What is a PACE Program? You want to know...

Championing PACE: Comprehensive Care for the Elderly with Donna Wilhelm

In this episode, Erin reconnects with Donna Wilhelm, Vice President for Advocacy and Government Relations for Trinity Health Continuing Care, to discuss the impactful PACE (Programs of All-Inclusive Care for the Elderly) program. Donna shares insights about her career shift into senior living services, her role in the PACE initiative, and the comprehensive support it offers for seniors and their caregivers, from medical care to everyday necessities like air conditioners and laundry. The conversation also covers the political challenges PACE faces, including the necessity to advocate for federal and state support to ensure its sustainability and expansion. Both Erin and Donna emphasize the critical need for programs like PACE to become mandatory, amid the growing demand for senior care solutions.

00:00 Introduction and Guest Welcome
00:38 Donna Wilhelm's Role and Background
01:55 Overview of the PACE Program
02:28 Eligibility and Services of PACE
03:18 Financial Aspects and Risk Management
05:17 Real-Life Examples and Impact
06:46 Interdisciplinary Team and Care Approach
08:22 Expansion and Advocacy for PACE
15:53 Caregiver Support and Holistic Care
18:52 Dementia Care in PACE
20:37 Managing Expenses and Medicare Coverage
21:34 Political Implications and Advocacy
23:23 Medicaid Funding Challenges
25:27 Potential Cuts and Their Impact
27:22 The Importance of PACE
35:16 Scalability and Future of PACE
36:59 Conclusion and Call to Action

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Transcript

Erin: 0:35

y'all. In my best Southern voice I'm really excited about today because you get to hear another southern lady, miss Donna Wilhelm, who I worked with at a previous community, a locally owned, community for a little while called Mercy Medical. she was the vice president of sales. What was your. Yeah,

Donna: 0:55

I was vice president of sales and marketing for Mercy Medical, so

Erin: 1:00

yeah.

Donna: 1:00

Yeah. Seems like a hundred years ago, Erin.

Erin: 1:02

it does seem like a hundred years ago and now, she's working in, such a purpose driven, Service inside Senior living, which is the PACE program. And I want to give Donna the floor so she can talk about her title, what she does. But before I do that, I just wanna say to everyone who's listening, this is a bit of a full circle moment for me because having Donna on the episode, on this podcast, on this episode is something that, you know. 14 years ago, I don't know if I ever would have thought that this was a possibility. Donna was high up in the food chain and I was an administrator of, a 64 apartment memory care community that was struggling. Mightily and there were many different pools going on, and, the dynamics were interesting, but here we are. And it's really exciting for me. Donna, welcome.

Donna: 2:04

we learned from each other, Erin. We've learned from each other, and that's, I think, the way it's supposed to be. but I'm happy to be here. Happy to, to be, speaking to with your listeners. And just a little bit about me. I am the Vice President, for advocacy and government relations for Trinity Health Continuing Care, which includes Trinity Health Pace. We have three national ministries under continuing care, and that's senior Communities, our Home Health and Hospice, and our PACE Program. but we're here today to talk about pace. I serve as the. The advocacy person, which means I, I fight for all sorts of things, but mostly I fight for our participants to remain in our program for the funding to be appropriate, to cover the level of care that we have, and for access and growth. So it's important that the program grows, so that more and more seniors have access to, this very important home and community service that allows people who are nursing home eligible to remain in their home. So that's me in a nutshell.

Erin: 3:02

Yeah, that's a lot. So PACE stands for, it's an acronym. Tell us what it stands for.

