Participants enjoy festive Valentine’s Day dances


Piedmont Health SeniorCare hosted its annual Valentine’s Day dances on February 12 and 13. Participants and staff dressed in red and pink, joined the conga line and got low under the limbo stick in celebration of Valentine’s Day. Participants also had Valentine’s photos taken and the PHSC King and Queen were crowned. Music by a DJ and special Valentine’s snacks were also provided to complete the fun event.

Burlington Site Hosts Healthy Living Event



On Saturday, Jan. 31, the Burlington facility hosted an event, “TIPS on Healthy Living,” to kick off the new year. Brunch was served and participants learned about healthy eating, medication management, and the importance of exercise and rest. Participants also played Stress Management BINGO, a fun way to learn tips on reducing stress in daily living.

Japanese visitors tour local senior housing

In its first U.S. tour in more than 14 years, a Japanese senior citizens group visited Orange and Chatham senior housing communities last week before heading north to see more options in Washington, D.C.

The Japanese Foundation for Senior Citizens delegates visited a a house in Carrboro designed by architect Jason Hart of CUBE Design + Research that helps homeowners age in place, as well as a nursing home, Signature of Chapel Hill, and several wellness centers at local continuing care retirement communities (CCRCs).

They also toured Carolina House, an assisted living center in Chapel Hill, and Charles House-Winmore, a private-pay eldercare home in Carrboro.

The group held discussions at senior centers in Chatham and Orange counties and the Pittsboro branch of Piedmont Health SeniorCare (PACE), whose five county centers serve seniors living at home in Alamance, Caswell, Chatham, Lee and Orange counties.

The Chatham County Senior Center presented a talk by attorney Mark Shelburne of the N.C. Housing Finance Agency, who explained how the federal Low-Income Tax Housing Credit is the largest and most successful affordable housing program in America – having provided 2.4 million senior housing units to date and adding an additional 100,000 units annually.

The foundation’s president, Hiroshi Takahashi, and his assistant, Reiko Ogawa, led the group of 17 participants, which included housing industry leaders, professors of Toyo University, the International University of Health and Welfare, and Kintetsu International, a world leader in travel, freight and business technology.

The visit was facilitated by Chapel Hill residents and stateside Foundation members Richard Crume and his wife, Yoko Sakuma Crume, an expert in aging research and policy.

The group held working lunches with local leaders in senior housing at Galloway Ridge, Carol Woods and The Cedars at Meadowmont.

At last Wednesday’s lunch, Bob Woodruff, president and CEO of The Cedars, and Krista Lemery, administrator of Home Care and Clinic at The Cedars, sat with Takahashi and Mika Yamamoto, a professor of social work at Toyo University.

They agreed that food was one of the most important aspects of senior care because aging decreases a person’s sense of smell and taste, which are integral to the enjoyment of food.

“We have the best food, but also get the most complaints about it because no one likes to eat at the same restaurant every meal, even if it is the best restaurant in town,” Woodruff said. “Our chef, who came to us from an exclusive country club, is always working to bring new food experiences to the table to keep the dining experience fresh.”

They noted that population demographics and industrialization/modernization are driving forces in both societies, with the historical American system of families taking care of elders collapsing earlier than Japan’s. That’s why, Woodruff said, the United States has so many CCRCs now.

Takahashi said there are no places like The Cedars membership program in Japan, but the Japanese are starting to implement a program that identifies where older people are living and then tries to provide elder care services there as it provides services for other generations, too.

He described one Japanese village where small houses are clustered around a community house that provides day care for people of all ages – children, adults with disabilities and mental/cognitive health issues – run by volunteers but supported by nurses, psychologists and other health-care professionals. The community house includes a traditional shrine to spark the sharing of memories and to reminisce about the past.

The challenge to having places like The Cedars, Carol Woods and Galloway Ridge in Japan is affordability, because the cost of land is so high, Takahashi said. The Cedars at Meadowmont is spread over 47 acres.

“People have really just started to want these,” Takahashi said, “but when some go to better places than others it sends a message.”

The Japanese government is worried about escalating costs of long-term care insurance and other social programs because the number of older adults continues to increase, just as it does in the United States, but without the immigration of young workers the United States enjoys.

On the upside, providing senior care benefits allows different sections of the economy – for-profit and non-profit – to grow, Takahashi said.

Japan has a universal medical health insurance program which covers all but 2 percent of the population. That 2 percent is covered by a welfare program, much like Medicaid in the United States.

The universal long-term care insurance program is unique in the world with only five or six other countries providing such care, but it does require everyone who is able to pay into the system, just as they pay into Japan’s universal health insurance program.

A care manager works with the client, their family and health-care providers to choose one of five levels of care. The upper level of care provided by long-term care insurance is capped at $3,500 per month. Long-term care insurance pays 90 percent and the individual has pays 10 percent.

Japan’s health-care provisions – the Welfare Act of the mid-1960s and the 2000 Long-term Care Insurance Act – has helped Japanese women live the longest of any country; and Japanese men live to average age of 85, Takahashi said.

During a presentation at the Seymour Center, Takahashi said important questions the group is trying to answer are: Are our seniors having a successful aging experience? How should care be provided? How do we deal with people living alone? How should we help people maintain a high motivation to live?

When asked what the best thing he learned here was, Takahashi answered, “the wide variety of what each of the retirement services has to offer.”

By: Sally Keeney/ Chapel Hill News

Published: November 10, 2014


Funding means program for seniors can accept new clients

After six months of capped enrollment on the statewide Program for All-Inclusive Care for the Elderly, a Burlington facility that looks after nearly 140 adults is able to accept new participants again.

“We’re so excited about it,” said Marianne Ratcliffe, executive director of Piedmont Health SeniorCare, which has a facility on Vaughn Road and another in Pittsboro.

Most of the participants in the program live at home and are taken to the facility during the day, where they take part in activities and receive medical services.

From April 1 to Sept. 30, the state’s Division of Medical Assistance imposed a freeze on enrollment at the Burlington facility — and PACE facilities around the state — to “study the growth rate of PACE … and ensure that adequate funds were appropriated” for the next fiscal year to allow two new PACE facilities to open.

Brian Toomey, CEO of Piedmont Health SeniorCare, told the Times-News in June that if enrollment caps and a decreased budget carried over into the next year, the nonprofit would have to close its Burlington facility to pay off debt on its Pittsboro center, which opened in January.

But with the state’s new budget, $52 million in Medicaid funds was approved for PACE programs, now allowing Piedmont Health’s Burlington center to add three new participants each month, and the Pittsboro facility to add six monthly.

Participants in PACE, which is a waiver program through Medicaid and Medicare, are usually dually eligible for both programs, Ratcliffe said.

“Every month for John Smith, we get a capitated payment — one lump sum from Medicare and Medicaid,” Ratcliffe said. “The PACE program is responsible for whatever medical services are needed to keep that senior safe and healthy at home. Whatever happens to that person — if they need cancer treatment, dialysis, to be hospitalized — we get this capitated lump sum payment, and we have the responsibility for caring for that individual, regardless of the scope of services.”

Ratcliffe said the program offers at least a 20 percent savings for the state, with its Medicaid office paying $3,310 per PACE participant each month. As of April, she said, the average long-term monthly Medicaid rate for someone staying in a nursing home was $4,712.

“The PACE model is not saying nursing homes are terrible,” Ratcliffe said. “There is a place for nursing homes. This provides them with an opportunity to age at home.”

Now that the state has approved enough funding to allow the PACE facilities to continue to grow, Ratcliffe said Piedmont Health SeniorCare is grateful to local Republican legislators Sen. Rick Gunn, Rep. Dennis Riddell and Rep. Steve Ross, as well as Dr. Robin Cummings, deputy secretary, and others at the N.C. Department of Health and Human Services for working to secure PACE’s budget.

For more information on Piedmont Health SeniorCare, call the Burlington facility at 336-532-000, or visit its website at


By Natalie Allison Janicello / Times-News
Published: Wednesday, October 29, 2014 at 05:26 PM.

PACE: A model for efficient use of tax dollars


As anyone who has been following the news knows, North Carolina Gov. Pat McCrory has launched a full-scale effort to cut state government spending. The governor recently asked state agencies to cut costs on the final months of the budget year, saying he wanted to “keep a tight hand on the taxpayer’s purse,” according to reports in the Raleigh News & Observer.

