Keep Up With PACE S1E3 | Samira Beckwith, President and CEO at Hope Healthcare

Host Ankur Patel, MD, MBA, FAAFP, Chief Medical Officer, Tabula Rasa HealthCare, interviews Dr. Samira Beckwith. Dr. Beckwith has served as President and CEO of Hope Healthcare in southwest Florida for more than 30 years. Within the state of Florida, she served on the Transition Advisory Committee on Health and Wellness, the Florida Center for Nursing Board of Directors, and the Long-Term Care Advisory Committee. Dr. Beckwith has also served on the White House Conference on Aging, and on the boards of the National Hospice and Palliative Care Organization and the National Hospice Foundation. She is the Founding President of the Florida PACE Providers Association and a Founding Director of the National Partnership for Hospice Innovation, as well as past president of the Florida Hospice and Palliative Care Association. 

Transcript

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Hello and namaste, everyone. I am Dr. Ankur Patel, Chief Medical Officer, Tabula Rasa HealthCare, and the author of the book Age Is Just a Number. Welcome to the episode of Keep up with PACE. I am pleased and honored to introduce today's guest, Dr. Samira Beckwith. Dr. Beckwith has served as President and CEO of Hope Healthcare in Southwest Florida for more than 30 years. Within the state of Florida, she served on Transition Advisory Committee on Health and Wellness, the Board of Directors of Florida's Center of Nursing, and the Long Term Care Advisory Committee. Dr. Beckwith served on the White House Conference on Aging, and served as a chair for both the Board of National Hospice and Palliative Care Organization, and the National Hospice Foundation. She is the founding President of the Florida PACE Association and founding Director of the National Hospice Work Group. Namaste, Samira, and welcome to the episode of Keep up with PACE. You are so welcome. It's a pleasure to be here with you today. Samira, PACE has taught me to see things from a different perspective and never limit myself to just one point of view. And that came from learning and understanding how different PACE organizations work. So, I'm very curious and eager to learn more about your PACE organization, how it was started, the background, how many participants you serve, and more. I agree with you completely about the fact that PACE really teaches us that everybody has a story, everybody is special, and the fact that each organization grows differently in each community. And, here in southwest Florida, at Hope PACE, we became very interested in PACE when we learned about the very special unique package of services that could be offered to people who had limited abilities with their ADLs, and were looking to stay at home for as long as possible. So, we began to explore PACE. And it took us about three or four years to help the state to understand PACE. And then we actually opened our PACE center, our first PACE center, about ten years ago. So, we've been operating a little bit over ten years and began with one single PACE center. And then we decided that we wanted to limit the travel time for our participants, and we also wanted to geographically locate each center throughout the service area close to people's own homes. So, with that, we now actually have five PACE centers distributed throughout our geographical service area. And currently, how many participants do you serve? With those five PACE centers, we are now serving about 500 people through those five PACE centers. Great. So, now five PACE centers. This is an amazing story. In ten years, you grew from one PACE center to five PACE centers - 500 participants. And so, it looks like that strategy worked - to geographically divide the center so participants could have more access to the PACE center. What made Hope Healthcare, who is more into hospice business, decide to go into PACE? That is really such an important question. Because, we did start as hospice in the communities that we serve about 40 years ago. So, we were providing wonderful hospice care to the communities that we serve. And, what we realized early is the fact that there was a group of people who could benefit from our core skills that we had developed under hospice, those core skills very similar to PACE. The fact that hospice is delivered through an interdisciplinary team, and the fact that we focus on caring for the person, as well as for the family, and focus on quality of life - and keeping people at home for as long as possible and caring for them in different settings across the continuum of care. Doesn't that sound very much like the definition of PACE? The difference between the two is that in hospice, people had to have a prognosis that made them eligible for hospice. And in PACE, it really is the fact that they need help with activities of daily living and that they're at risk of being in a nursing home. So, when we recognize the similarities between the two programs and how we could use the skills that we'd already developed over years in hospice with PACE, and we had people coming to us wanting our services that they didn't qualify for hospice, we found PACE. It's reimbursed differently. However, the core skills apply, and we were so excited, and that's why we decided to open a PACE program to care for this group of people. Isn't it amazing how certain principles in healthcare can really create this whole different organization? The principle that we believe in hospice and PACE is very similar that focusing on quality of life, using an interdisciplinary team. So, that is great. So, what message you will have for other hospice companies around the country that- should they get into PACE, and how you can encourage them to get into PACE? I have tried to encourage other hospices, and there are other hospices now across the country that are offering PACE as one of their services. Because of the similarity, it is just so radically evident that it's the same skill set. It's just working with people who have a longer prognosis in PACE. So, I've encouraged hospices, as well as encouraged other care organizations, to look at how to apply the skills that they have to PACE - because it's just such an interesting program that has been around for many years and still not being offered as often as it should be - or could be. No, that is absolutely correct. And this is something that, to our listeners, that this is one of an opportunity that if you are already in hospice world, the principles are the

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to focus on the quality of life for the patient with using an interdisciplinary team, and that might be an opportunity to grow PACE there. Samira, we will be shifting gears a little bit to more about you. And, I'm very curious to learn about you, and when I was doing research and preparing for this interview, I came across something that touched my heart. And you are the recipient of the 2010 Ellis Island Medal of Honor. And to our listeners, I would just like to explain to them that this medal is presented to a distinguished American who represents the very essence of American way of life, having greatly contributed to our national identity while preserving the distinct values and heritage of their ancestors. And Samira, as an immigrant myself, and my parents moving to this country with an American dream and working very hard so that I can have a better life - what was your first reaction when you heard that you will be the recipient of the Ellis Island Medal of Honor? Well, thank you for even mentioning the Ellis Island Award. It was really overwhelming when I was there receiving the award and thinking about all of the people who have come to this country that have been able to make a difference and to be chosen to receive that award was very, very special. It's even difficult to articulate the overwhelming appreciation that I had for receiving that award and being recognized in that way. And, thinking about my parents. You talk about your parents coming to this country, and I think that's something that we all share. We moved here when I was very young. And the courage that it takes for people to make that kind of trip, hoping for a better life for themselves and really for their children is something that I know about - and sounds like something you know about, too. And, I don't know, I'm practically in tears thinking about it now because it was so very special. And, I just hold it very close in my heart and think about my parents whenever I think about that award. And, I also was so honored because it recognized the work of so many in hospice care and in caring for seniors and caring for people through the PACE program. And, I don't think that sometimes the work that so many of us do in caring for this very vulnerable group of people is recognized enough. So, I felt as though I was also accepting that award on behalf of all of us who work in senior care. And, I say "work in", but really are dedicated to better life for people when they're facing serious illness and aging. So, I also think that I maybe help to shine a light on this very important work. Thank you. That is a very inspirational story. And, when I was even reading about it - I was more teary in a way that I was thinking about how my grandparents worked very hard to send my parents here to America. My parents had a dream that I get a better education. A nd, it's little work that generations of folks do that today I am able to have a better life because of them. So, thank you for sharing that inspirational story. And, I agree that courage and believing in yourself that you can do the impossible. So, thank you for sharing that story with our listeners. So with that, when you came here as an immigrant kid starting a new life in America and tell us more about your journey from there. And now you are a CEO of a healthcare company. For me, that journey seemed to be very natural journey because of the fact that I was helped by so many people along the way - education, mentors - that I had this desire to be sure that people have the help that they need. And, so it's a very natural journey to focus on social work in my graduate degree and then to also start looking at the needs of people who had serious illness. Something I'm also going to share - since I'm sharing so many personal issues today or experiences - was the fact that I had Hodgkins disease when I was in my graduate program at Ohio State University. And when I was diagnosed with Hodgkins, I ended up being in the hospital quite a bit at a time. Remember how - not like today when everything is outpatient - but back it's going to date me when I say this - back to the 70's, when a serious illness you were in the hospital. And back then, nobody used the C-word. And, I found myself amongst a number of people who had cancer, and many of them did not survive their cancer. So I would sit in waiting rooms, I'd be in the hospital for a month at a time. And I became very interested in what happens to people when they have serious illness, what happens to their families, what