Donna: 3:08

Yeah, PACE stands for Programs of All Inclusive Care for the Elderly. I think what's so important about that is it's all inclusive. So it's important to note that for people who enter the program, they have to meet certain eligibility requirements. They have to be 55 and older. they have to require nursing home level of care. So that's one big caveat. Nursing home level of care, they have to live in an area that's served by pace. It's not every area has pace in it, in its, in its district. and they have to be able to remain at home and in the community safely with the support of the PACE program. So not everybody will qualify for pace, but for those who do, we provide wraparound. All inclusive services for those folks. So for them to remain at home, we usually get paid in a capitated, we always get paid in a capitated bundle, so we receive payments from Medicare and Medicaid if the person qualifies for both, if they are dually eligible, if they are only Medicaid, then we receive just that capitated amount, and if they're only Medicare, we receive that capitated amount, plus a private pay portion. however, 99% of PACE participants are Medicaid enrolled and over 80% are dually enrolled in Medicare and Medicaid, and that's nationwide. so most of the folks have coverage on, both Medicare and Medicaid. All of them are nursing home eligible. So when I say it's, it's capitated, so we take that bundled payment, so to speak, and it's a monthly per member per month payment that we receive for that amount of money. We are 100% full risk. So what the heck did that mean? That means that for that we are on the hook for their care for everything. So if this person has to go to the hospital. we pay for that. If this person has to see a cardiologist, we pay for that. If they need a kidney transplant, we pay for that. so all of it we are on the hook for, so we behooves the PACE program obviously to do the right thing and really take good care of our participants. You should be doing that anyway because it's the right thing to do. from the financial aspect, it certainly means a lot to, to provide the care that prevents some of those really big, medical episodes from happening. So we do our best to do that and take really good care of our participants. But it also enables us, because PACE has a little more freedom than some of those Medicare and Medicaid programs. It enables us to, I like to say it allows us to take care of our participants like we would our own mother. and I'll give you a very good example, Erin, and I think I've shared this with you before in our PACE program in mobile, we live in the deep south. It gets darn hot and sticky here in the summertime, as you well know. So we had a participant who was in our mobile pace program who, she lived alone. She lived in a very small home, and she had a lot of, lung issues. so the, the heat was really bad for her. and her air conditioner died at her house. she did not have the money to fix it. are not wealthy individuals. Air conditioners. Price. So it made, without pace, this particular lady who, was well into her eighties, could not have stayed in that home. And because of her chronic conditions would've likely end up in a nursing home without pace. there was just no other option. for us, for the PACE program, we were like, it would serve her better, and is a heck of a lot less expensive to just fix her air conditioner. So we were able to use that money to fix her air conditioner, which compared to a nursing home with, it's just like a drop in the bucket. It's just like a total drop in the bucket. And it allowed her to stay in her home where she preferred to be, and she was able to stay with the supportive piece. And there are thousand other stories like that, that it's just common sense thinking, what would you do if this was your. Mother, would you stick her in a nursing home or would you fix the air conditioner? some of it's just very common sense stuff. a lot of those, all the decisions in pace are made by the interdisciplinary team. It's a group of professionals that, you have physicians, you have nurse practitioners, you have therapists, you have the, the aide, the driver of the bus that drops off, the little lady at home. All of these folks sit on the IDT. And so when those discussions are made about. what's best to be done for this individual? It's a team approach. it's not as if the physician sits at the head and directs everything down. Everybody has a voice at the table and is able to say, I think this would work best for this person, or This wouldn't work best for this person, or, we can't recommend that because of, so it, it's. I like to say it's in your face case management because the pace IDT really knows everything that's going on with that participant. So those wraparound services are pretty significant. they are meeting the needs of this individual at a level that, that really has not been met before. but so allowing them to remain in their home safely. So it's a super program. It, it really allows for the person to, to be where they wanna be, and I'm an advocate for nursing homes. I think we'll always need nursing homes. I think we always need assisted living. I will say, there will always be a place for them, in the medical world. however, I think if you ask anybody, really anybody. Would you rather stay at home? I think they're gonna say yes for absolutely as long as possible. I want to remain at my home. so it's important, an important program to do that. Now, I touched on earlier that you have to live in an area that is served by pace. So you're thinking, gosh, I never heard of it. and there's probably a really good reason you've never heard of it, is it's a really, the best kept secret. and that's not because we want to be, it's just because pace is still relatively small. So Trinity Health Paces, where I work, we have programs in 12 State. we serve over 3,500 participants in our PACE programs. But nationally, like I said, there are over 80,000 people in PACE programs, in 33 states and the District of Columbia. and you may ask, why is it not in, in every state? the issue with that is. The Centers for Medicare and Medicaid, which oversees PACE programs and most every other, medical program out there, has told the state that, you have mandated programs like say nursing homes are mandated and you have to have them, Medicaid has to pay for them through the state. And then you have optional programs that are fine to have, States can opt in, states can choose to have these optional programs and pay for those as, as people choose. to be in, PACE is optional in CMS, so only 33 states and the District of Columbia have chosen to. Although some states have pretty good coverage, meaning they cover the entire state, very few states have 100% coverage of all locations. for an example, we are in Alabama. There's one PACE program, and it's ours and it's in mobile. We only cover two counties, the mobile and Baldwin County. there needs to be a push from, constituents, in the state to go to their state legislators and say, Hey, I want pace. I want pace in Montgomery and I want PACE in Birmingham, and I want pace in Huntsville, to be able to speak to that and so that the state can expand it. And also in other states, we have successfully expanded pace. in a lot of states, recently we just had our grant opening, actually Friday for a program in Montgomery County, Maryland. They had one PACE grant program for 20 years. 20 years. It took Maryland's amount of time to finally move forward. so now we have the second one in Montgomery County, but we've expanded into Louisiana. We've expanded into, Florida. And a lot of states that are very supportive of the PACE program have really, embraced it. Really embraced it because they've seen what a wonderful program it is. And from a state perspective, if I'm a state Medicaid director, I'm gonna be like, how much does this cost me? And what's the difference in cost between caring for this person in a PACE program and caring for this person in a nursing home? Nationally, that's over a 12% savings to the state. So if I were a Medicaid director and someone said, you can save 12% for these very high cost, individuals to be cared for, I'm gonna sign up for that all day long. so states are really adopting this at, a much faster pace than they used to. but still the word needs to get down and these states need to jump on board and adopt pace.

