Keep Up With PACE S1E12 | Best of KUWP Season 1 Finale

Keep Up With PACE concludes Season 1 with a compilation of best moments from each episode. Guests include PACE leaders such as Shawn Bloom (CEO of the National PACE Association), Maria Zamora (CEO at Center for Elders’ Independence), and Adam Burrows (Medical Director at Upham’s Corner PACE) who share insights into the future of PACE, successful initiatives they’ve implemented, and heartfelt stories of participants who have benefited from PACE.

Episode Breakdown

Intro: 00:00 – 01:53

Future of PACE (Shawn Bloom): 01:54 – 05:37

Lessons from COVID (Maria Zamora): 05:47 – 09:57

Partnerships in PACE (Samira Beckwith): 10:04 – 15:12

PACE Success Story/Housing (Dan Drake): 15:20 – 18:44

Preventing Burnout (Ross Colt): 18:53 – 21:32

Opioid Initiative Program (Jeff Montemurro): 21:39 – 27:40

Interdisciplinary Teams (Adam Burrows): 28:04 – 31:19

Staff Retention (Alan Sadowsky): 31:29 – 36:18

Creating Meaningful Life for Participants (Stephen Gordon): 36:42 – 40:21

Extending Quantity/Quality of Life (David Wensel): 40:36 – 44:35

Why Work in PACE? (Luz Ramos): 44:43 – 47:44

Outro: 48:00 – End

Transcript

0:00

Hello and namaste everyone. I am Dr. Ankur Patel, Chief Medical Officer Tabula Rasa and the author of the book Age is Just a Number. Welcome to the season finale of Keep Up With PACE. The purpose for starting this podcast was to increase PACE awareness so PACE can grow. I believe that PACE is one of the best models of care for the type of participants we serve. If we can grow PACE, we can impact more participants by caring for them at home and improve not just the quantity of life, but also the quality of life. I have dedicated this podcast to the PACE model of care and the thousands of team members who serve our participants like you. I want to thank all the listeners for your love, support, and feedback. When I started this podcast, I thought if ten people, other than my wife and parents, listened to this podcast, it would be worth the effort. But I'm proud to say each episode had hundreds of downloads. So thank you, thank you, thank you for that. To make this podcast even more successful, I need your help. Please pause for a second and rate, review, and subscribe to the podcast on whichever platform you are listening to. We decided to do something different for the finale and I'm happy to present the best of Keep Up with PACE. So let the show begin! The future will always be bright when you stay focused, optimistic and confident. And we all believe that the future of PACE is bright. Let's listen to what Shawn Bloom, CEO of National PACE Association, has to say about the future of PACE. We're talking about future of PACE. I'm a big believer that in the midst of chaos, there's always an opportunity. And we have always been talking about new normal. And I feel like, why settle for new normal? We can do new better. So tell me, in this new, better world, what does the future of PACE looks like to you? Yeah, you know, in many ways I think it's going to accelerate what we had all historically hoped that it would be. And that is if you look historically at PACE, PACE has been a single model of care that has what I call an eligibility boundary around it. You have to be 55 years of age, nursing home eligible, live in this community, and that's fine. But we have not been connected to or adjunct with, so to speak, other service options in my view. So moving forward, I do see PACE being part of kind of what I call bigger systems. So if you think about it, think about an organization today that sponsors PACE. They've got nursing homes, they may have a hospital, they may have housing, they may have community based services. We've never really been configured strategically within that mix. We've always been this kind of just stand alone model of care. Moving forward, I see PACE being a lot closer to senior housing. I think the role of senior housing and PACE has always been something that's not been fully appreciated. And I think moving forward, I think to the extent that our country moves away from institutional options, it's the first tip of the spear. You can't ignore the need for housing, good housing options. So, I think PACE is going to be closer to housing. I also see PACE as potentially a model of care that may exist in what I call retirement communities. A lot of retirement communities, continuing care, retirement CCRCs. They are designed to allow individuals to really age over time and have available on the campus whatever needs that they might have. And that typically involves senior housing involves assisted living nursing homes, and maybe even in home care. PACE would sit beautifully in that. And it's a very different cohort. 90% of the people we serve, 90 plus percent of the people we serve are duly eligible. The greatest number of people in this country that need long-term care are not, at least at the moment, of need Medicaid eligible. So I think we have a real opportunity to put PACE in different models of care and let it be kind of what I call the care delivery model that exists within that. So I see that. And then lastly, I also see PACE programs understanding that there are individuals that have needs before they become nurse and home eligible. And I've often referred to it as building a pathway to PACE, a service pathway to PACE. What about taking a lot of the competencies within PACE and building them outside of PACE? For example, individuals that may not be nursing home eligible but need a little bit of help at home. They might need a trusted service provider to help them with home modifications, maybe even light ADL care, those types of things. So I think there's a lot of capabilities within PACE that are beneficial to individuals that are not yet nursing home eligible. So as you can imagine, I think PACE could and should fit in a much broader spectrum. Friends that was Shawn Bloom, CEO, National PACE Association. And Shawn, thank you for being my very first guest on the podcast episode. During World War C "COVID", how did we care for our participants, especially in the times of crisis, pressure, uncertainty, and adversities? And the answer is PACE. It is even unbelievable to think how PACE organization kept a nursing home eligible patient in their home with minimal resources. And that is because PACE has an incredible team who is resilient, adopts change, and is very innovative. Let's listen to what lessons Maria Zamora, CEO of the Centers for Elders Independence, learned from COVID. With all this, COVID and I always think that victory comes from finding opportunities in a problem. So what are the top one to two things that you feel like their opportunity was created in your organization and you might make some change for better? I said at one point that COVID was the opportunity that none of us wanted. And I truly believe that because I think what COVID taught us, particularly as PACE organizations, who, when you have a long-standing model of care that is surrounded or umbrellaed under a lot of heavy regulatory requirements, it can often feel like, well, we can't really make any changes. We just need to just kind of stick to the script and keep moving forward. I think what COVID taught all of us is we can be incredibly flexible, we can be innovative, and we can still do so within the constructs of our regulations. We learned to broaden our points of delivery, to really think about what else could we do in the home? We learned how to leverage technology in a different way. We initiated a program called Web Links, and it's an iPad training program. And as the participants graduate from the program, they are given an iPad. We were awarded some grant funding, and had planned this before COVID, and they were supposed to be large classes in person. So then, just like everything else, the team here, the IT and activities team had to pivot and say, okay, how do we deliver this content virtually to people? I mean, we're trying to train them how to use the device. How do we train them on how to use the device on the device? So, they did a really incredible job pivoting this training. We worked with a local entity that does this type of training to secure the trainers, and it still exists today. And some of the really beautiful stories that have come out of this - we had one participant who said that she had a sister in the hospital. And now, of course, during COVID, she couldn't visit her. And her sister was really declining even more because she was just very depressed, having a hard time recovering. With the iPad, she was able to FaceTime with her sister, and that made such a significant difference for both women. We had another participant who has been on the verge of being unhoused for many years. We do a graduation ceremony, and so I saw him after, and I congratulated him - I ran into him in the center. “Mr. X, congratulations on graduating from the Web Links program.” And he said to me, "I've never really finished anything in my life - so it was meaningful to me that I finished this program and that you had the celebration for us." And he said, "I love this place. I told my center director that I would sleep in the broom closet here if I could because I don't ever want to leave PACE." So we were able to leverage technology and just really think about how do you deliver care outside of the