Let’s Talk About PACE
Centra PACE nurse practitioner, Kathy Worley, joins Kate on this episode of the podcast to discuss the PACE program, why it’s important for the community and why this model of care makes such a difference.
Note: Due to extra social distancing during recording for the safety of all parties, some audio may sound more muffled than normal. [Additional note: your host, Kate, recently got married and her name change is reflected below.]
Speaker 1:
Thanks for joining us for this episode of Centra Scripts, where we talk health and wellness and practical tips for your everyday life. And now here's your host, Kate Justice.
Kate Justice:
Thanks again for joining us on this of Centra Scripts. I am Kate Justice and I'm so excited to be here today. We're doing something that we have never done before on this podcast, and that is have our guests join us via phone today. So I am joined by Kathy Worley, a nurse practitioner for a program here called PACE. Kathy, thank you so much for joining me today.
Kathy Worley:
It's my pleasure, Kate.
Kate Justice:
And Kathy, let's just have you introduce yourself to everyone real quickly. Tell a little bit about who you are, what you do and how long you've been here at Centra.
Kathy Worley:
All right. Well, I'm Kathy Worley. I'm a nurse practitioner. I've been a nurse practitioner for about 30 years. I've been with PACE about four, excuse me, five years now. PACE in Gretna kind of opened five years ago, and I was hired to be the nurse practitioner here at this site. What I do, basically here at Gretna PACE and in all of our PACE sites, we have a nurse practitioner that works in the clinic to see our participants work as their primary care provider when they join PACE. So we have the oversight of our folks medically, and we help them as they come to PACE and help them with their medicines, help them with any diagnostics they need. If they're sick, I do their assessments. And then every six months, of course we do big assessments where we actually do blood work and evaluate for all their chronic and any acute illnesses they may be having. So, yeah. It's fun. I enjoy what I do and I live here in Gretna, so it all works out great for me.
Kate Justice:
Yeah. That's awesome. So this is like hometown care for you being right where you grew up?
Kathy Worley:
You got it.
Kate Justice:
Yeah, that's amazing.
Kathy Worley:
And a lot of my jobs over the last 30 years, I've traveled. Living in Gretna, you either have to work and travel to Lynchburg or other counties. And basically this is the first time I've been able to work in my community, and it's a beautiful situation to know the folks in the community and the industries and all around us, and at the same time, serve a lot of the participants that I've known most of my life.
Kate Justice:
That's so amazing to be able to have that care right there in your own backyard and be able to have those kind of established relationships with people in your hometown is really cool. I want to back up for just a second though, for anybody that's joining us that maybe doesn't know what PACE is. So P-A-C-E, PACE is the program that we're talking about today, and it's a super important program and a big portion of the care that we offer here through Centra. So Kathy, tell us a little bit about what PACE is and why it's important.
Kathy Worley:
I call it the hidden gem. I didn't know about PACE until I applied for the job, but I have done research and PACE stands for, it's an acronym for Program of All-inclusive Care for the Elderly, and a little history on that I've found out about in my research over the last five years is that the PACE model actually mimics a study of the Asian, community actually in California, and how well they cared for their elders in the community and had resources and would help families with their loved ones as they aged in place. So from that study and model, PACE was actually formed, and actually a national PACE started in 1994. And so here we are in 2021, almost 2022, and every state has a PACE. It's basically owned individually by different companies, run them, but the theory is still the national model.
Kathy Worley:
And so Centra PACE actually started probably some 15 years ago with the Lynchburg site, with Dr. Verna Sellers, our medical director, helping to get that off the ground. And then Farmville opened their PACE site. And then five years ago, Gretna sprung loose. And here we are, each site has its own personalities, so to speak, because we have our own employees, our own participants, individual needs, depending on the location. We're rural here. We have a lot of travel with our transport team to go get folks because we are in a rural community. Whereas perhaps in the city like Lynchburg, a lot of their participants live locally closer by. So everybody has their own... Every site has its own individual ways of doing things, but at the same time we work as a group and we feed off of each other's experiences so that we can grow and learn. And we are able to kind of think outside the box to see what we can do to help folks.
Kathy Worley:
So folks actually are referred to us and we have a navigator that goes out and can give folks more information about PACE. And if you want to see more about PACE, we can actually set folks up for what we call pre-PACE assessments, where you get to come in and meet different parts of our team. We actually... Other than the clinic that's all I've been talking about, and then transport of course, which is very important to go get folks and take them to doctors and appointments and such and bring them to the center, we have a recreational therapist that entertains folks and keeps them stimulated in the day room. We have dietary, a dietician that works with whatever needs they have for a certain diet.
Kathy Worley:
We get our meals from Virginia Baptist Hospital. So once a day at lunchtime, they get a good hot meal as well as a light breakfast and maybe an afternoon snack depending on how long people are staying during the day. We have therapy, occupational therapy, physical therapy that are able to facilitate as well with whatever exercises or needs therapy-wise that can help that person maximize their function. We have social worker and folks that can do awesome things with coordinating with other community services and helping with any psychological or mental health counseling needs. They have home care. That's awesome to be able to go out and assess what the needs are in the home. What could we do to make it safer, as well as some CNAs, certified nursing assistants, that can go in and actually do task-based care. If you just need help in the morning getting up and ready for the bus, or if you need help with lunch at midday, or if you actually need time with CNAs, we have agencies that we also consult with and collaborate. When it all gets together and works together, it's a beautiful thing, and that's, I guess, the difference in PACE in anywhere else I've ever worked before.