Erin: 12:21

Yeah. So there's a lot to unpack here. Yes, because for people inside senior living, we get phone calls all the time. About how, and there are people that we can serve and there are people that we can't serve, and people who are eligible for pace typically are the people that we cannot serve. Because number one, they qualify for skilled nursing. Which some people who qualify for skilled nursing can live successfully inside senior living. But not every single one of them, and not in every single state. So there's lots of gray area that to navigate. But when we look at, from a financial standpoint, and there's all kinds of talk going on about how to serve the underserved. And when a sales director. Can help problem solve for people In these 33 states, which are obviously specific to counties in those 33 states,

Donna: 13:20

it's,

Erin: 13:21

if you have a PACE program and somebody calls you and they don't know about it, you could just be giving them, one of the greatest gifts that they could ever receive. to be able to replace somebody's air conditioner, or correct me if I'm wrong, build a ramp in someone's house. Exactly. Because I remember have some other

Donna: 13:39

examples.

Erin: 13:40

yes. I remember. way back when hearing about that and thinking oh my God, that is God's work.

Donna: 13:46

Yes.

Erin: 13:46

You know what I mean? Like it's, yes. to be able to say to someone, we're going to do this for you because you need this and it affects you medically like. that is, that's an amazing conversation to have to be able to actually do that for somebody. And something as simple, and I have a personal experience with it because I tried to get my grandmother on the PACE program and then I have another family member that I think could benefit from this, that I'm working with a family about is something as simple as just picking up laundry. You have laundry routes?

Donna: 14:26

We do.

Erin: 14:27

You go pick up people's laundry, which yes, is mind blowing to me because that costs a lot of money to just go pick up people's laundry. That costs money, that costs

Donna: 14:44

personnel,

Erin: 14:44

that cost gas, that costs like cars like so much.

Donna: 14:49

I would say so much services. Are really issues of dignity for the participants that we serve. And I'll never forget this, and this was, gosh, I dunno, 14 years ago, but when we had our grand opening at our PACE program in mobile, the archbishop was there, he had the blessing. It was like this big to do. And I remember touring him. through the facility and we came to the room that has the laundry, that has showers, that has a little lockers for people to put their stuff up in. It had a place that we can actually wash people's hair and cut their hair. and his comment to me was, what this says, he said, what this says to me is you are caring for the dignity of the person. So many folks, and these are not, again, wealthy people. They, their homes are their homes and they may not be fabulous places for everybody, but they're home to them. they may not have access even to, or the ability to get into a shower anymore, or a tub that's, safe. And so we can go pick them up. We can bring them to our pay site. And, they get shaves, they get showers, their hair is fixed, their laundry's done. And so when they go home, they're in clean clothes. They've got their clean clothes with them. They've had a meal, they've been cared for, they've been checked out by the nurses and the physician. so those are things that, that go a lot deeper than people really expect. I think we tend to take these things for granted as people get all oh, they have that. A lot of people just don't have that, and a PACE program can provide that with folks.

Erin: 16:27

Yeah. it really is amazing. And let's talk about the caregiver support. We know that there's a huge sandwich generation Yes. surge where I even see it with some of my friends who have younger kids and then they have older parents and they're trying to navigate it. And so yes, we're talking about caring for. The person, but we are also caring for the caregiver as well because like you were saying, there's like a daycare kind of component, like a day program where they can come in and see the doctors, see all the specialists or the, the type of care that they need, Eat, shower, and then be able to come home. And there's transportation involved with that as well. Yeah.

Donna: 17:14

We do provide transportation for our participants both to the center and to their physician appointments. if they have an outside appointment, we take them. we have dialysis patients that we're providing transportation for three times a week to dialysis. So those are all, included in the services that we provide. And I think you touched on something that's real important and that's caregiver the care of the caregiver. most, if not all of our participants have somebody that helps care for them in the home. maybe it's a daughter, maybe it's a spouse. and so they have come to pace because they're struggling doing that, but they want to do that. they still want this person to remain in their home. But I think one awesome thing that, that we give caregivers that you know, that, aside from the support of all those things that you just mentioned. Is it somebody to call immediately if something happens, or if you think something's happening or if you have a question? we've always said, call pace first. call us first so you know, before you think there's, a possibility that person needs to maybe go to the er. Certainly don't hesitate if that's your thinking. but if you do have questions, call us and let us triage that person and make sure that it's nothing else that could be handled either in the home or the nurse coming out, to manage that. So it gives those caregivers the peace of mind of saying, I've got someone on the other end of the phone all the time, that can help me if I have these questions or feel like there's an urgency and that's peace of mind that, most caregivers just simply don't

Erin: 18:41

have. Yeah, it's great. It's, and to help make decisions to, to have, help make decisions. Yeah. Yeah. because we all get decision fatigue and to be able to have somebody who is at your call, at, to be able to say, this is what's going on. And they have seen them that week and the driver has seen them and they have all these input. There's just a holistic level of care there that, is. I find it to be very valuable, just from, it's

Donna: 19:12

very valuable

Erin: 19:13

yes. to be a caregiver for 15 years for my grandmother to know what that would've been like, and to be walking with certain family members for having that component and dementia care is something that's rising. And so how does PACE handle dementia care, per se. So let, what if you have somebody who's on your. Who is a participant and now all of a sudden dementia becomes prevalent. is it works the same way, Same way. You have to,

Donna: 19:44

and I'll be honest, more than half of our participants have some form of dementia. that is a very common diagnosis for people in a PACE program, as it is common for people in nursing homes. we care for them in the very same way, making sure they're safe at home, making sure they have what they need at home. bringing them into our PACE program and our PACE programs for those, folks that say Alzheimer's intend to wander, we actually have day rooms that are secured. So they, they can't get out and wander about or get out of the building and if they do, all sorts of alarms go off. So we have ways that protect them. but that is a very common diagnosis within the PACE world. Yeah.

Erin: 20:23

And so just to reiterate,'cause this sounds amazing. who wouldn't want this?

Donna: 20:27

They could, yeah.

Erin: 20:29

It is for very specific People. Yes. And income limits. So we're going back to Medicare, Medicaid. there's financial stipulations for this and it's very specific, right? yes.

Donna: 20:47

It differs in what those, financial requirements are for the PACE program. They are, mirrored after the nursing home eligibility requirements. you know what you have are folks that have to qualify, for long-term care. I will say that what is fabulous about pace, because our folks are still in their homes. They don't have copays, they don't have deductibles. their income is to manage the expenses in their home, not to pay us. it's wonderful that they can maintain that, especially if they have a spouse, if they have a caregiver giver living with them, that the household is maintained, for their care and their safety. the Medicare and the Medicaid capitation rate covers it 100%.

