Keeping PACE with the Pandemic: Experiences from and Impacts of COVID-19 on Care Provision Among North Carolina’s Programs of All-Inclusive Care for the Elderly, a Qualitative Study

Abstract

Background: The novel coronavirus disease 2019 (COVID-19) pandemic has deeply affected long-term care (LTC) for older adults, particularly in Programs of All-Inclusive Care for the Elderly (PACE). Older adults are more susceptible to serious illness and/or death from COVID-19, so studying care for this population is important. The pandemic arose in the midst of a larger LTC crisis in the United States centered on an aging population, unsustainability of current financing methods, and provider and staff shortages, among other challenges. COVID-19 is an opportunity to reform LTC, and this study may help shape the future of LTC by examining the resilience of the PACE model against the health system pressures of COVID-19. Objective: This study investigates the immediate and long-term effects of COVID-19 on care provision in North Carolina’s PACE (NC PACE) programs. Since PACE is organized by state, the research team chose to investigate sites in North Carolina. Methods: NC PACE administrators were recruited and interviewed through online audio conferencing with a structured interview designed by the research team. The totality of NC PACE (N=12) was represented in the study. The interviews were transcribed, coded, and qualitatively analyzed using thematic analysis. Results: Five themes emerged from thematic analysis, each with 2-3 subthemes: insufficient access to and integration with LTC providers and medical and mental healthcare specialists, reevaluation of the core PACE model with the transition to home-based care, that the provision of high-touch care promoted participants’ psychosocial wellbeing, reorientation to pivot toward family-oriented care delivery, and that a culture of caring enabled a successful COVID-19 response. Conclusion: PACE was overall successful in mounting a COVID-19 response that upheld safety of its participants, promoted the physical and mental wellbeing of its participants, and responded to the needs of informal/family caregivers. Administrators project that PACE’s service model has permanently changed after the pandemic toward increased home-based care. Results from this study also have implications for the provision of mental health care in the PACE service population and for the federal government’s financial relationship with PACE. PACE’s success during a period in which it was difficult to uphold care quality presents a learning opportunity for LTC in the future.Bachelor of Science in Public Healt