happens to them when they can't stay at home. And, the system of care at the time needed to be changed. And that's what drew me to hospice. And then hospice drew me to PACE and drew me to palliative care. How can we better care for the person as a human being, as a holistic care, and how can we care for their family? So, in many ways, this has been a personal journey from moving to this country when I was young, to my own experience in graduate school, and then finding these different kinds of programs that could help people when they're very vulnerable. So, there is another part of my personal journey. Thank you for sharing your personal story with us. Staying on the leadership topic, you were appointed to the White House Conference on Aging, and you also took part in the U.S. Senate Special Committee on Aging. What were your roles and responsibility in that? Both were great experiences. I've just had so many opportunities to share what people need at these most difficult times when they are most vulnerable. And, we have to think about aging as a chapter of life - and, just as any other chapter of life, w hat can we do to help people during that chapter live as fully as possible? And, people sometimes think about PACE, or hospice, or other aging programs as focusing on the sad part or what people can't do. What I tried to do as a representative at the White House Conference on Aging, and what I've tried to do in speaking to other groups, including the Senate Committee on Aging, is to instill the thought that we need to help people to look at what they can do, to find programs and methods that they can really actively engage in those kinds of activities - and to help them as much as possible and treat them as people. All the current rage right now is to talk about person-centered care. Yes. PACE is the perfect, original person-centered care. To be in PACE, you need to have a special heart, and it's a hidden gem, and this model needs to grow. You were also appointed to the board of directors for the Florida Center of Nursing and the transition team. Tell us more about that. One thing that we've learned in PACE, and other areas of healthcare, is that we need passionate, dedicated, well-educated staff in many different settings. PACE is one of them. And, so I was very pleased and honored to be appointed by the governor to the Florida Center for Nursing. And, what we really focused on at the Center for Nursing is how to provide the best education in nursing, how to open up access for additional nursing education programs, and how to ensure that the nurses who were moving to Florida - and the nurses who are graduating from programs at Florida colleges and universities - are able to meet the needs of a changing and growing number of seniors. Well, all Floridians, not just seniors from that particular perspective. And, so it really was a very important center and is still doing wonderful work. And you're also the founding President of Florida PACE Association. Why did you think that was very important to start the PACE Association in Florida? Well, as I mentioned earlier, Hope became the second PACE provider in the state of Florida. And we had to do so much work to be sure that the state, our agency for healthcare, our legislature, or other regulatory bodies really understood PACE and embraced the idea of having PACE available throughout the state. So, once we became the second PACE provider - and I really have been passionate about helping others start PACE programs in the state of Florida. After there were two of us, then three of us, then four of us, it really became quite evident that we needed to work together to understand best practices, to work with the state on regulatory and legislative issues, on rate setting methodology. So, it was really a natural next step to bring everyone together into a Florida PACE provider association. And since we've done that now we have even more groups starting PACE in the state of Florida and coming together. So, in fact, last year, I think we doubled the number of PACE participants that will be in the state of Florida, as well as the number of PACE providers. Wow. So, what will be the estimated number that Florida serves, number of participants in PACE? Well, because the number of PACE program has doubled, and they're just now getting started. So, in fact, they're not even quite up and running yet. They're still in the implementation phase. We don't have that number of how many people will actually be able to PACE participants, but we know that it will probably double in the next three years. That is amazing. And, so that's what we're looking forward to. I think you said this. It's kind of been a well-kept secret. Yes. And, so by having a PACE provider association, we've been able to get the secret out in the open. And, now more people want to know about PACE for themselves, for their family members, for their communities and your podcast - and other efforts - at the national level. I know you've had Shawn Bloom on as a guest, and that was such a wonderful interview. Yes, thank you. I think that gets the information out to people. I think that's what we really need to do. When I was talking to Shawn about the barriers in growth and PACE, and I did not know, but he mentioned that actually some states have a cap that you cannot have more than 200 participants in PACE. Do you have any cap in Florida? Well, I would say the answer to that is yes and no. Okay. Because we've been educating the legislature and the Agency for Healthcare about PACE, that