Erin: 21:32

That's so good.

Donna: 21:34

It's so good.

Erin: 21:35

It is so good. So good. 33 states, and that's specific to counties. It's not necessarily, statewide and it's

Donna: 21:45

actually spelled out by zip codes, which even gets more granular. However, most of the time when those, territories are awarded, they of course fill up a zip code. They're included, but that's all inclusive within a county. we have very few where there might be some, lines drawn where, one zip code doesn't, doesn't qualify and another one does. And those are tricky because, you can't cross that line.

Erin: 22:09

this is gonna take us into a bit of a political conversation, which, I am not political. Oh, my

Donna: 22:15

favorite.

Erin: 22:15

Yeah. I know. I am not political. I don't, I am drawn to chaos and so I have been paying a little bit more attention to what's going on this past, year, but don't have a real, opinion. I. To share on any official level, but I do, and I'm going to my first advocacy day to, to be able to become an advocate for senior living and different things like that. And you mentioned, how people need to call their senators and, all their, whoever it is that they need to call to say, Hey, we want more of this in our state. But as great as PACE is, and you have made it out, made it sound like it is an amazing, opportunity. And it is. And we know that there's this huge boom that's coming that's going to need senior living at all levels, right? And there's not enough senior living housing and there's four people, and then there's a lot of people who can't afford senior living. And so PACE certainly is a huge viable option. For a select few, and I say all this to say to reiterate what you said is it's optional.

Donna: 23:32

Yeah.

Erin: 23:34

Optional being the key word there. Absolute. And any fluctuation you know of. Budget cuts and perceptions and opinions and anything else that can get in the way could remove this benefit, this opportunity. This program from people. Am I correct with that?

Donna: 23:59

You are so correct and we are in kind of an unknown, political, position. and I won't get political with it, but I will say that there's a lot of discussion right now about Medicaid funding on the federal level. although Medicaid is a state program, it is, very highly financed by the federal government. there are matching rates. There are, provider taxes, there are all sorts of things that the feds for years, and this is no, nothing new. this has been going on for decades and decades, where the state simply just can't afford to cover Medicaid 100%. it, it's just, it's never been a thing. it's not a thing now. so right now there are. Some threats to Medicaid at the federal level, which will impact every single state. So not just states that Pacer, happens to be in, but every single state. So as we're watching what Congress is doing, and some of the proposals that have been put out there, some of these could be quite drastic and could really eliminate, Tens of millions million to each of the state. hundreds of millions, quite possibly to each of the states. So I know I live in a state and we work in a lot of states with Trinity. I'll be honest, there's not a Medicaid program out there that's yeah, we'll just use all that extra money we have sitting out here, or legislature raise taxes. These are not things that, these are not conversations that are had because they're not realistic. So when states get into budget cuts, and we seem to have this stance every single year, even without the federal threats, where. The budgets are tight. And so you talk about funding, you talk about what you can do, what you can't do. you talk about, rates, you talk about optional programs and in the end, they all seem to work it out and get to a point that, sustains the Medicaid program and the eligibility requirements and the right, however. If some of these cuts that are proposed at the federal level go through the states will have no choice. they're going to have it, they're gonna be in a situation where they don't know what to do. they will be minus a lot of money. So what do you do? and you can look at this even from your own, budget that you do at home. you get rid of the things that you don't have to have, right? So you're like, like I no longer alarm for my Starbucks coffee every day, and I'm gonna have to cut off the cable. these are all things that we all have those conversations about. so for Medicaid, they're gonna say, what do I have to do? I have to provide care and a nursing home, I have to hospitalization, laundry list of things that I'm gonna. And then on the other side, what do I not have to do? So these are things that, are not dictated by the feds that you have to do. So cms, it's great that you have them, but you don't have to have into that bucket. as do a lot of, dentistry, eyeglasses, all those things are optional in the states. a lot of home and community based services, lot of waiver programs. Are optional. states really won't have a whole lot of wiggle room or a whole lot of choice in what they do. so for pace, and really for any optional program, it puts a, a bullseye in your bag that says, if these cuts, if any cuts are mandated by the feds, paces at. A pretty heavy risk of elimination. certainly some states will maintain it, I think because they have just really committed to it. and they'll have to cut in other areas. But what does that mean, cut in other areas? Does that mean, provider rates go down that are no longer, so it's no longer sustainable to do business in that state? and it could well be a combination of both of those things. It could be elimination of optional programs and a decrease in rates for providers. Either way, it's just, the sustainability of Medicaid, with, without the federal match is just not even a thing, and I say that Medicaid because it covers children and elderly. It really is the foundation for healthcare in this country because it covers so many people that would not have coverage otherwise. It's the foundation of it. and what happens when you mess with a foundation? you're putting cracks in it, you're basically tearing it up. Then the whole system relies on that. that foundation, you could see some pretty drastic things happen in healthcare should some of these things that are being proposed, they're being talked about and, I'm not making this up. the consequences could be quite dire across the board.