center, both inside and outside. Maria, your journey in PACE has been very inspirational, and thank you for sharing that journey with us. Synergy is when one and one is not two and it is eleven. It is incredible to see when two different organizations work together and go above and beyond to care for the participants. I have seen that passion from the PACE side as a previous PACE Medical Director, and from the vendor side as a Chief Medical Officer of Tabula Rasa HealthCare. I have so many examples, but when I see a CareKinesis pharmacist in New Jersey try to go above or beyond for a PACE nurse in Florida, who is the only nurse on call over the weekend, to make sure that the nurse can conveniently get the medication for the participants, and the caregiver does not have to stress about it and the participant does not need to go to the ER and we can treat that participant at home. I have so many great stories like this, but let's listen from Dr. Samira Beckwith, President and CEO, Hope Healthcare, on the importance of partnerships in PACE. So how 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, and 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. Yes. 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. Samira, thank you for partnering with CareVention HealthCare and it's always a pleasure to learn from each other. We all have challenging days at work where nothing is going according to plan, and it is easy to get demoralized and disappointed. And sometimes we even question, is this the right job for me? You are not alone. I had those days when I felt the same, but what kept me going was the success stories that gave me the satisfaction and reminded me of my purpose, why I'm in PACE. Let's listen to PACE success story and housing barriers from my good friend Dan Drake, President and CEO of Trinity Health PACE. Staying on the success story - our listeners love to hear PACE success stories. Would you like to share any success stories? Yeah, I think I have one that always stands out in my mind. I was executive director at LIFE University of Pennsylvania, and the state of Pennsylvania came to us and said, hey, we have this new initiative. We'd like to take people out of the nursing home that we feel could live independently and we'll get them an apartment, but they need health care. And we said, okay. And we assessed a couple of people. And, one of the participants, who was just a wonderful woman who lived in West Philadelphia, was so happy that she was able to transition from the nursing home to her own apartment. And, she kept coming into the program and we were thinking, wow, she's doing pretty well. Why were you in a nursing home? Well, she lost her housing. So, the reason she was in a nursing home was she lost her housing. She was nursing facility eligible with her diagnosis, but could have stayed in the community with a program such as ours. She had been in a nursing home for seven years. Wow. Seven years because she didn't have housing. So, that Thanksgiving, she invited three of us to her house because she hadn't cooked Thanksgiving dinner in seven years. I always remember that story because I think one of the biggest barriers to care for the elderly in a lot of communities we serve is housing. And, we would like to do a better job partnering with different senior housing so that we can bring people who are in the nursing home because of that. Most people in the nursing home are there because they need to be there. But there, you know, we just looked it up - it's almost 33% of people in the nursing home are there because they have no housing. Wow. Yeah. That is a barrier. Do you see Trinity Health PACE going into the housing business, or will more stay with partnering with senior living? Well, you just gave me a softball. So, we are starting a new site in Woodland, Pennsylvania called Mercy Kinder Park. It will be open in June of 2022. And we are partnering with the Delaware County Housing Authority. So, it's going to be an over 65 building. We are taking up 18,000 sq. ft. on the first floor, and then there are going to be over 100 units above us for senior housing. New Cortland, in Philadelphia, did a similar model when they ran PACE, and it was ultra-successful. So, we would really like to partner with anybody who wants to build senior housing in the nine states that we operate in, because that is a huge barrier to our program. Success stories keep me going. Ask yourself what keeps you going? And Dan - Fly, Eagles, Fly! We always focus on our participants and their caregivers mental health, but we often forget to take care of our mental health. Burnout in healthcare workers is real and I urge you to all commit that