every time period measured, averaging 172 community days in the first six months versus 149 for those outside the program.
Mortality was also lower. Over the full observation period, 19 percent of PACE enrollees died compared to 25 percent of comparison individuals. After controlling for baseline health differences, the evaluation estimated that a typical PACE participant had a median life expectancy of 5.2 years, compared to 3.9 years for someone with the same health profile outside the program. That’s a 33 percent difference.
Why PACE Exists
PACE was designed to solve a specific problem: many older adults end up in nursing homes not because they need 24-hour institutional care, but because no single program coordinates all the services that would let them stay home. A person might need a doctor, a physical therapist, a ride to appointments, help with meals, and someone to monitor their medications. Without PACE, those services come from different providers who rarely communicate with each other, and gaps in coordination lead to hospitalizations and nursing home admissions.
By wrapping everything into one program with one team, PACE keeps people in their communities longer while actually reducing the total cost of their care. The model pays for itself largely through avoided hospital stays and nursing home placements, which are among the most expensive services in healthcare.