there's no one really that's not able to enroll new people. So, we are continuing to move the cap so that it really isn't a cap, and we're looking at more ways to narrow the cap. I wouldn't say remove it, but to make it less of an obstacle. So, keep communicating with the legislators about the benefits of PACE and how many participants are benefiting from it. So, that kind of - if the cap is still there, you can increase the cap so PACE can continue to grow in Florida. Absolutely. That's what we're doing. And the more PACE providers there are, the easier it is to do, because now more legislators have a PACE provider in their community and they're hearing from their constituents. For example, hearing from a constituent that - "thank you for having PACE in my area, because now I can go to work while my mom is now in the PACE program and she doesn't have to go to a nursing home." So, we're telling those stories all over the state as we are through NPA all over the country. And other states are telling those stories, then more people want to have PACE in their area. So, it started as a little snowball, and now it's turning into a storm, a positive storm all over the country. I should - maybe shouldn't use that analogy when there have been so many winter storms across the country. But it is growing. That's good to hear. So, from your experience, because we have PACE around in 32 states, but not in all states yet. And, even in some states where PACE is there, but they have barriers to grow because all states will have the different rules, regulations. What advice do you have to other PACE organizations, and how they can empower and strengthen their PACE organization, or PACE association, at a state-level, because not all states have strong PACE associations. I think that's so important. That's why we came together - to work together as PACE providers in the state of Florida, because with that volume working together, I think that it gives us a louder voice and we can tell the story. So, I believe the key is to tell the story, tell the story again and again to new people, to new possible providers that want to get into PACE and provide it. I think, for example, healthcare systems hear about PACE and come to understand that it's another way to provide care and services as other hospices, as other type of organizations know about it and to tell the story. I think that's the way that we grow is to tell the story as often as possible and in many different ways. I sometimes host a community TV show in our area. Someone else is the host, but occasionally - Lee Pitts Live - he allows me to come on the show and to be a host and to talk about what I want to talk about and what guests I want to bring on. So, we have to tell the stories in our own communities. We have to tell them at the state level, we have to tell them at the national level, and we have to work together. So I think those are all the keys. It sounds simple, but it takes that coming together and to be dedicated to telling those stories. And stories - I feel like the best part about PACE is hearing the great success stories. And, any time that we all meet at NPA and I'm talking to other medical directors, the favorite part of the conference - at NPA, for me - is to meet other PACE providers and talk about the success story. So, would you like to share a participant's success story? It is so easy to find stories that are success stories for our participants. And, I will tell one story that we had. A woman - who- the daughter called, and the daughter said, "I don't want my mom to go to a nursing home." Now, I must say, there are times when people need to be in a nursing facility. They turn to Hope because they know about Hope in the community. And, she knew me in the community and I was able to listen and then to offer PACE as an opportunity for her to continue to work and have her mom cared for her. And she was just amazed. I don't know if you ever have had this happen? We share what we can do in PACE. Have her mom picked up, have her mom go to the center, socialize, see a nurse practitioner, see a doctor, receive the right medication if she's starting to get sick and not feeling well. And then how she could be taken to other appointments...and she said, "what - you can do all that, and I can continue to work?" And we said, "yes." The mom has been in PACE for three years and everybody is happy. Beautiful. This is something - to listento other PACE stories - is one of my favorite part about this podcast, too. And, we have been doing it, and I think we will continue to do that. That each episode, the guest shares their personal success story in PACE about their participants. So, thank you for sharing that. Just before we move on more towards the growth of PACE, I would like to ask one more question about at the state - because that's something I learned, too. In New Jersey, we have around six PACE organizations, and we have a assigned zip codes. And normally, two organizations do not have the same zip code. And I thought that was normal for all the state. And then I learned from Maria Zamora that in California it's not like that. And actually two organizations can have same zip code and they can compete for the PACE participants. How is it in Florida? Well, in Florida we don't have duplicate zip codes. Okay. There is one area where it happened for different reasons. But our state recognizes the fact that PACE is very similar to our Medicaid managed care programs. And so people, when they choose PACE, it's very difficult to be sure they know