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PACE: Keeping a Person with Dementia at Home with Comprehensive Support

The Program of All-Inclusive Care for the Elderly (PACE) is a Medicare and Medicaid program designed to help older adults, including those with dementia, remain living at home rather than moving to a nursing home. It provides coordinated medical care, adult day center services, home care, and other supports—all aimed at keeping the person safe and engaged while giving family caregivers a much-needed break. If you’re feeling overwhelmed and worried about how to manage dementia care at home, PACE may be a lifeline that brings structure, socialization, and medical oversight right to your doorstep.

Key points

  • PACE is a comprehensive Medicare/Medicaid program that provides medical care, adult day center, home care, and transportation to help people with dementia stay at home.
  • Eligibility requires being 55+, living in a PACE service area, and needing nursing home level of care—but you don’t have to be bedbound.
  • The adult day center offers structured activities, socialization, and a safe environment, giving caregivers a reliable break to prevent burnout.
  • Start the enrollment process early, even if you’re managing okay now. Crisis planning leads to costly nursing home placements.
  • Use positive language when introducing PACE to your loved one: 'I have a surprise for you' works better than 'Do you want to go?'
  • If PACE isn’t available, ask the Area Agency on Aging about Medicaid waivers, adult day health centers, or veteran benefits.

What is PACE and How Does It Work?

Eligibility for PACE generally requires that you be 55 or older, live in a PACE service area, and be certified by your state as needing nursing home level of care. Most participants are dually eligible for Medicare and Medicaid, but private pay is also an option. Because PACE is state-specific, the first step is to contact your local Area Agency on Aging to find out if a PACE program exists near you and what the application process looks like. Don’t wait until a crisis—starting early can help you plan and avoid costly emergency placements.

General caregiving information, not medical advice. Check medications and major care changes with your clinician.

Step-by-step

  1. Call your Area Agency on Aging: ask if PACE serves your county, the eligibility requirements (age 55+, nursing home level of care), and enrollment steps. If not available, ask about Medicaid home and community-based waivers or veteran-directed care.

  2. Gather medical records and insurance cards before PACE’s formal evaluation to speed the nursing-home-level-of-care certification.

  3. Tour the nearest PACE center with your loved one; assess if the space is calm, staff interact warmly, and ask about the daily schedule, meals, and how they handle restlessness or refusals.

  4. Confirm which services are included—adult day attendance, transportation, home health aides, personal care, medication management, therapy, caregiver support—and what costs extra.

  5. Ask specifically: 'How do you support someone who wanders or becomes anxious? Is there a quiet room? How do you handle refusals?' Reject sedation or restraint; seek person-centered responses.

  6. Clarify how PACE coordinates with current doctors (e.g., neurologist) and whether existing providers can stay involved or the PACE team manages all care.

  7. If your loved one is hesitant, use a positive invitation: 'Let’s check out this new place together—they have music and snacks, and I’ll stay with you.' Avoid asking 'Do you want to go?'

  8. Start with short visits (2 hours), then gradually extend. Your calm presence early on eases anxiety; staff will guide the transition.

  9. Use the hours your loved one is at the center for genuine self-care (nap, errands, support group)—this sustains your ability to care for them.

  10. Attend care plan meetings and promptly share changes in behavior, appetite, or sleep so the team can adjust medications, therapy, or activities.

What not to do

  • Do not assume PACE is only for those already frail or bedbound; enrolling earlier while mobile and engaged can prevent steeper decline.

  • Do not label the program as 'daycare' or as something they 'have to' do—it feels like abandonment. Frame it as a place to try together.

  • Do not disengage after enrollment; remain an active partner—attend meetings, share feedback, and help staff understand the person’s history and preferences.

  • Do not skip your own rest. Respite benefits both: your loved one gets stimulation, and you return more patient and present.

  • Do not wait for a crisis; applications and assessments take weeks or months, so start early on a good day so support is in place when needed.

Practical tools

  • Community Resource Finder

    Free online tool from the Alzheimer’s Association (communityresourcefinder.org). Search by zip code for PACE programs, adult day centers, respite care, support groups, and other local services with contact details.

  • Daily Schedule Card

    Laminated card listing the PACE center’s routine (e.g., 9 a.m. music, 10 a.m. snack). Show each morning to build predictability—reduces anxiety for people with dementia.

  • Comfort Object Kit

    Small bag with a favorite photo, soft blanket, familiar music player, or fidget object. Give to staff on the first day, explaining what soothes your loved one when anxious or restless.

  • Area Agency on Aging Contact Card

    Wallet- or phone-stored card with your local Area Agency on Aging phone number and website. First call for PACE inquiries, Medicaid waivers, and caregiver support.

Discuss with your clinician

Ask your loved one’s primary care doctor or neurologist: 'Is my loved one at the stage where PACE would be appropriate? Do they meet the nursing home level of care requirement?'

Discuss any medications that might affect participation in PACE activities, such as sedatives or antipsychotics. Ask: 'Can we adjust the medication schedule so my loved one is alert during the day at the center?'

If your loved one has complex medical needs (e.g., feeding tube, oxygen, wound care), ask: 'Can the PACE team manage these at home, or would we need additional nursing support?'

Inquire about advance care planning: 'How does PACE handle end-of-life care? Can they coordinate with hospice if needed?'

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