Among the chief causes for concern is Medicaid, which health officials say has run up $140 million in unanticipated spending. If the governor’s advisors are looking for a model for Medicaid reform, I would like to humbly and helpfully suggest that Piedmont Health has a model that they can emulate: Piedmont Health SeniorCare.
Piedmont Health SeniorCare is a Program of All-Inclusive Care for the Elderly (PACE). PACE has been growing all over the country (Piedmont Health SeniorCare late last year expanded the program from the existing facility in Burlington, adding another in Pittsboro.) PACE has been lauded all over the country, with publications such as the Washington Post and New York Times highlighting them as part of the future for long-term care in this country.
PACE serves citizens who are 55 years old or older and eligible for nursing home care. The program allows participants to stay at home – where they receive comprehensive, coordinated care from a team of providers – rather than moving to a nursing home. Institutionalized care is more expensive for the Medicaid system than staying at home, and senior citizens tend to be more comfortable at home, closer to families, friends and loved ones.
But besides appealing to patients and their loved ones, PACE has some qualities that should be very attractive to anyone looking to control Medicaid spending. For one thing, its costs are predictable – don’t blame PACE for any of that $140 million in unanticipated spending. That’s because PACE funding is capitated; PACE providers get a fixed amount of funding and take on care at full risk and responsibility for any expenses incurred beyond the funds provided. PACE saves the state $17,000 per person per year in Medicaid funding.
And it’s important to realize that PACE works with the frail elderly; people with multiple, chronic conditions as well as disabilities that inhabit their ability to eat, bathe, dress and perform other essential functions. Almost half of PACE participants have a formal diagnosis of dementia, including Alzheimer’s. At the time of enrollment, the average PACE participant is taking 12 medications. In sum, PACE serves the state’s most costly and medically complicated population. 
When you mention Medicaid, many people may think of women and children, but more Medicaid spending actually goes to the kind of population served by PACE. If you can save money spent on the frail elderly, you are hitting the sweet spot of Medicaid savings.
Despite this, PACE health outcomes are remarkably good. Participants experience fewer hospitalizations compared to other Medicaid programs and have a low risk for long-term nursing home placement. On average, PACE participants experience one hospitalization every two years, and one emergency room visit every three years. Only 4 percent requite nursing home placement.
These health outcomes are the envy of other Medicaid programs that service long-term care residents.
Research by Abt Associates further underscores the outcomes. The research shows that, in comparison to traditional Medicare/Medicaid enrollees, PACE participants have lower rates of inpatient utilization, higher rates for utilization of ambulatory services and a lower mortality rate. In addition, participants reported a better health status and higher quality of life.
These health outcomes should not be a surprise. High-quality care is required under state and federal rules, and PACE has rigorous quality-assurance protocols and program data that is reviewed annually by government regulators. Gov. McCrory has previously stated his support for PACE programs, and rightly so. It is worth mentioning that North Carolina is a leader in the PACE model. The state now has 10 PACE programs – about 10 percent of all the PACE programs in the country. PACE helps establish North Carolina as a leader in health-care innovation.
It is laudable that our governor and General Assembly are committed to being responsible with taxpayer money, especially with the Medicaid program. As they look for ways to rein in costs, they should make sure to recognize what is working well and what is not, and they may want to look to PACE as a model for how Medicaid funds should be spent.

Piedmont Health SeniorCare celebrates historic milestone

Piedmont Health SeniorCare Celebrates Historic Milestone
PACE Community Celebrates Opening of Over 100 Programs
March 6, 2014 – Burlington, NC– Today, Piedmont Health SeniorCare joins caregivers across the country celebrating a historic milestone in the growth of community-based care for seniors. With the opening of four new programs this month, the number of Programs of All-inclusive Care for the Elderly (PACE) now exceeds 100. PACE, which was developed in San Francisco in the 1970s, helps to keep nursing home-eligible elders living in the community.
“The story of PACE is a rarity in today’s health care policy environment,” said Shawn Bloom, president and CEO of the National PACE Association. “PACE is a commonsense approach to providing care to older people that was rigorously studied and tested and then able to become a permanent part of our health care system. We don’t often see successful innovations allowed to thrive and grow like PACE.”
PACE programs bring together a coordinated team of doctors, nurses, social workers and therapists to provide seniors with an individualized care plan that addresses each person’s unique medical care and social needs. The result is higher quality care and far more favorable outcomes compared to traditional care options. More than 90 percent of PACE enrollees reside outside of nursing homes.
“In Burlington, NC, Piedmont Health SeniorCare has been operating a PACE program for 5 years,” said Executive Director, Marianne Ratcliffe. “We are very proud of the hundreds of individuals and families we have helped by providing a way to keep older individuals in the community for as long as possible.”
The PACE model was developed in the 1970s in San Francisco by On Lok, a community-based organization serving Chinese and Italian American neighborhoods. Marie-Louise Ansak, a health care consultant, developed the model with the goal of allowing elders to remain in their communities for as long as possible. The PACE model was so successful it was studied by the state of California and federal health care policy officials.
Support from the Robert Wood Johnson Foundation and the John A. Hartford Foundation led to the development of a Medicare Demonstration Project and start-up funds for different types of sponsors to develop PACE in their communities. The success of 15 PACE replication programs led Congress to pass legislation creating PACE as a permanent provider type as part of the Balanced Budget Act of 1997. Just this week, President Obama’s 2015 budget proposal seeks to extend the role of PACE by calling on Congress to create a PACE pilot program for people age 55 and under who need long-term services and supports.
PACE is unique because it integrates care delivery by directly providing all medically necessary care and services through an interdisciplinary team, transportation system and PACE center. Using a bundled payment model, PACE serves high-need, high-cost individuals who require daily hands-on care.
The four new PACE organizations opening this month are in California, Massachusetts, Michigan and Virginia. There are now 103 PACE organizations operating in 31 states.