title: The growing pains of integrated health care for the elderly: lessons from the expansion of PACE.
abstract: The early success of the demonstration Program of All-Inclusive Care for the Elderly (PACE) led to its designation as a permanent Medicare program in 1997. But the growth in the number of programs and enrollment has lagged and does not meet expectations. This article offers insights into the mechanisms influencing the expansion of PACE, from information obtained in interviews and surveys of administrators, medical directors, and financial officers in 27 PACE programs. Sixteen barriers to expansion were found, including competition, PACE model characteristics, poor understanding of the program among referral sources, and a lack of financing for expansion. This experience offers important lessons for providing integrated health care to the frail elderly.
authors.affiliation: University of Rochester, USA.
authors.forename: Diane L
authors.initials: DL
authors.lastname: Gross
authors.forename: Helena
authors.initials: H
authors.lastname: Temkin-Greener
authors.forename: Stephen
authors.initials: S
authors.lastname: Kunitz
authors.forename: Dana B
authors.initials: DB
authors.lastname: Mukamel
mesh_terms: D000368:Aged; D003191:Comprehensive Health Care / Q000458:organization & administration*; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D016330:Frail Elderly; D006297:Health Services Accessibility; D006302:Health Services Research; D006299:Health Services for the Aged / Q000458:organization & administration*; D006707:Homes for the Aged; D006801:Humans; D008134:Long-Term Care / Q000458:organization & administration; D006278:Medicare / Q000458:organization & administration*; D017146:Models, Organizational; D009735:Nursing Homes; D017063:Outcome Assessment, Health Care; D015397:Program Evaluation; D011785:Quality Assurance, Health Care; D019984:Quality Indicators, Health Care; D011795:Surveys and Questionnaires; D014481:United States