Erin: 28:47

Ooh. So if that were to happen, let's just say worst case scenario, all the participants that are on pace now, like they would lose those services because it would just. it, you wouldn't even potentially see it. Say, okay, you can keep it for who you have, but you can't take on anymore. We wouldn't even see that.

Donna: 29:09

Yeah. And that's our fear, certainly, that message is getting across to, to the members of Congress that, these are potential outcomes for this decision. and I think, and trust me, pace is not the only organization out there saying, You know what I mean? The hospitals are out there saying, this will impact coverage. we're, we'll go back to the days when, where, so many people coming to e our er, our ERs, that's hard to say and not have any coverage. our rates are likely to be cut for those that do you have coverage? Y so the scenario, plays out in each of those, healthcare entities in a different way. but it's big enough that the voice on the hill right now is very loud. So I'm not sure how that could be ignored by members of Congress, by members of the administration. I just don't know how they can ignore those, the number of people that are out there saying this is a terrible idea.

Erin: 30:09

Yeah. And you save them 12%. Hello? 12%? Yeah. Yeah, 12%. not every waiver program, not every optional program actually has an ROI that you can give them,

Donna: 30:23

and in some states it's more than 12%. It depends on what their nursing home rates are. I think in Alabama it's over 20%.

Erin: 30:30

Amazing. and I guess it's important to say this is not like. You only have a certain amount of people that can be participants at the same time.

Donna: 30:39

That's right.

Erin: 30:39

So it's not like you can have 10,000 participants and you're making,

Donna: 30:44

or cap in Alabama at 200, Erin. we would love to have better, impact, more impact on more lives, but we are capped at 200 participants.

Erin: 30:54

And what about other states? Are they the same? Is it like the same number? A lot of.

Donna: 30:58

A lot of states have caps, but many states do not have caps on enrollment. They're just like, if you can take them. So no. A lot of states do not cap enrollment because they see the value in it. They really have seen the value in it. Yeah.

Erin: 31:14

Oh, that's interesting. Okay, so go back to, if you can remember those senior living days. senior Living does have the opportunity to refer to the PACE program to be a service, is pace friendly to senior living? is actually moving into senior living an option potentially for some case participants.

Donna: 31:36

it can be an option where it's a problem. I will tell you, it's probably what we've experienced in Alabama is the regulations don't allow you to admit somebody's nursing home eligible. And I'll be honest, most of our folks are pretty darn sick. the, they're not coming to us. because they, Need help in one little area. these are folks with a lot of chronic conditions. These are folks on a lot of medications. They have a lot of needs. there's a dually eligible and they're, they are known for being significantly more costly and having more needs than other populations. And but that is the population that we serve. So now I would say that senior living, may not always be the right choice. for a lot of reasons, but mostly because I'm not sure it would be a good fit for the level of care that they're at.

Erin: 32:26

Yeah. Yeah. I do believe that pace is God's work, like literally at hand. Clearly the government is paying for it, but the implementers and the facilitators are. I mean, Trinity is a Catholic-based company, right? We're

Donna: 32:43

a faith-based, not-for-profit. Yes.

Erin: 32:45

Yeah. Faith-based, not-for-profit company. And, do an amazing job to be able to do the decks or the ramps or, the air conditioner, to take care of dignity in such a powerful way that an underserved population may never have had been taken care of in that way. Yeah. Which is powerful.