you will take some time in a day for yourself and your family. Let's listen to my friend and a patriot Army Colonel, Dr. Ross Colt, Medical Director for the Gary and Mary West PACE on preventing healthcare personnel burnout. A very good example, during, especially post-COVID, this topic always comes along - is burnout, and healthcare worker burnout. What lessons did you learn from your military that you can apply here, especially when it comes to preventing either physician burnout, or any healthcare personal burnout? That is a great question. And, I remember one of my mentors I had in the military, who subsequently became a general officer, he gave me a great analogy. He said, you as a - at the time I was a company commander - and, he said, you will be juggling many balls in your life and the higher you go, the more balls that you're juggling. So, if you're the CEO of a hospital, you're juggling more balls than if you're the CEO of a clinic, for example. But, he said an important thing - there are two important lessons to learn. So, lesson number one is some of the balls are rubber, and some of the balls are glass. So, the rubber balls you can temporarily drop and you can pick them up again and get right back to it. That might be something like that project that's due at work in a month. You might be able to take a couple of days off of that and then come back to it over time. That might be a rubber ball. You can pick that one up again. The glass balls are things like your health, your family, your mental health, your spiritual health. Those are things that once you drop them, they may shatter and they may never come back again. So, lesson number one is recognizing which balls are rubber and which balls are glass. Lesson number two, nobody can keep all the balls in the air. I think that is one thing that we as physicians in particular think that we're invincible. We're bulletproof. We can keep all the balls in the air, but no human can. And so, important to recognize that which of these balls can I set down, just for a moment, and then keep juggling - and which of the balls are glass that if I drop them, they'll shatter. Ross, thank you for your service, and you have been a wonderful addition to the PACE community. Our nation is struggling with the opioid pandemic, but in PACE, we have a success story of decreasing the use of opioids. I urge you to listen to episode number 6 and learn how an occupational therapist opioid initiative decreased opioid use by 75%. Listen in brief to Jeff Montemurro, Occupational Therapist at Inspira LIFE in Vineland, New Jersey. So, I remember you coming to me early 2016. I was like, two weeks in, and your first thing I remember you told me, Dr. P, so many of our participants are on opioids and we can reduce it. And, I remember that conversation. And, there's where I think - to all the medical directors who are listening - is whenever an IDT member comes to us with some kind of initiative, we need to encourage them, and remove the barriers for them. Jeff took the initiative here. And, then the next question with us was how we can all work together? So, that's how we got the providers involved. We invited our pain doctor for lunch, and we took him on a tour at the PACE center and showed him what we do. And, he was really surprised with what non-pharmacological treatments Jeff was offering. And, in his defense, he looked into our eyes and honestly told us, when you referred to me, I assumed that you have done everything that you could, and I'm prescribing opioids. A lot of it too, I think, was just education, right? Everybody understanding each other's roles. So, I know that I've done quite a bit of work, and still do, work with the pharmacist who is in with the Inspira LIFE program as well, too. And, understanding - pharmacist is doing the med reviews. They're triggering people that are high fall risk. And, a lot of times the high fall risk meds are meds that they're on for neuropathy, or for pain, or their opioids. And so, working together with them saying, okay, if we're going to try and minimize some of these meds, we got to have a backup plan. What are we going to do to treat their pain? Working with the PCPs, they know traditionally PT works on gate stability and strengthening, and OT works on self care and cognition and safety. But, there's this whole other realm of pain management umbrella that I think a lot of time gets overlooked. And so, just understanding for the nurses and the PCPs and the pharmacist, hey, your rehab department is able to be a huge player in pain management. And, let's see what we can do as far as in-house management for treatment before we consider that outside referral.

