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Frail older adults can stay at home with LIFE program’s help

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Numerous studies reflect that a large majority of older adults want to continue to live at home for as long as possible.

But “aging in place” can become difficult if we begin to suffer functional and cognitive losses and are no longer able to live fully independently. The burdens placed on our family caregivers can become overwhelming.

In recent years, the expansion of community-based and home care support services has allowed many seniors who would have otherwise been required to move to a nursing home to remain at home. This article is intended to alert readers to the existing of one such program that has benefited a number of my clients and their families. It is a program that I think is underappreciated.  

The LIFE program provides health-care and supportive services for older persons who are certified to need a nursing home level of care but are able to live safely at home with the program’s support. If you have limited financial resources and your income is within 300 percent of the Federal Benefit Rate ($2,163 in 2014) your participation in the LIFE program may be fully covered by a combination of Medicaid and Medicare. (And private payment may be an option for those who do not qualify for those programs).

On a national level, this wonderful but underutilized program is referred to as PACE (Program of All-inclusive Care for the Elderly). The name was changed in Pennsylvania to avoid confusion with our state pharmaceutical assistance program. The Pennsylvania program is generally referred to as LIFE (Living Independently For Elders).

The LIFE program brings together all the medical and social services needed to provide community-based care for seniors who are frail enough to meet the Medicaid standards for nursing-home care. The program is designed to meet all of its participants health related needs. You are generally provided with transportation to and from your home to an adult day health center where you can participate in activities and medical appointments. However, services may also be given in your home, a hospital, or a long term care facility where necessary.

Because the LIFE interdisciplinary health care team authorizes and coordinates all your health care services, the program becomes a one-stop alternative that simplifies your access to health care. And increased coordination of your care can result in improved quality of that care.

The Balanced Budget Act of 1997 established the PACE model as a permanent provider type under both the Medicare and Medicaid programs. Most LIFE participants are eligible to receive services under both Medicare and Medicaid. The joint funding sources may be sufficient to provide total care for dually eligible beneficiaries.

Like another home care alternative – the Aging Waiver Program, LIFE serves individuals who are 60 years of age or older, who would otherwise qualify clinically to be in a nursing facility, but who choose instead to remain in their homes with the support of LIFE program services. (The age threshold for LIFE can be reduced to age 55 depending on the program). Clinical eligibility for participation in LIFE programs is determined through an assessment done by the local Area Agency on Aging, in cooperation with the individual’s personal physician.

To qualify for Medicaid payment for LIFE services, the individual’s available income and available resources must be at or below 300% of the federal benefit rate. The available resource ceiling is $8,000. Limited “spend down” is available since the LIFE program rules do allow individuals with income in excess of the ceiling to qualify for partial Medicaid funding by paying a monthly share of the cost of LIFE services, with Medicaid paying the monthly remainder. If an individual wishes to pay privately for participation in the LIFE program, his/her monthly premium is equal to that amount that would otherwise be paid by Medicaid.

Enrollment is voluntary. Once enrolled, PACE becomes the sole source of all Medicare and Medicaid covered services, as well as other medical, social, or rehabilitation services required by the enrollee. If an enrollee requires placement in a nursing home, the LIFE provider is responsible for the cost of care. An enrollee’s needs are determined by PACE’s team of care providers, which includes primary care physicians, nurses, therapists, social workers, personal care attendants, dieticans, and drivers.

With capitation plans like PACE, providers receive a flat monthly fee in return for covering the entire spectrum of care for enrollees from acute to long-term. The payment does not vary no matter how many services are provided. This provides a strong incentive for the LIFE program to keep its participants healthy.

Pennsylvania has one the most vigorous PACE programs in the country. People can thrive under the program. But many seniors are unaware of or don’t understand the value of the LIFE alternative. And, depending on where you live, it may not be an option for you. As of July 2014, LIFE is available in many but not all geographic areas of Pennsylvania. A list of areas and providers is available on the PA Department of Public Welfare website: http://tinyurl.com/mgs33q8.  For your ease of reference I’ve reproduced the list below.

National information about PACE and a list of programs in each state is available on the Pace4You website at http://tinyurl.com/nlxxlgp.   