about all their choices. And, our areas are so well covered - and our state law, actually, is that it can't be duplicate areas. At least in Florida, I think that's best - because of the fact that it's hard enough to get people to understand PACE. There's plenty of capacity in our existing PACE programs. They have plenty of room to grow, and they're out there educating the community and educating the other care providers about PACE. I think to add additional PACE providers in the same community, or the same zip code areas, would create a lot of confusion. So, I think because we're all working together to educate everybody about PACE as an alternative, a very special alternative to a nursing home or another Medicaid managed care program, I think that it makes us stronger. Working together, communicating the message to the legislator, sharing successful stories. And, even if the two organizations share the same zip code, still CalPACE has made it work - that they can still work together and grow PACE there. Those were good stories from CalPACE, from Samira, you - with the Florida PACE Association - and, I hope that more states comes together and grow their PACE organizations in their state. Staying on the growth, where do you vision PACE to grow in the next five to ten years. I really hope that it's so expanded that it becomes a common choice in every community because of the fact that people do want to stay at home for as long as possible, that everybody knows about PACE. As people age and they need more help to stay at home - or maybe even need more help in their assisted living facility to stay there - it becomes very common. So, I don't even want to predict a number. I want to predict more, and hope more, for a situation where everybody knows about PACE as they age and they're looking for alternatives to stay at home. Right now, it's not a common topic that people even know about as a choice. Yes. Right now, I still remember when I started as a medical director for a PACE program in South Jersey, and that was January 2016, and I had to explain people. Actually, it takes me ten to 15 minutes just to explain my friends and family, what I do. And my dad. I still remember the story I was explaining to my dad. I'm a medical director of a PACE organization, and it took me ten minutes to explain him, and he looks at me, this sounds too good to be true. And I'm like, yes. And my dad is like, why there are only X number of participants than in your program. I'm like, that's what I'm saying, that it's a great model of care and the word needs to get out. So, how do you think external PACE vendors, like CareKinesis, or CareVention HealthCare, help grow PACE? I believe that because we can't offer everything - we're required to be all inclusive. However, we need partners to help us - CareKinesis, helping with the medication. Especially risk - because we're at risk for all hospitalizations, emergency room visits, other physician visits if somebody breaks something and has to go to an orthopedist - and we need to be sure that we're working with partners who understand our goals and our needs in caring for our participants. And, now there are more partners coming forward. And, so it's how do we work together to achieve those goals? Because I need to mention this, no money, no mission, and PACE is a great mission. At the same time, we have to have a positive bottom line to be able to continue to care for people and to expand our centers and our outreach. So, we need to work with partners that understand that goal. I agree. No, I still remember in my PACE organization, when I started, we were financially struggling to a point that we were thinking about - do we even want to continue to run this PACE center? And, long story short, we turned it around in one year. But, one of the keys was that I worked with my external vendors very closely, explained to them the mission about it. And, one of the vendors was CareKinesis, a nd we worked together on brown-bag events and reducing adverse drug events. And, that reduced significant amount of unnecessary hospital admissions and visits. Oh, absolutely. It does make a difference. So, that we work with outside vendors and partners and to be sure that they are aligned with our mission and actually help us to learn things. Yes. You know, something else - and Hope PACE does work with CareKinesis, for example, when someone comes to the center and they're starting to get sick or something, I don't know, pick a UTI - and see our physician or nurse practitioner. And, we need a medication right then. You know, we don't need the family to have to travel to a pharmacy, wait in line for - southwest Florida, wait in line for two hours, hope it's been called in, and then maybe start that medication that could take three or four days. Yes. Here in southwest Florida - by the time. And it's just because it's so busy, so we can get people started on the right medication, help them right away. And that could avoid a hospitalization. Absolutely. Yes. That's my biggest lesson I learned from PACE is I don't need to do everything. My team does not need to do everything - partner with good vendors. And, I always used to say, you are not my vendor, you are my partner in this. And, explaining to the vendor your mission, your goal. And that's very important in PACE- when you have the same goal that helps. And the vendor also feels valued about partnering with the PACE organization. Well, absolutely. And it should be that partnership. I think that's a much better word because it is working