Nursing homes offer skilled nursing and around-the-clock care for individuals who are too sick or frail to adequately care for themselves. However, many of these individuals would prefer to remain in their own homes rather than live in a nursing home. There may also be concerns about the costs involved in nursing home care. Fortunately, many states, including California, offer two alternative programs to nursing homes: the Program of All-Inclusive Care for the Elderly (PACE), and the Social Managed Care Plan.
The PACE is an optional benefit that is offered under both Medicare and Medicaid plans, and features a comprehensive medical and social services package that can be utilized at adult day care, inpatient, and home facilities. Doctors, nurses, and other health care professionals work together to assess an individual’s needs, develop a care plan, and deliver the required services. The PACE participants must be at least 55 years old, live in a PACE service area, be able to live safely in a community setting, and be deemed as requiring nursing home level care by a health care professional.
California’s PACE manages all the medical and social services required by its participants in order for them to maintain their independence and quality of life while remaining in their homes. Such services include (but are not limited to) skilled nursing, primary care, physical therapy, recreational therapy, transportation, meal preparation, personal care, and nutritional counseling. These services are available 24 hours a day, 7 days a week, and 365 days a year. Payments for the PACE are made monthly through either Medicare or Medicaid.
The Social Managed Care Plan is an organization that not only provides the full benefits of Medicare’s Managed Care Plan, but the additional benefits of prescription drug coverage, adult day care, personal care, homemaker services, and medical transportation. In some cases, eye, ear, and dental care services may also be provided. This comprehensive plan is typically not provided through Medicare or most senior health care plans.
There are several participating sites for the Social Managed Care Plan. One of these, called the Senior Care Action Network (SCAN), has locations in San Diego, Ventura, Glendale, and Long Beach, California. In order to qualify for the SCAN, participants must be at least 65 years of age, have Medicare Part A and Part B coverage, and be paying for the Part B premium during their enrollment in the Social Managed Care Plan. Additionally, the participant must reside in the SCAN service area. Qualifying participants must also obtain a Nursing Home Certificate that states that the potential enrollee’s current caregiver, such as a close family member, is insufficient to keep the enrollee out of a nursing home.
Costs for the Social Managed Care Plan are estimated by the number and types of services provided. Therefore, plan premiums and co-payments will differ. More information about Social Managed Care Plan costs and benefits may be obtained by researching Medicare Managed Care options.
Tags: california, managed care, Nursing Homes, PACE, skilled nursing
