Elderly, frail find alternative to nursing home

ST. LOUIS -- Lillian Morris hasn't always had an easy time of it. She battled through anemia, a stroke about 10 years ago and more recently, two broken hips.

But this much she knew: She had lived on the same patch of family land in south St. Louis since 1939, at times confined to bed or a wheelchair, and she was not about to give it up to move into a nursing home.

That was when PACE, the Program of All-Inclusive Care for the Elderly, entered the picture.

Combining transportation, adult day care and medical treatment, the program is designed to help frail and often low-income senior citizens maintain their independence in their homes for as long as possible.

For Morris' 47-year-old son, PACE stepped in just as he was beginning to feel stretched to his limit. Besides caring for his 72-year-old disabled mother, he was caring for a brother who is mentally handicapped and partially blind.

"Things turned around when PACE came around," James Roberts said.

Morris' doctor recommended the program, which is administered by Alexian Brothers Community Services St. Louis, part of a health care network.

Although Roberts' training as an army medic helped, caring for his mother was difficult at times before she started the program last fall, Roberts said. Frustration would get the better of them, and it took a long time for him to feel comfortable helping with some of her basic needs.

As he recalled those stressful days, he mentions feeding tubes and catheters in passing, a normal part of the daily routine.

Lives of their own

Today, the program frees him to have a life of his own. "It gives her a life, too," he said.

And that is one of its goals.

Every weekday morning at 7:30 a.m., a van picks up Morris from the small, three-bedroom house she shares with her two sons for a short trip to the center, which serves 126 people.

Morris' neck was so stiff when she first started she could only look at the floor. Today, she enjoys looking out the window of the van, watching the traffic and the neighborhood once shielded from her view.

"Now I can take in addresses and signs," she said.

Her life has changed in other ways. She attends a daily interdenominational service at the center, she goes on day trips to the park or shopping, and she participates in morning exercises.

Physical therapist Dana Garascia sees the difference.

Morris is getting stronger. She is able to straighten out her neck and feet. She can maneuver her wheelchair herself. And she smiles a lot more often, Garascia said.

Morris has noticed it, too.

"I couldn't talk good when I came in, and now I talk too much," she joked.

Garascia said she's worked to help Roberts have an easier time caring for his mother. He has learned different ways to lift her, how to put her into bed and ways to stretch her legs and neck.

Operates in 14 states

PACE programs operate in 14 states, including California, Colorado, Maryland, Massachusetts, Michigan, New York, Ohio, Oregon, South Carolina, Tennessee, Texas, Washington and Wisconsin.

The program is designed to be an alternative to a nursing home. It receives an average of $4,000 per client each month from Medicaid and Medicare.

It will administer funds to pay for a patient's dental work if that work could result in better nutrition; in some cases, money is approved to pay heating or air conditioning bills. "The key is to prevent health care problems from happening," according to Robert Greenwood, spokesman for the National PACE Association.

When it becomes evident that patients need more intense care, they are referred to a nursing home. Some PACE clients are referred by health care providers or a health or senior services agency. In some cases, they learn of the program by word of mouth.

To qualify, clients must be 55 or older, live in an area the program serves and be judged by the state to need nursing home level care. A typical patient is 80 years old.

The program last month received a nod of approval from the federal government. The U.S. Centers for Medicare and Medicaid made Alexian Brothers in St. Louis the first PACE program nationwide to be permanently funded, allowing administrators to look into expanding the program.

The PACE model began in the 1970s in San Francisco when Chinese-Americans created On Lok Senior Services, a network of services that allowed elderly residents to remain in their family homes. "On lok" is Cantonese for "peaceful, happy abode."