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PACE: Your All-in-One Partner for Staying at Home with Dementia

The Program of All-Inclusive Care for the Elderly (PACE) is a lifeline for families who want their loved one to remain at home but need comprehensive, coordinated support. It wraps medical care, adult day center activities, home care, and even transportation into one seamless program, often at no cost if you qualify for Medicaid. For caregivers feeling stretched thin, PACE can mean the difference between crisis placement and years of safe, dignified aging in place.

Key points

  • PACE is a single, coordinated program that combines medical care, adult day center, home care, and transportation—all aimed at keeping your loved one at home.
  • Eligibility requires being 55+, living in a PACE service area, and needing a nursing-home level of care. Most people with moderate to advanced dementia qualify.
  • If you have Medicaid, PACE is free. If you have Medicare only, there is a monthly premium (around $3,000), but it covers everything.
  • The adult day center is your main respite tool—use it regularly to prevent caregiver burnout and give your loved one meaningful social engagement.
  • Start the enrollment process early, before a crisis. Contact the National PACE Association or your Area Agency on Aging to find a center near you.
  • Communicate openly with the PACE team about any changes in your loved one's condition—they can adjust the care plan proactively.

What is PACE and how does it work?

PACE stands for Program of All-Inclusive Care for the Elderly. Think of it as a one-stop shop that pulls together all the pieces you'd otherwise have to juggle yourself: doctor visits, medications, adult day center, home care, and even help with meals and transportation. As one expert explains, PACE takes the Medicare and Medicaid dollars that would normally be scattered across different providers and puts them into one integrated delivery system. That means your loved one gets a team—a doctor, nurse, social worker, therapist, and aides—who all know them and work together to keep them at home as long as possible.

Why is PACE especially helpful for dementia caregivers?

Dementia care is exhausting because it's not just one thing—it's medical management, behavioral challenges, safety supervision, and emotional support all at once. PACE addresses this by offering adult day center programming that provides socialization and structured activities designed for people with memory loss. This gives the person with dementia a safe, engaging place to be during the day, while you get a real break. As one caregiver resource notes, time apart is healthy for both of you: the person with dementia gets to interact with peers and trained staff, and you get to rest, run errands, or simply breathe. PACE also coordinates home care so that if your loved one needs help with bathing or meals on days they stay home, that help arrives without you having to arrange it separately.

How does PACE help avoid nursing home placement?

The whole goal of PACE is to prevent or delay nursing home placement. It does this by catching problems early—a nurse might notice a change in behavior or a new medication issue before it becomes a crisis. The program also provides in-home support like meal delivery, home modifications, and even emergency response systems. As one source puts it, PACE is 'basically encouraging people to stay at home versus be in a nursing home or hospital.' For families who are determined to keep their loved one home but feel they're running out of steam, PACE can be the extra set of hands that makes it sustainable.

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

Step-by-step

  1. Check if PACE is available in your area. Visit the National PACE Association website (www.npaonline.org) and enter your zip code. As of now, PACE operates in 31 states, so it may not be everywhere. If you don't see a center near you, call your local Area Agency on Aging—they can tell you about similar programs in your state.

  2. Determine if your loved one meets the eligibility criteria. To qualify for PACE, the person must be 55 or older, live in a PACE service area, and be certified by their state as needing a nursing-home level of care. They must also be able to live safely in the community with PACE support. A social worker or PACE enrollment coordinator can help you assess this.

  3. Call the nearest PACE center and ask for an informational meeting or tour. Most centers welcome you to visit, meet the team, and see the adult day center. Bring a list of your loved one's medical conditions, medications, and current challenges (like falls, wandering, or incontinence). Ask how they handle dementia-specific behaviors—some centers have specialized memory care programming.

  4. Review the financial side. If your loved one qualifies for Medicaid, PACE is typically free—no premiums, copays, or deductibles for covered services. If they have Medicare only, there is a monthly premium (around $3,000 as of one source), but that still covers all medical care, day center, home care, and prescriptions. If you have private insurance or can pay out-of-pocket, ask the center about sliding-scale options.

  5. Once enrolled, work with the PACE team to create a personalized care plan. This plan will include a schedule for adult day center attendance (often 2–5 days a week), home care visits (for bathing, dressing, or meals), and medical appointments. The team will also arrange transportation—many PACE centers have vans that pick up and drop off at your home.