Donna: 33:07

Yeah. and I've heard a lot of, comparisons, but, I heard one of our executive directors once say that it, it allows people that have never been at the front of the line to come to the front of the line. And that's a real meaningful, picture that you're drawing of a population that, that you know, somewhat on the fringes. and It allows them care that maybe others can afford. And so they're always at the front of the line receiving those things, but just moves them, up into a space that they haven't been able to be in before.

Erin: 33:38

Yeah. I view pace as being like the caboose engine that can, Like it's catching some steam, we are valuable. We offer amazing opportunities and care and programs. for the most vulnerable of our society. And it needs to be championed, it needs to be supported. And we can do that by calling or writing, to our congressmen, our senators, both on the federal and state level.

Donna: 34:11

in the state level. Yes. Absolutely. absolutely. and I think as more and more join that. That conversation, will see more pace growth. I think it's important that pace gets moved out of the optional bucket. CMS move. there was legislation that was introduced in the last Congress that should be introduced in this, Congress as well that does that makes some changes. Act actually amends the Social Security Act to include some, some language from case that would make it mandatory under CMS. so there, it's not like the conversation's not been had, it's not as if the, there aren't folks working on that, but, Just say it would require an act of Congress. And I laugh a little bit when I say that because it would require an act of Congress. but it's, but it's not out of reach. I've always said, I would retire before I, I saw pace, as a mandatory program. I don't think so. I think I will see it, before that, mostly because I won't retire. The, I think there is a movement that's pretty strong. If we can survive what's happening now, like literally now, with the Medicaid stuff, then I think really the sky's the limit for where PACE can go with this.

Erin: 35:24

Yeah, man, the goal is to make it mandatory.

Donna: 35:27

Mandatory, yes.

Erin: 35:29

Not optional. It's mandatory with the numbers that we have that are coming, we need this, uncapped, mandatory uncapped. We're saving you 12 to 20% like hard in a hard ROI. Yeah. This only makes sense. This only makes sense.

Donna: 35:51

I heard a, someone say, is pace scalable? how could you grow it across the, and this is my, this has always been my response. I imagine a hundred years ago, literally like a hundred years ago, when nursing homes were expanding across the country, I bet somebody said, is this really scalable? how are you gonna build these enormous buildings, have them everywhere and, have people living in the, all these little rooms. I. Impossible. like such a big, and now there's four or five in every community. they're all over the state. They're all over the country. so I think we need to use that same mindset with pace. Of course, it's scalable, Absolutely. It's scalable to be able to do that. If you could do it with these ginormous buildings as our nursing homes, you can do it with a PACE program. So sometimes I think we, we tend to look at the challenges, understanding that there are definite ways around them. and yes, I think pace is absolutely,

Erin: 36:54

who doesn't wanna work in an environment where you give, when you're almost a hero every day.

Donna: 37:02

Yeah. Yeah.

Erin: 37:03

You feel that way inside senior living to some extent, but I feel like in, in a pace standpoint, like it's very different. It could be senior, it's very

Donna: 37:16

different as I've done both, and it's very, it is different. there's a level of, appreciation and gratitude that may be a, a little higher. but, you. Lived in the world. but it's, it's a program worth saving. It's a program worth growing. Ah,

Erin: 37:32

love it. That's great. And I think that's the end right there. It is a program worth saving. And it is a program worth loving and it is scalable and it needs to be mandatory.

Donna: 37:44

Yes, definitely love it.

Erin: 37:46

I'm fired up. I would go and help advocate on pace advocacy days. You just let me know. Yeah, I'll be there. yeah, for sure. if that's a thing because I know senior living does it. I saw Alzheimer's awareness, people going to advocate for it, the state. And I'm like, okay. So once I get my, we just

Donna: 38:04

on the hill in March doing that very thing, and I'll be back in just a few weeks to talk about. It's very same subject. So yes,

Erin: 38:12

so good. So good. Thank you Donna for being here. Thank you for educating me and other people on pace and what we need to do to support, this program. It's very important. Thanks for having

Donna: 38:24

me. Super to see you again. And go pace.

Erin: 38:27

That's right. Go pace. And as always, for my listeners, aspire for more for you and Pace. And.