Rheumatoid arthritis makes it hard for
Ida Mae Shannon, 72, to get around. After her kneecap was replaced, she
could no longer push her laundry cart to the coin laundry. Cooped up and
lonely, she worried that she would have to move from her O'Fallon Park
apartment to a nursing home.
A social worker helped her find an alternative. It's called the Program of
All-Inclusive Care of the Elderly. The innovative program, which has
headquarters at 3900 South Grand Boulevard, provides whatever services are
needed for a person to remain independent.
For instance, a van picks Shannon up three days a week and takes her to
the program's adult day-care center for activities such as bingo and
cookie-baking. She can have a hot meal, see her doctor at the on-site
clinic and pick up her medicine. The program also sends someone to do her
Staying out of a nursing home not only makes Shannon and the other 181
participants happy; it saves taxpayers money. A flat monthly fee covers
everything from toenail clipping to open-heart surgery. On an annual
basis, the cost to the state Medicaid program runs about $8,000 per person
below nursing home bills.
The approach has piqued legislators'
interest. Rep. Jodi Stefanick, R-St. Louis County, brought her interim
committee on Medicaid cost containment to the PACE center on Monday to
"I'm really excited about this idea," Stefanick said. She said
it helped elderly people keep control over their lives while coordinating
their care and making the state's cost more predictable.
The St. Louis center is one of 38 PACE programs nationally and the only
one in Missouri. Illinois has one - in Chicago. All are operated by
nonprofit organizations. Alexian Brothers Community Services runs the St.
All but two of the participants here qualify as low-income, so their bills
are paid by the state Medicaid program. The cost: $2,376 a month for each
participant. Medicare, the federal program for the elderly, kicks in an
additional $1,400 a month, on average.
The flat fee covers everything from chore services such as grocery buying
and housecleaning to medical services such as hospitalization and therapy
after a fall. The fee also covers doctor visits and prescription drugs.
There are no deductibles or co-pays.
Anita Jane Tierney, 80, was surprised when she heard about the program.
"It sounded too good to be true," said Tierney, who lives in a
condo in Mehlville with her Maltese dog, Brutus. Since she signed up two
years ago, she has had eye surgery and was fitted for dentures and hearing
"All these things are thousands and thousands of dollars, and I could
never have afforded them," she said.
A nursing home would cost about $8,000 more a year for each participant,
estimates Shawn Bloom, president of the National PACE Association. That
means taxpayers would spend $1.6 million more each year for the roughly
200 people using the St. Louis center.
Deno Fabbre, the St. Louis center's chief executive, would like to open
another center in the north part of St. Louis. But Missouri's policies
make it hard to expand.
The state's eligibility criteria are so strict that a person on Medicaid
must be in worse health to enter the PACE program than to move into a
A point system assesses how much help the person needs for daily tasks,
such as eating and using the toilet. A person must score 24 points to be
eligible for PACE but only 18 points to move into a nursing home.
Elderly people also must be extremely poor to qualify for Medicaid. They
can have income of no more than $985 a month and $999 in assets, not
counting their house and car.
Fabbre said that bars working-class people who have a small pension of
perhaps $1,100 a month. Yet those are "the very people that the state
should want in this program" so that they don't lose their
independence and become dependent on the state for nursing home care.
Reporter Virginia Young: