PACE Leads the Transformation of Elder Care in America

Growing old is not for the faint of heart, but old age and the eventual end stages of life come for everyone lucky enough to live to a ripe old age. More people than ever are experiencing old age; dramatic increases in life expectancy and the aging of the American baby boom generation, born between 1946 and 1964, have caused a surge in the elderly population never before experienced in history. 

Since World War II, the average life expectancy of Americans has skyrocketed from 66 in 1945 to almost 80 in 2021. With 70 million American baby boomers alive today, people between 65 and 85 years of age are the largest segment of the United States population. Many of today’s elderly people will need a nursing home level of care by the time they turn 55 due to chronic illness or disabilities that inhibit their ability to perform activities of daily living and care for themselves.

It is better for seniors with chronic care needs and their families to live and be served in their community. In the past many American homes housed multigenerational families where members could provide and care for one another. Nowadays members of this nuclear family unit are often geographically distant from each other and are unable to provide direct care.

This has occurred just as the elderly population has sharply increased, and without an intact nuclear family household today’s baby boomer parents cannot reasonably expect their own busy children to keep them safe and secure at home. This has generated demand for alternative living facilities, including independent living, assisted living, and homes for the aged. It has also raised many questions of how these arrangements will be funded. 

Ultimately, our society has had to reinvent how we care for the aging population. 

The government’s impersonal approach to housing seniors has cultivated a stigma that old folks’ homes and skilled nursing facilities are like prisons for old people whose only crime is to live beyond their ability to live independently. Nursing homes are important; they provide round-the-clock skilled care for those who are medically complex and can’t care for themselves in their homes or elsewhere. However, nursing homes are necessarily restrictive, and dependent elders can feel warehoused and forgotten when they are institutionalized away from friends, family and the home they have known for years. 

Nursing homes are designed to keep people alive, but not necessarily to thrive. Children that are potentially multiple states away can become fatigued managing their own lives in addition to their parents’, and feel they have no other options than placing a loved one into a nursing facility. 

The first statewide system of in-community living support specifically designed to avoid or delay nursing home placement was the MI Choice Waiver program established in 1992. This system allowed Medicaid qualified persons who otherwise met nursing home criteria to receive the same care in the familiarity and comfort of their own home. 

This program has proven very successful at keeping people out of nursing homes, and one notable waiver agency in the tri-city area is A&D Home Health Care. After decades spent developing innovative solutions for helping seniors in the community live full active lives in their personal homes with the support of nurses, therapists, home care aides and social work case managers the next logical step was to expand the scope of A&D’s care to include all aspects of an aging person’s care. 

Instead of fragmented care that stopped at the door to a hospital or nursing home, “What if the care A&D provided could continue inside those facilities and guide the person back to their most desired outcome?”

The answer to this question would be found in a relatively new government sponsored program called PACE – A Program of All-inclusive Care for the Elderly. 

PACE is a complete package which provides a physician clinic for medical management, a rehabilitation center, social work to navigate government bureaucracy, day center for activities and meals, transportation to and from appointments, in-home caregivers and more.  It does this by becoming a payor source for all of an aging person’s care needs. 

Instead of Medicare and Medicaid determining what care you can or can’t receive, the aging individual and their team of professionals at PACE work together to determine what is needed for best outcomes.  No cookie cutter rules are found inside the PACE facility, only individually tailored care plans and goals. 

This program would be a perfect solution for advocating on behalf of A&D’s elderly clients in all aspects of their care in and out of facilities. See more about the workings of PACE at the National PACE Association.


In 2015 Great Lakes PACE was formed as an extension of the mission of the A&D Charitable Foundation. It was formed to bring this exciting new model of PACE care to the Tri-city area. Great Lakes PACE truly is like having a nurse in the family, and dozens of nurses, assistants, and doctors too, all dedicated to understanding the health and circumstances of a limited number of program participants to help them live safely in their communities.

The average PACE participant is 76 years old and has multiple, complex medical conditions, cognitive and/or functional impairments, and significant health and long-term care needs; Almost all qualifying =applicants receive all PACE services without any out-of-pocket expense.

Great Lakes PACE has a limited census that allows enrollment of no more than 250 participants at a time – compare this caseload to the typical 2500 patient panel that many physician practices maintain, and you can see the difference in how PACE can focus care and resources for each participant individually.

The participants know and trust their doctors and nurses, and the caregivers know the participants as well. Patients receive all their PACE primary care from the clinic at the state-of-the-art PACE medical and adult day care center located at 3378 Fashion Square Blvd., Saginaw, MI 48603 [see greatlakespace.org], and if they need hospitalization, emergency room or specialist care then PACE coordinates, transports and covers all of that care communicating closely with those facilities and providers regarding the participant’s needs. 

PACE participants always have someone to call when in need, because PACE has 24-hour on-call help from nurses, physicians and pharmacists. PACE also monitors, prescribes and pays for all medicines, determining the best way a person can receive and take all their medications effectively.

More generally, PACE participants have access to a whole team of professionals that help keep participants independent and safe while residing in the local community. An interdisciplinary healthcare team (IDT) implements a comprehensive and individualized care plan to address the chronic health needs of participants and their family caregivers, with strict attention paid to the care and lifestyle preferences of each participant. The Interdisciplinary Team (IDT)includes a primary care physician, nurses, social workers, therapists, among others. 

When the Interdisciplinary Team (IDT) works together with participants and families, the PACE program participants receive quality care at their own pace. The goal of an IDT is to do the right thing by the participant; to understand and honor the participant’s goals of care, respecting their right to live where they want and provide care according to their wishes, not necessarily family’s, facilities’ or friends’ wishes. The team acts as the patient’s shield, avoiding improper medication, unnecessary operations, avoidable hospitalizations and exposure to deadly contagions by staying so closely involved in a participant’s care both in facilities as well as in the community. 

PACE is designed to work with the senior’s family or caregivers to give them respite and help with all aspects of participant care. Caregiver burnout is recognized as a real concern as it is probably the single biggest reason a person can end up in a living facility.

PACE staff know how lonely and challenging it can be as a caregiver, and the fact that 97.5% of family caregivers would recommend PACE shows how much the program can help. What caregivers have chosen to do demands dedication, physical stamina, and compassion. The objective is to support participants and their caregivers by providing practical, meaningful services that are included for all Great Lakes PACE participants.



Great Lakes PACE lives up to its moniker of all-inclusive care by providing that care in the state-of the art day center and at home, as well as with transportation. Day center activities and meals are provided at no additional cost!

If you or a loved one is struggling to stay in their home and wish to investigate PACE further, you can call the Great Lakes PACE program at 888-520-7223. Call for a consultation before the program fills up!

If you like what you hear, PACE will invite you to come tour the adult daycare center and state-of-the art health clinic. The recognizable PACE bus will be in your neighborhood so we can pick you up and drop you back at home. You can enjoy a delicious complimentary lunch.

Individuals wishing to enroll in a PACE program must be 55 years old or older and reside in a service area of a PACE organization. For anyone uncertain of their eligibility, kind and friendly Great Lakes Pace intake staff can help step callers through the process. Eligibility details can be found on the Great Lakes PACE website, here.