And, the problem that we ran into is the backtracking piece, right? Once we issue the pill, once we start with the orthopedic referrals, once we start with the pain management referrals - it's: 25:11

"I want more, more, more." And then, to take that back, it's really hard to unwind. So, it's kind of just trying to set some precedents and policies. And, it's not to say that those things aren't beneficial, or not needed. I just think we need to focus on in-house management as much as possible. And then, obviously we use that as a backup plan if the non-pharm modalities are not successful. Because, they aren't always, but a lot of times they can be sufficient and providing relief. Definitely, to your point, that you mentioned about them. The participant will be dissatisfied. And, I remember those reports coming to my table about why participants' dissatisfaction rate is high, and that's where the balance comes in. One of the biggest advantage that we had after our pain specialist came to our center, see what Jeff and his team is doing, what the providers are doing. So actually, the specialist was also thinking too. He was on the same page like us, that even if the patient was going to him to get opioids, they know that eventually with the help of the Inspira LIFE program, we will be decreasing, and tapering the patient off opioids. Absolutely. And, I mean, historically, it's tough because pain is a sensation, and everybody interprets that differently. So, there's this huge emotional insight component behind it as well, where all of these things kind of factor in. And, the people that we're seeing, being in PACE, they're 55 or older. So, pain is probably not something new for them. For a lot of these people, it's not an acute issue. It's something chronic that they've been dealing with for years upon years. They haven't sought treatment, or the only treatment that they've sought, or received, is pharmacology. So, introducing something new at this later stage in the game is one of the biggest barriers and challenges. And, we have to start to tear down those walls and really work together as a team. I know one of the other barriers we would see quite often is kind of staff splitting - when I would be doing my assessment, and one of the questions I always ask is, are you having any pain? No, I'm fine. Okay. Therapy pain zero out of ten - clinic does the assessment the same day, sometimes within the same hour. And, pain is reported as nine out of ten or ten out of ten. And, often times, then you have to wonder, why is the report so different? One department is going to offer you exercise and modalities, and the other department is going to be offering you medication. So, a lot of times just communicating amongst those departments, hey, I see that in your assessment, they didn't report any pain. In my assessment, they're reporting pain. Then the referral should be coming back to rehab. Okay, well, I want you to meet with my rehab team, and see if there's anything they can do to help you. They have X, Y, and Z going on. This was one of my proudest moments in PACE that we were able to decrease the opioid use by 75%. Jeff, thank you for your great initiative and I encourage all the other Medical Directors to empower their interdisciplinary team members to come up with one quality improvement project that can benefit our participants. An individual might prevent an ER visit, but teamwork keeps our participants safely at home. The heart of PACE, the interdisciplinary team, which sets PACE apart from any other model of care. A great PACE mentor once told me, Ankur, the doctor is one member of the interdisciplinary team. Let's listen to my friend and mentor, Dr. Adam Burrows, Medical Director, Upham's PACE. And I remember in our past conversation when we were talking about the culture, and especially with the IDT, everybody is different. But you mentioned that what you like most about the PACE is everyone in IDT has a voice and it's an anti-hierarchical model. Tell us some more about that. Yes, I think PACE is deliberately anti-hierarchical. The visionaries who founded PACE back in San Francisco, they were wary of PACE becoming overly medicalized, right. Marie-Louise Ansack and others at On Lok, they want to avoid PACE becoming too medicalized. And so they developed this interdisciplinary model of care where each member of the team has equal standing. And the PACE model only really works if everyone around the table has a voice and is contributing. They have to contribute from their individual discipline, whether we have eleven disciplines in PACE, and then we add more just to make it more complicated. But everyone has to be prepared to contribute from their discipline. But that will never be sufficient. You also have to be willing to engage in all the creative problem solving and care planning that makes the model work. So you have to also be willing and able to speak outside your discipline. So as a leader in PACE, you want to cultivate that culture where everyone on the team feels empowered to speak up because everyone on the team, the whole reason there is this interdisciplinary model is that every member of the team has an important piece of the puzzle. And just as you were suggesting, the doc is one member of the team. Unlike other teams in medicine, surgical teams, for example, the doc is not at... And I'll send this record to your family, too! No, I'm sure there's a reason why it's structured that way in the surgical world, in the hospital, but here in the community, it's very different. It's a different culture. And in this culture, the doc is not at the top of the pyramid of the team. The doc is one member of the team. I agree. And that's the beauty about the PACE. I always say that it's easy for me to take care of the sickest patient because I have an amazing team to back me up. And especially with the social needs and other social determinants of health. Adam, thank you for your contribution to PACE. Thank you for mentoring me and many other Medical Directors and I look forward to learning more from you. Over this past year, you have heard "The Great Resignation". In April 2021, a record 4 million Americans quit their jobs. In June 2021, approximately 3.9 million American workers quit their job. What would you do when hundreds of your staff members resign? Let's listen to Dr. Alan Sadowsky, Vice President of the Morse Life Health System, and you will find