toward that same goal of the best care possible and the right care at the right time for people. And, really PACE is that model. Coordinated care for people across settings, which has now become the goal of the entire healthcare system. I'll shift gears towards your passion. You are a very dedicated champion for palliative care and end of life issues. And, you served as a chair for both the National Hospice and Palliative Care Organization and National Hospice Foundation. And, I feel like end of life decision should not be made at end of life. And one of the biggest challenges that our nation is facing is caring for the patient in the last six months of their life. And, it's a big elephant in the room that people don't want to talk about. So, tell me more about your experience and thoughts about end of life issues nationwide. May I first give you a compliment? I have read your book, Age Is Just a Number, and your particular focus and chapter on palliative care and hospice care is so well developed. And, actually, your entire book. Thank you. Well, I wish I would have had it 15 years ago. I would probably be in better shape myself if I would have read it earlier. Thank you. I'm honored to hear that. Well, it's very true. The advice that you give is the same advice I give to people. People want to live the best possible and best quality of life. And, we as healthcare providers - also other types of aging service providers and providers for people with serious illness - we need to be able to have conversations with people about the trajectory of their illness or the trajectory of their debilities, and help them to understand ahead of time what kind of choices might need to be made. And, so we need to have those conversations with people. And, I'm going to say this, too, in language that they understand. And, I don't mean the fact that people aren't capable of understanding some of the medical language. However, I have heard a healthcare professional say, do you want us to do everything for your mom? What does that mean? Agree. Everything to keep them comfortable, to help them live as well as possible, to focus on quality of life? What does that mean? We can do lots of things, but what will help and to help them understand that? And those kind of conversations really need to happen all throughout a person's healthcare - understanding that is really very important. And as PACE providers, we need to be able to have conversations with the family, with the person, as their illness or their debilities progress - so they know what their choices will be, and they can make the best choice possible for themselves or their family member. And, I feel like now in PACE that most of the medical directors I talk to, are doing - most of the PACE programs will have "goals of care" form written down, discussed, and talked with the family and the participants. So, when the time comes, we know that what we need to do. And, I always feel like PACE is like a minor league. What works in the minor league needs to go to the major league, which is what I feel like what's good in PACE should go to a population health level with health system or Medicaid Advantage plans. And, I feel like the end of life, I feel like PACE is doing a good job. And I think now major league players can definitely learn from PACE - how to care for the patient in the last six months of their life. Well, I agree with that completely. And I also appreciate now that many PACE programs are working with their local hospice providers. So, that is there a way to, again, as a partner in care, to not have to provide all of the care themselves, but to develop or to have a contact for the special expertise that might be needed in pain control, symptom management, understanding conversations, some of the issues that come up for people. And, I also believe that through PACE and these other providers that you're talking about and opening up the conversations, maybe we can really transform our entire healthcare system to understand that the closing chapter of life - the last six months, the last year - is a natural part of the life cycle. And that's what always makes me think that- what else we can do from PACE and take it? Because one of the things, which I also mentioned in my book, that when I was doing research for end of life, and one of the study that it was, I think from Kaiser Family Foundation, and they mentioned that 96% of the people 65 and older consider it is important to write their wishes for medical care in case of serious illness. But, only a quarter have shared such a document with their doctors. Yeah. And, I feel like that is one of the biggest gaps. I think that is a gap. And, maybe sometimes because when they do start to talk about it, it makes their family uncomfortable. Yes. Or even makes some of their health care providers uncomfortable. So, we have to help the entire healthcare system and our communities be more open about the discussion. It's not easy. Yes. I've been working with hospice, and I even remember the early days when I was so seriously ill myself, and understanding that what was happening is that the system was uncomfortable. And, so people weren't listening to the person with serious illness. The many people I met in waiting rooms who didn't survive their cancer, and who would listen to them? At the time, we're so uncomfortable, v ery few people listened. Now, that's changed, and we now provide more support. At the same time, the journey continues, and we have to continue to be more comfortable with the