A Conversation With ... Deanna Beckenholdt

The Program of All-Inclusive Care for the Elderly is a national program, but new for Jordan Valley. It has a goal of keeping seniors who need care in their homes. How does the program work and what services will be offered?
Our program is typically funded by Medicare and Medicaid to deliver the necessary care at the participant’s home. To be eligible for enrollment, a participant needs to be 55 and older, certified in the state of Missouri to need nursing home level of care and able to live safely in the community with the help of PACE services. Approximately 90% are dually eligible. The average age of the PACE participant is 76 years old. Here at PACE, we look for participants that need help with bathing, eating, toileting, dressing, brushing hair and teeth, food shopping, laundry, cooking, house cleaning, taking medications, trimming nails. We have a full interdisciplinary team that includes the social worker, the dietician, all transportation, personal care assistant, nurse, activity director, physical therapy, occupational therapy and speech therapy. We can provide both services in the home and the adult day center. It’s a person-centered care.

Launching in July, the local PACE program has space for up to 300 participants. This is the first program serving southwest Missouri, do you have plans to expand with demand?
Absolutely. So really, it’s an unlimited number. We are looking at phase two and phase three with our growth model. There is a great need in southwest Missouri for skilled services in the home.

There’s roughly 165 PACE programs nationwide, and this one will be the third in the state. According to PACE data, about 72,000 seniors are getting care from PACE while there are about 1.2 million folks in residential nursing homes. Do you think PACE will eventually be as utilized as nursing homes?
We’re not necessarily looking to be competitors with nursing homes. We want to be partners as another option, an alternative to nursing home care. It also gives that relief for caregivers that are providing for their family members at home that are able to live safely at home.

The National Poll on Healthy Aging found 1 in 5 Americans will be over age 65 by 2030, and most want to stay at home as long as they can. Does keeping people in their home as they age improve health outcomes?
It absolutely improves health outcomes. Forty-nine percent of PACE participants have been diagnosed with dementia and while we do offer an adult day center for socialization, which is very important for mental health, we can also offer those activities in their home to make sure that all of their mental health needs are met. We’ve got some great partners in our hospital systems here with reducing rehospitalizations. We want them to call us to be able to meet their needs, anticipate their needs, before going to the hospital. Our tagline is Healthy Living Daily Care. We can prevent some of those issues that come up before they go to the hospital.

As you’re gauging the success of the program, what are the key metrics you’ll look at?
Rehospitalizations, medications. We will be here writing all of their medications, and so looking to reduce some of the polypharmacy. Also, medication reconciliation, improving outcomes for wound care. A big piece of PACE is also to be able to provide transportation to specialist appointments.

Some PACE programs are run by for-profit entities. How is this structured?
Jordan Valley Senior Care is nonprofit. It is a three-way agreement PACE organizations have with the [U.S. Centers for Medicare & Medicaid Services], the state of Missouri and the PACE organization.

You said 90% of PACE patients are eligible for both Medicare and Medicaid. For those that would need to do self-pay, does that model exist and how does this cost compare to residential care?
If you don’t have Medicare or Medicaid, you are still able to join the program. It’s much less expensive because it covers all of your part A, B and D benefits. We do preventive therapy. We don’t wait for something to happen for you to get therapy services. We try to be ahead of that. It also includes all medications, therapy, appointments, doctors, specialists, all wrapped in one. So, it is a huge cost savings from a traditional nursing home.

Workforce shortages are a persistent challenge in health systems. How have your recruitment efforts gone and what is the size of the staff?
So far, we’ve been very fortunate to have so many very excited people in our community looking forward to having this PACE program come to southwest Missouri. Our caregivers really want what’s best for our community and they feel like it’s a giving back. So far, we’ve had a great response to our positions posted. Currently we’re starting out with 12 full-time as of day one in three vehicles. We will very shortly be posting more positions and hiring the rest of the team. Currently we are serving a 60-mile radius.

The PACE model started in the 1970s. Why do you think this has taken so long to get here?
I know there’s been a lot of talk in the past of people that have wanted to bring PACE to southwest Missouri. I think that with COVID, people didn’t want to go to a nursing home, and in-home care was needed more than ever. This model was looked at as a game-changer for our community to be able to provide services to where participants wanted to be, and they want to live in their home. Jordan Valley has a tradition of serving the underserved and they’ve done a great job with women and children and adults, and we are looking at the most vulnerable population, which is our seniors, and we want to be able to take care of them in our community.