your answer. So how did you handle the staffing management when 100 staff members resigned? We did a lot of things. That's a great question. First of all, we re-examined our pay structure and we wanted to make sure that we were considered one of the best places to work in South Florida. So we increased the wages of the direct care staff. Okay. Many staff were very intrigued by the opportunities for increased overtime. So we did that. We have also engaged in some, I think, truly creative approaches. For example, the western part of this county is an area marked by high crime, high unemployment, very high incidents of AIDS and cardiac issues. We are in the middle now of an initiative where since we know we're going to continue to grow and we're going to continue to have a demand for jobs we launched an initiative in that part of the community where we have engaged in a partnership with a local nurse training program. And we're training people. We're paying for them to be trained to be home health aides or CNAs or work in hospitality. Nice. And then we're paying mentors on this side to help them to make it through that first six months. We have found through our own analysis that if they're able to survive through the first six months, they're much more likely to become long-term employees. We've gotten a lot of receptivity from the political community, the educational community. We have some start-up grants. We have some philanthropists who are interested in helping with seed money. So, ultimately what we want to establish is like a farm system. So we have a ready pool of people from the local community who see this as a viable way out to a lifestyle that is economically depressed and entering the working world where there are opportunities for advancement and new career. Wow, I'm really amazed. What a creative way to handle the situation that can possibly help the community, create jobs in the community, serve the participants. And we know that. And you are absolutely right that in PACE and normally in senior care the first six months is very important because I can totally see that the first six months they are questioning that did I sign up for the right job? But once you are in PACE for six months I bet the satisfaction rate is higher. Yeah, it's PACE. It's all the different, we have 40 different portals that you could enter our campus for work. What happens is after six months, for example, we've learned one of the reasons people for whatever reason don't make it through their early months is they feel lost in the system. They don't know if their supervisor understands them. If they're contributing the way they're supposed to. So we're working on a mentor system and we've also added an incentive for the mentors so it becomes in their interest for a new worker to succeed. And when you're in a fairly large facility we have 2,500 employees it's easy to get lost. That's part A. Part B - there are practical things. They may not have a reliable car or they may have a childcare issue - a kid who's got chronic issues with health or something. So after a period of a few months they develop networks - I can care for your kids a couple of days, you care for mine, or we could carpool. They become part of the family here and they come up with their own creative ways so that they can be a successful employee and not be terrified that the kid comes home and there's no one to watch them. Maybe they have a shared relationship with someone who's working a swing shift or something like that. And it really helps to have work buddies. Alan, thank you for sharing your innovative ideas with us because I bet our listeners are also struggling with employee retention, so your ideas will definitely help our listeners. Our conversation reminds me of Richard Branson's quote, "you take care of your employees, they will take care of your customers" and in our case, participants. Health inequalities and the social determinants of health are not a footnote to the determinants of health. They are the main issue. And I am proud to say that in PACE, social determinants of health are our primary focus. And we have been doing this for years. To be a PACE doctor, you need not only to understand your participant's body, but you need to understand their mind and connect with their soul. Let's listen to my friend and a very passionate PACE doctor, Dr. Stephen Gordon, Founder and CEO of Edenbridge Health. The specialist is looking at a single organ system and not at the whole person. That's true. We are looking at the whole person. We're not just looking at the whole person, we're looking at their whole environment, their social determinants. We're doing their home visits and we're knocking on the walls and see, we're understanding what matters to them. We're understanding their family, we're understanding their history. So that's actually leads to our third principle. Sometimes we get our second and third principle, which is this idea of helping people create a meaningful life. So we've redesigned our intake process to not just be about, okay, what medications are you on and all this different stuff. But how do you get meaning out of your life? And what we found is that most people get meaning out of one of three different things. Not everyone. And Gretchen Alkema, who is also a hero of mine, works at a SCAN Foundation. She once said to me, "the main thing actually we just need to do is get out of the way. We need to make sure the medications, everything we're doing, is not interrupting whatever does matter to someone." And that's sort of the fourth of the getters. But a lot of people get satisfaction with one of three things socialization, spirituality and productivity. And so by socialization, that means that instead of seating people around tables based on who's on a low salt diet or who's on thick and liquids or who's in a wheelchair or whatever, let's sit people around the table based on who they're likely to become friends with. So that when the next wave of the pandemic hits, they're able to actually sustain that social relationship remotely. And they're actually socializing. Let's actually invest in hearing aids and all the technologies. Charlotte Yay is another one of my heroes, and she's obviously a big proponent of everything to do with making sure that hearing technology is available for everyone. Let's overcome. Let's make sure that if someone is spiritual and going to church