  6. Use the adult day center as your primary respite tool. Drop your loved one off in the morning and pick them up in the afternoon. During that time, you can rest, run errands, go to your own doctor appointments, or simply have quiet time at home. The center will provide meals, activities, and supervision. If your loved one is resistant at first, the staff are trained to help with transitions—ask them for tips.

  7. Communicate regularly with the PACE team about any changes. If your loved one has a new behavior (like increased agitation or wandering), tell the nurse or social worker. They can adjust medications, recommend environmental changes, or provide additional in-home support. This proactive approach is what keeps people out of crisis and out of nursing homes.

  8. Plan for emergencies. PACE centers typically have 24/7 on-call staff. If you have a sudden need—like you get sick or have a family emergency—call the center. They may be able to arrange temporary increased home care or an overnight stay at the center (some PACE programs offer short-term residential respite).

What not to do

  • Don't assume PACE is only for people who are already bedridden or very frail. Many people with early- to mid-stage dementia qualify because they need supervision or help with some daily tasks. The program is designed to keep people active and engaged, not just to provide custodial care.

  • Don't wait until you're in crisis to apply. Enrollment can take several weeks, and there may be a waitlist. Start the process when you first notice that caregiving is becoming overwhelming—not after you've already had a burnout or a hospitalization.

  • Don't assume you have to give up control. PACE is a team approach, but you remain the primary decision-maker. You can choose which services to use and how often. If you don't want your loved one at the day center every day, you can opt for fewer days. The team works with you, not over you.

  • Don't forget to ask about transportation. Many caregivers assume they'll still have to drive their loved one to appointments, but PACE vans are often available for medical visits, day center, and even shopping trips. This alone can save you hours each week.

  • Don't neglect your own health while using PACE. The program is meant to give you a break—so take it. Use the time to rest, exercise, see friends, or attend a support group. You are not abandoning your loved one; you are strengthening your ability to care for them long-term.

Practical tools

  • National PACE Association Website

    Go to www.npaonline.org and use the 'Find a PACE Program' tool. Enter your zip code to see if there's a center near you. The site also has a FAQ section and contact information for each center.

  • Phrases to Use When Introducing PACE to Your Loved One

    If your loved one is resistant to the idea of a day center, try these scripts: 'Mom, I found a place where you can spend the day with other people your age—they have games, music, and lunch. I'll pick you up in the afternoon.' Or: 'Dad, I need a little time to take care of some things. This place will keep you safe and have fun activities. Let's try it together for one day.' Avoid saying 'You need a break from me' or 'I can't handle you anymore.'

  • Area Agency on Aging (AAA) Contact

    Call 1-800-677-1116 (Eldercare Locator) to find your local AAA. They can tell you if PACE is available in your area and help you with the application. They also know about other home- and community-based services that might fill gaps.

  • Caregiver Journal for Tracking Changes

    Keep a simple notebook or use a notes app to record daily observations: mood, appetite, sleep, any falls or new behaviors. Share this with the PACE team at each visit. This helps them spot patterns and adjust care before problems escalate.

  • Medicaid Eligibility Checklist

    Before applying, gather: proof of income (Social Security, pensions), assets (bank accounts, property), medical records showing need for nursing-home level care, and identification. Your local PACE center or AAA can provide a state-specific checklist.

  • Emergency Respite Backup Plan

    Even with PACE, have a backup plan for sudden caregiver illness or emergency. Ask the PACE center if they offer short-term residential respite (some do). Also identify a neighbor, friend, or paid caregiver who can step in for a day or two. Keep their contact info posted on the fridge.

Discuss with your clinician

Ask your loved one's doctor if they are certified as needing a nursing-home level of care—this is a requirement for PACE enrollment. The doctor may need to fill out a form or provide a letter.

If your loved one has complex medical needs (like a feeding tube, oxygen, or frequent seizures), ask the PACE center's medical director if they can manage these at the day center or at home. Some conditions may require additional coordination.

If your loved one is on multiple medications, especially for dementia, pain, or behavior, ask the PACE pharmacist to review them for interactions and appropriateness. The PACE team can adjust prescriptions under the doctor's supervision.

If you are considering PACE but your loved one already has a primary care doctor, ask if that doctor will continue to be involved or if care will transfer to the PACE center's medical team. Some PACE programs require using their own providers.

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