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Addressing Non-Medical Impacts on Health

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InnovAge Virginia PACE - Roanoke Valley Exterior Entrance With An InnovAge Van Parked In Front
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Addressing Non-Medical Impacts on Health

March 17, 2022
This post was authored by InnovAge Chief Medical Officer Dr. Melissa Welch.

Like many baby boomers, thinking about how to best to care for my aging parents is at the front of my mind. Countless conversations with my parents on the best solution for them to help them age at home led my mother, who is 80, to start paying attention to the InnovAge vans in her neighborhood. These are the same vans that give thousands of seniors the freedom to move safety to and from their homes. “I thought, ‘Okay, yes this is what Melissa was talking about,’” she shared.  

InnovAge offers a model of care that allows older adults to age at home, while surrounded by the services necessary to keep them living safely in their communities. The Program of All-inclusive Care for the Elderly is an alternative to nursing facilities that helps seniors age independently, at the place they call home, while addressing physical, social, and emotional well-being.

The program provides all medical care and social support at centers in local neighborhoods. It is an excellent example of a care model that addresses what are called social determinants of health. These include safe housing, transportation, nutritious foods, good communication, and physical activity – all non-medical factors that can have big impacts on a person’s health.

Each participant in PACE, receives personalized care plans. Their plans address needs from home care needs, nutrition, oral health, and physical and mental abilities to medication delivery, caregiver support, and transportation. This all-encompassing approach to a person’s health and well-being has resulted in proven value and improved clinical outcomes for PACE participants. Still, too often, PACE is overlooked or under-recognized for its success in seamlessly integrating social determinants of health within care delivery. Unfortunately, the discussion on social determinants of health seems to be silent on, or barely mentions, PACE.

As a primary care provider fresh out of training, the closest model to PACE I experienced was known as community-oriented primary care, or COPC. This was care that centered on people where they lived, ensuring access, care coordination, communication, case management, and more. I still remember an older adult couple who walked, from their home, into our community-based clinic. We eagerly watched over them as a clinical team, including social and mental health workers, public health nurses, health educators, and more. The couple knew us personally and we knew them. Our care extended into their homes and into hospitals when they needed inpatient care. We helped them to transition as they aged in place. This was the early 1990s.

In the years that followed, the COPC model faded, but recent attention to COPC as a value-based care model (focused on providing quality care over quantity) is heartening. PACE deserves the same attention.

PACE, Cantonese for “peaceful, happy home,” emanated from the ON LOK model in San Francisco where the Chinese community wanted a model of care that would meet the needs of elderly in the community. The model was replicated nationally after Congressional legislation in 1986. As a young physician in San Francisco, it was wonderful to be at the forefront of watching PACE evolve. 

The opportunity for greater expansion of PACE nationally is driven by the growing older adult population in the United States, as well as by the number of them wishing to age in place. InnovAge is prepared to meet this challenge. As it does, I am encouraged that my parents and those like them will benefit greatly from PACE’s integrated care services and I believe more older adults, like my mother, will also be excited to see the “vans” coming into their neighborhoods.
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