every Sunday is what provides their life with meaning, that they don't stop going because they're afraid of having an accident. I have a five year old, a seven year old, and a ten year old at home. And not that many years ago, they were all in diapers, and I never blamed any of them for having accidents. I'm not quite sure why we live in a society where we blame elderly people for being incontinent. Sphincters get old and stop working. And so let's make sure someone's wearing protective garments. Let's make sure that they continue going to church and don't stop going just because of incontinence. And let's have our vans actually be driving people to church, if that's what matters, for synagogue or mosque or wherever they're going to be able to. Let's actually stop a 97 year old with an A1C of 6.8, from checking finger sticks four times a day and instead let's let her A1C drift up to a more reasonable level. Yeah, I'd say 8-8.5, probably. Yeah! And let's in the afternoon, she can go and she can go read stories to school kids at the local kindergarten if that's what's going to provide meaning to her. And another part of meaning is productivity. You have people who are enrolled in programs who are completely cognitively intact. Yeah. Why not have a former accountant who is cognitively intact do pro bono taxes for a local nonprofit? Why not do things like that? Stephen, I love your passion and enthusiasm and how you've helped participants create meaningful life. What is successful aging to me? I have asked this question to hundreds of patients and they told me hundreds of different answers. Still, the common theme across all the answers is that quality of life is very important over quantity of life. And what if I tell you that in PACE we add quality and quantity of life to our participants? Let's listen to my friend, mentor, and a great human who has contributed a lot to PACE, Dr. David Wensel, Chief Medical Officer, Tru Community Care. So let's talk about the typical PACE participants so people can know what that is. So on a national level, the average age I think currently of a PACE participant is 74. There's more females than males because females tend to live longer than males currently, although we're making some headway into that now. We're making progress on that. And they on average, have 15 diagnosis or chronic illnesses that we're managing. And they're average taking ten and a half medications a day. And they have a deficit in at least two of their activities of daily living. So many of the people that we have come to our PACE program and I could list off many of them now, they have been caught in a system where they had a primary care provider that they might see once a month or every three or four months. They have a multitude of subspecialists cardiologists, pulmonologists, nephrologists, endocrinologists, I mean, on and on and on. Lots of "ologists". And none of those providers have the opportunity, time or ability to communicate with one another outside of their medical notes. And so many times, many of those frail elders who are living in the community, they're barely living in the community. They end up getting a lot of their care in the emergency department. And so the most vivid memories for me of PACE participants are those who had seven, eight, nine ER visits in the months leading up to enrolling in PACE and then being able to go sometimes one to two years without having to have an ER visit because we were managing them better, providing them support because, you know, most hospitalizations aren't medical, they're psychosocial. Exactly. If we look at the psychosocial determinants of care and help them with their food insecurity, their inability to get medications or be able to take them appropriately, or just their monitoring of their weights and their blood pressure and that sort of stuff, their blood sugar is better. And provide them better support in their homes, try to help them clean their environments better. So many things that PACE does, we provide them transportation to get back and forth to the appointments. We have seen a significant reduction not only in their emergency department visits, but as you know, Ankur, the bigger thing is it actually extends their life. I agree. So they live on average about 30 to 36 months longer than the person, their counterparts, who are living in a nursing home or a skilled nursing facility, not because those facilities are bad. Yes. Right. I always say that because we don't want to be disparaging toward nursing facilities because we have a huge need in our country for that. Yes. It's not because they are bad. It's just because the support we provide them, by keeping them living independent in the community, they do better and their quality of life is better. That's the key, too. We just don't add months to their life, but we add quality months to their life. And we do it cheaper, which is triple aim. Right. We do it cheaper than the average Medicare recipient. Right. That's the only thing that makes Medicare wake up in. That's the reason we want all those positives about PACE to be known so we can grow and more participants can benefit from PACE services and live in community and age successfully with better quality of life. David, thank you for your contribution and advocacy to end of life, hospice, and palliative care. My grandmother is my biggest inspiration. She was an independent, spiritual, educated, and motivated woman who devoted her life to help others. She was my Mother Teresa. When I used to whine about my challenging patient, she used to tell me, "When you face a challenging patient and you're in a dilemma regarding what to do, just take a second and think about me. What you would do if that patient was your grandmother. And trust me, you'll find your answer." As a clinician and an administrator, when I make decisions, I always think about how this decision would have affected my grandmother if she had been the patient. And guess what? I always find my answer. This has shaped the mantra I walk into work every day - I will care for my patients as I would care for my grandmother. My grandmother is the reason why I work in PACE. What is your reason? Let's listen from a brilliant, humble, and inspiring person, my friend, Dr. Luz Ramos, Chief Quality Officer and Regional Medical Officer of InnovAge. If you could step into my shoe, what would you ask yourself that I didn't ask you?