conversation. Yeah. And to that point, especially, and I always use this as an example with all my patients, because you shared a lot of your personal stories. So, I'll open up and share one of my personal stories - is about my grandmother, who was my mentor. And, I think she is the reason who I am today and she played a very important role in my life. But, she passed away at the age of 93 with zero chronic conditions, and she was on zero medications. And, I remember her calling my father, my uncle, myself. And she told her five, six years before she passed away, that what were her wishes - a nd she actually said she does not want any artificial way to prolong her life. She does not want any feeding tube. She does not want even a traditional Hindu cremation ceremony. And, she looked at me and my cousin, who is a doctor in India, and she's like my grandkids became doctors learning on somebody else's body. So, she wanted to donate her body to a medical school. So, when that time came, we honored her wishes, and we would have never thought about that. We would have a lot of guilt in what to do. But, we feel like she gave us the best gift, telling her end of life wishes to us and that we were proud of her but also make the journey very easy when she passed away. And that is something that I always use as an example with my patients that talking about your end of life wishes - I know it's a hard topic, but talk to your loved ones, your caregiver, and that is one of the best gifts you can give to your family. That is so special. And, if we could have that experience for everyone, I think that that's our goal, at least to help people then leave a legacy like she's left for you. Sure. And now you're sharing it with others. I've always said that you need someone to speak for you when you can't speak for yourself. Yes. And that oftentimes happen when someone is aging or has a serious illness or a chronic illness. It's hard to speak for yourself. So, having your family or a loved one, or a caregiver be able to speak for you is so important. And, I'm truly touched by the story of your grandmother, and I hope I can be just like her. Thank you. You are very inspirational like her, Samira. Thank you. So, we are more coming towards the end of our interview. But, before we go to the rapid-fire round, I have two more questions. If you could step into my shoes, what would you ask yourself that I didn't ask you? I can't think of anything else that I would have asked me. We could have talked about more detail about what PACE is. And, I think people can get that information somewhere else. I hope that what we've done is to just inspire people to continue the work that they do, if they already work with PACE, and if they don't, to find a way to help start PACE in their community or their organization. And, if they do work with PACE, in addition to being inspired, how to make it even better and expand it. B ecause, I think that's our future. And, if we don't do it, other programs will develop that won't provide the same quality of care. And how can listeners connect to you? Well, I would love to. If anybody is interested in connecting, my email is easy to find. Samira. Beckwith@HopeHCS.org. Our website, HopeHCS.org or HopePACE.org. And, I'm on LinkedIn, so I'm pretty easy to find. Thank you. So, now we will go into our rapid-fire round where I will ask you five questions, and you can answer in one to two sentences. What does failing mean to you? Failing to me means that I've given it a try, and that it's time to try something else and to fine-tune what it was that I was trying to do. You know, we're down here in southwest Florida, and Edison said "you have to fail a lot to accomplish anything." And, he had many ideas that didn't work out, but they led to electricity and the light bulb. Excellent. Describe PACE in one sentence. Coordinated care for people to be able to live at home for as long as possible and to live as well as possible. Great. If you had a magic wand, what is the one thing you would change about PACE? I would go to CMS and I would wave my wand and expect them to adjust the regulations so that more people can access PACE, and that it can really grow. Because I think CMS has not kept up with the needs of seniors and updating the PACE regulations. Excellent. Who inspired you and why? I'm inspired by almost everyone I meet because I learn something from each person I talk with, and then I have the opportunity to connect with. However, if I had to choose one person - my mom. Because she had the courage to come to this country with my father and to find a better life for her children. Very inspirational. One positive message for our listeners. Always look at what you can do. Do not be overwhelmed by what we can't do but to look at what we can do. Amazing answer, Samira. Well, thank you, Samira, for being our guest. It was a pleasure speaking with you. Thank you. Oh, you're so welcome. I enjoyed being with you. And, I'm going to listen to all of your podcasts. They're so wonderful. Thank you for joining us for this episode of Keep up With PACE. We hope that you found the information shared valuable, and I invite you to join us for the next episode. Keep up with PACE is sponsored by CareVention HealthCare, a division of Tabula Rasa HealthCare. CareVention HealthCare provides comprehensive services and solutions for PACE organizations at every stage. For information about CareVention HealthCare, visit our website at CareVentionHC.com. See you in the next episode with a new guest. Until then, namaste and goodbye.