All-Inclusive Care for the Elderly (PACE)

For an older adult who needs nursing-home-level care but wants to keep living at home, one program tries to make that possible by folding everything into a single plan. PACE, the Program of All-Inclusive Care for the Elderly, is a Medicare and Medicaid program that provides all of a person's medical care, daily support, and social services through one coordinated team, so they can stay in the community instead of moving to a nursing home. This guide explains how PACE works, who qualifies, what it covers, how it is paid for, how to enroll, the common misconceptions, and how to weigh whether it fits.

How PACE Works

PACE is built around a single idea: instead of a family stitching together doctors, therapists, aides, and rides on their own, one team takes responsibility for all of it. Each participant is cared for by an interdisciplinary team of doctors, nurses, social workers, therapists, dietitians, and aides who share one plan and meet regularly to adjust it. That team knows the whole person, not just one organ or one problem, which is what lets the care stay coordinated even as needs change.

Much of the care centers on a PACE day center, where participants come for medical visits, therapy, meals, and social activities, with more care delivered at home when it is needed. How often someone attends depends on their needs, from a few days a week to daily, and transportation to and from the center is part of the program rather than a separate errand a family has to solve. For a family that has spent months juggling appointments and phone calls, that single point of contact is often the first real relief they feel.

Because the same team handles everything, a change in one area flows quickly into the rest of the plan. A fall, a new diagnosis, or a rough stretch at home gets noticed by people who already know the person, and the response does not depend on a family member chasing referrals between separate offices.

The model is well established and still growing: as of 2024, more than 150 PACE programs operated across more than 30 states and the District of Columbia, according to the National PACE Association. Each program serves a defined local area, so whether PACE is available at all depends on where a person lives.

Who Qualifies for PACE

Eligibility rests on need and location rather than income alone, and four conditions generally must be met before someone can join.

Age 55 or older: PACE is designed for older adults, with the minimum age set in federal rules. A certified need for nursing-home-level care: A state agency must confirm the person needs the level of care a nursing home provides. The ability to live safely in the community: At enrollment, the person must be able to live at home safely with PACE support in place. Residence in a PACE service area: The person must live within the local area a PACE program covers.

Meeting the nursing-home-level standard does not mean a person has to enter a nursing home. It is simply the threshold that shows the depth of need PACE is built to handle, and most participants are dually eligible for Medicare and Medicaid. A team reassessment happens regularly, so the plan keeps pace with a person whose needs rise or ease over time.

What a Day in PACE Looks Like

For many participants, the day center is the heart of the program, and picturing a typical day makes PACE easier to understand. A van picks the person up in the morning and brings them to the center, where the day might include a check-in with a nurse, a physical therapy session, a hot lunch, and time with other participants.

Behind the social side, the medical work is happening too. A doctor can see the person without a separate appointment across town, the pharmacy fills prescriptions, and staff watch for the small changes that often signal a bigger problem coming. The hours among other people matter as much as the medical care, since regular company eases the isolation that wears on older adults living alone. At the end of the day, the same van takes the person home, and any help they need there is arranged by the same team.

What PACE Covers

PACE earns the name all-inclusive because it covers the full range of services a frail older adult is likely to need, including some that Medicare and Medicaid would not normally pay for separately.

Because one team approves and arranges all of it, there is no gap where a needed service falls outside the plan. If the team decides a person needs something, the program is responsible for providing it rather than sending the family to find it.

Who Benefits Most From PACE

PACE is not the right tool for every situation, but for a particular kind of need it fits unusually well. The people who gain the most tend to share a few traits.

When several of these are true at once, PACE often does what no single service can, which is hold the whole situation together under one roof.

How PACE Is Paid For

Most people in PACE qualify for both Medicare and Medicaid, and for them the program usually costs nothing out of pocket. There are no deductibles or copayments for any care, drug, or service the PACE team approves, which removes the surprise bills that come with piecing care together elsewhere.

Someone who has Medicare but not Medicaid can still join by paying a monthly premium that covers the long-term care portion, and a person with neither can pay privately. Because the program is responsible for all costs once a person enrolls, it has a built-in reason to keep participants healthy and out of the hospital rather than to limit care. For families weighing the price of a nursing home against staying home, that all-in coverage is part of what makes PACE worth a close look.

What PACE Does Not Cover

The trade for that all-inclusive coverage is that care runs through the program. Participants generally must use PACE's own doctors and approved network, so a treatment from an outside provider that the team has not authorized is usually not covered. The clearest exception is a true emergency, where a person should always seek immediate help.

Coverage also stops at the edge of the service area. A person who moves outside the region a program serves has to leave PACE and find care another way, which is worth keeping in mind for a family that may relocate.

Common Misconceptions About PACE

PACE is widely misunderstood, partly because its name includes the word elderly and partly because it does not look like any single service families already know. A few myths keep people from considering it when it might be a strong fit.

The first is that PACE means giving up the home, when the entire point is the opposite, keeping a person in the community. The second is that PACE is only for people with no money, when in fact those who do not qualify for Medicaid can still join by paying privately or through Medicare. The third is that PACE is just another name for a nursing home, when it is really a way to deliver that level of care without the move. The last is that enrolling locks a person in for good, when anyone can leave the program at any time and return to other coverage. Clearing up these myths matters, because a family that rules PACE out on a misunderstanding can miss the one option that would have kept a loved one at home.

How to Enroll in PACE

A person can leave PACE at any time and for any reason, so enrollment is not a one-way door. Still, because PACE replaces the existing web of doctors and coverage, the choice is worth talking through carefully before starting.

Weighing Whether PACE Fits

PACE suits some families well and others poorly, so it helps to go in clear-eyed. The biggest trade-off is the network limit already described, which brings tight coordination at the cost of seeing outside providers freely. For someone who needs a lot of coordinated help and wants to avoid a nursing home, that trade is often worth it; for someone determined to keep a longtime specialist, it may not be.

Availability is the other real limit, since PACE operates only in certain areas and some programs keep wait lists when demand is high. Among the levels of care, it sits in an unusual spot, delivering nursing-home-level support to people still living at home. Where it operates and fits, it can be one of the most complete ways to age in the community.

Where to Get Help

If PACE might fit a loved one, a local senior advisor can help you understand it alongside the alternatives, including what to do when no program serves your area. For official program details and a directory of local programs, Medicare maintains a clear overview of PACE.

This guide is informational only and is not medical, legal, or financial advice. Program rules, eligibility, and availability vary by state and change over time. Confirm details with a local PACE program or your state Medicaid office before making decisions.