I think what will be good to ask is how do you keep up? What keeps you continuing to do PACE? For sure, when I do my recruitment and I try to onboard people as well, PACE is a hard job, Ankur. There will be good times, there will be hard times as well. And for every PACE Medical Director, physician, nurse practitioner, any clinical team or in operations, I don't know if you've always had that Friday afternoon special. Wherein you're ready to wrap up on Friday afternoon, by 4: 47:23

30 you have a participant just crashing. Something is just going, and you have to do something about it. So really, a lot of this is the people. Why? The people. The participants. That's really what drives me. Giving back to the elderly. Because really, they were the ones like what you said in the beginning of this talk - your grandmother raised you and giving back to her, making sure that she lived a good life towards the end would always be good and critical. And it's our way of giving back to our folks or elderly that have taken care of us through the year. So that's what drives me. And that's why I'm in PACE. And I hope and I know that there's a lot of providers out there, social workers, therapists that have the same vision and mission at heart in taking care of the elderly and I hope they do consider working for PACE programs. Luz, it's great to hear why you work in PACE, and I encourage all my listeners to ask themselves why they work for PACE. And it's time to care for those who care for us. I hope you enjoyed this episode. And before I end this episode, I would like to come back to the purpose of starting this podcast. I believe knowledge is power, but it is only partial power. The knowledge you acquire and its influence is enhanced when you implement it. There are twelve episodes in this season. From each episode think of one lesson, just one lesson that you learned, and try to implement it. That will be twelve lessons our participants will benefit from. Now think if even 500 of our listener do the same, our PACE participants across the country will benefit from 6,000 new lessons. This is the power of knowledge. So please recommend this podcast to your colleagues and lets make space for PACE and try to hit our PACE 2.0 goal of 200,000 participants. Alone, we can do little. Together, we can do so much. We are able to do this because I have a great team. I'm grateful for having a fantastic podcast team - Tony, my producer, Kelley, thank you for coordinating the show, and many other team members who work tirelessly behind the scenes make this podcast a success. I want to personally thank my sponsor, CareVention HealthCare, for sponsoring this podcast. CareVention HealthCare provides comprehensive services and solutions for PACE organizations at every stage. To learn more about CareVention HealthCare, visit our website at CareVentionHC.com. Also, please check out my book, Age is Just a Number. It is a great holiday gift for someone you know. All the proceeds from the book go to senior charity that address food insecurity, senior loneliness, and more. It's the holiday season! Please take some time for yourself and your family. Your mental health is as important as our participant's mental health. On behalf of Keep Up with PACE Team and CareVention HealthCare family, we wish you a happy and safe holiday. Cheers to a year of accomplishments and to a new year of achieving even more. See you next year with a new season and new guests. Until then, namaste and goodbye.