Here is a list of the 23 LIFE programs currently operating in Pennsylvania:

 

Albright LIFE Williamsport

901 Memorial Avenue

Williamsport, PA 17701

Ph: 570-322-5433

URL: click here to visit website 


NewCourtland LIFE

5457 Wayne Avenue

Philadelphia, PA 19144

Ph: 267-335-1500

URL: click here to visit website 


LIFE Lutheran Services, Inc.

840 Fifth Avenue

Chambersburg, PA 17201

Ph: 717-264-5433

E-mail: info@lifelutheranservices.org

URL: click here to visit website 


LIFE Butler County

231 West Diamond Street

Butler, PA 16001

Ph: 724-287-5433

URL: click here to visit website 


LIFE St. Mary

Attention: Erin Williams

2500 Northgate Road

Trevose, PA 19053

Ph: 267-991-7600

E-mail: ewilliams@stmaryhealthcare.org

URL: click here to visit website 


LIFE Geisinger – IHM Center

Attention: Maria Maletta Hastie

2300 Adams Avenue

Scranton, PA 18509

Ph: (800) 395-8759

Fax: (570) 558-6161

E-mail: mchastie@geisinger.edu

URL: click here to visit website 


Senior LIFE Johnstown

401 Broad Street

Johnstown, PA 15906

Ph: 877-998-LIFE

E-mail: info@seniorLIFEpa.com

URL: click here to visit website 


LIFE Lawrence County

PA 16101

Ph: 724-657-8800

URL: click here to visit website 


Senior LIFE Uniontown

89 W. Fayette Street

Uniontown, PA 15401

Ph: 877-998-LIFE

E-mail: info@seniorlifepa.com

URL: click here to visit website 


Senior LIFE Washington

2114 N. Franklin Drive

Washington, PA 15301

Ph: 877-998-LIFE

E-mail: info@seniorlifepa.com

URL: click here to visit website 


Albright LIFE Lancaster

417 W. Frederick Street

Lancaster, PA 17603

Ph: 717-381-4320

URL: click here to visit website 


LIFE – Pittsburgh

One – Parkway Center – 875 Greentree Road

Suite 200

Pittsburgh, PA 15220-

Ph: (412) 388-8042

URL: click here to visit website 


SeniorLIFE Lehigh Valley

2045 Westgate Drive, Suite 100

Bethlehem, PA 18017

Ph: 484-895-4302


Community LIFE

2400 Ardmore Boulevard

Suite 700

Pittsburgh, PA 15221-

Ph: (412) 436-1320

URL: click here to visit website 


Mercy LIFE

1900 South Broad Street

Philadelphia, PA 19145

Ph: (215) 339-4747

URL: click here to visit website 


LIFE – University of Pennsylvania School of Nursing

4508 Chestnut Street

Philadelphia, PA 19139

Ph: (215) 573-7200

URL: click here to visit website 


LIFE Beaver County

131 Pleasant Drive, Suite 1

Aliquippa, PA 15001

Ph: (724) 378-5400

URL: click here to visit website 


LIFE – NWPA

149 West 22nd St.

Erie, PA 16502

URL: click here to visit website 


SeniorLIFE Greensburg

123 Triangle Drive

Greensburg, PA 15601

Ph: 724-838-8300

E-mail: info@seniorlifepa.com

URL: click here to visit website 


LIFE Geisinger – Roosevelt Court Center

Attention: Marc Varano

1100 Spruce St., Suite 100

Kulpmont, PA 17834

Ph: 866-230-6465

Fax: 570-373-2101

E-mail: mavarano@geisinger.edu

URL: click here to visit website 


Senior LIFE York

1500 Memory Lane Ext.

York, PA 17402

Ph: 877-998-LIFE

E-mail: info@seniorlifepa.com

URL: click here to visit website 


Albright LIFE Lebanon

113 South 9th Street

Lebanon, PA 17042

Ph: 717-376-1133

URL: click here to visit website 


Senior LIFE Ebensburg

429 Manor Drive

Edensburg, PA 15931

Ph: 877-998-LIFE

E-mail: info@seniorlifepa.com

URL: click here to visit website