Kate Justice:
So when you say all inclusive care, that was a huge number of care points that you just described there to us. And obviously, it's very adaptable to the person that you're are working with. So explain to us maybe what kinds of patients and families, you all work with us. Who would be a good candidate for PACE?
Kathy Worley:
I'm glad you asked. So PACE nationally is recognized for folks over 55 years of age, and there has to be a community assessment, usually through social services where they are deemed needing more assistance and possibly even reaching the level of care of needing to be in a facility, like a nursing facility, because of their deficits and not being able to do their own individualized activities of daily living, like bathing, feeding, preparing their own meals, housework, things like that. And so we don't make that decision here at PACE, but once we get a referral from social services, then we certainly can go out and talk to that person to see if they want to try us out. Also folks, depending on where you're living, your location, if you live in a certain zip code, you may be more Lynchburg PACE or Farmville PACE or Gretna PACE.
Kathy Worley:
And so it is a requirement that you have to live kind of in our area, but yeah, 55 and older needing the care in order to safely and independently be in your home, and then living in our zip code. We have a variety of folks cognitively. We have folks that are well-adapted and able to communicate and come in for socialization, play games, play cards with their buddies, maybe having some early changes in their life, but having other health concerns or functional concerns that kind of puts us in that part where we can help them maintain longer in the home. And then also, we have folks that are in that end stage, perhaps dementia, that need more total care and need a break for the family. And we can bring that person in, keep them stimulated, take care of their care while they're here, so their family can have more of a quality of life as well.
Kathy Worley:
One thing about PACE different from a nursing facility is that we don't provide overnight care. So we're not a nursing facility, but we can provide a lot of the same care that you get in-house at a facility, except we just don't do the overnight care. So we are in a relationship with the families as patients choose PACE.
Kate Justice:
Well, and I love that aspect of it. You and I have had previous conversations to this conversation today, and I loved that you, in one of our very first times that you and I chatted, you said we don't call them patients, we call them participants. And that just was such a different level of defining what the program does for me when you explain that to me, because I think sometimes we hear the word patient and it's very transactional or it can feel like that sometimes, and it's a punch in, punch out, and this is your care card for the day. But when you call them participants, that's an active part of the program. And so people that are involved in this program are actively participating in their own care model. Is that correct?
Kathy Worley:
That is so true. And that is something we work on daily. When folks start with PACE, we introduce that as our philosophy. We go over their med list. We talk to them weekly about their meds if they need to. When they come in the center, if they're sick and need to see the clinic or have a concern, a nurse would triage that concern. I may see them if they need to. And we talk with them consistently and what do they think they can do to make this better? Because the patient is the center of the care. And I think that's the beauty of PACE. When I worked in family practice, you would see folks every six months maybe to refill prescriptions. And really, I didn't have a clue what was going on in that home. And so I really missed that whole side of assessment. Whereas here, your eyes are wide open. Our transport folks go in the homes to take people home. Our CNAs are in the home. We get day-to-day reports if there's a change. So yeah, I'm daily aware of all of our participants, whether I'm changing any of their plan of care or not, which is great.
Kate Justice:
Yeah. You mentioned a few minutes ago the word relationship, and I think that that is a huge piece of defining what this program is and how you all interact with these participants and their families. For those who are struggling, maybe those family members that are struggling for caring for their aging family member or maybe a family member that is exhibiting some of those things that we talked about in the beginning of this, as far as signs or symptoms of other things, what does this program do to stand in the gap for those families?
Kathy Worley:
Good question. So families are going to have stress when caring for loved ones. And so PACE actually cares for the family as well as the participant because without the family, we don't have as great of control or help for that participant. So we recognize caregiver stress. Our social worker here has introduced a caregiver support group during COVID. It was kind of difficult, but even through Teams meetings or on the phone, just letting families vent to other family going through similar things. That's something we have assets here, but yeah, just knowing you're not alone, that you have a whole team, and the family is one of the values members of that team, as well as the participant that is working towards the same goal. We ask about your goals of life in the very big beginning, when we first get to know folks. And with that then, we want to really stand up for folks' rights as far as autonomy and protecting them from having anything done that they don't want to have done. We talk with other providers that we refer to about what patients want or don't want. And so their wishes are known throughout their care here at PACE. We try to share that with everyone.
Kate Justice:
Well, that's so huge to be able to, as a family member, be able to vulnerably and transparently say, "I'm struggling and this is what I'm struggling with," and have somebody be able to come alongside them. And so the support group and the care that they receive as a family unit in this is something that's so distinct and different, and it's something that we want to celebrate in this conversation today. So let's talk for a second here too, about this idea of community involvement with a program like this. What does this look like for maybe referring physicians or organizations outside of Centra? How does PACE coordinate with those types of care?
Kathy Worley:
Right. So all folks need to do is either call us. We have a navigator, like I said, at each site that is just a wonderful resource of other community assets out there if PACE isn't the fit, but also you can call and get information. You can just refer that patient name to us if they give you permission to. A lot of the doctor's offices locally have done that. They kind of know about PACE, and we'll get medical records. Our team will get to know them. And then it's an opportunity for the patient and family to choose. If they want to [inaudible 00:15:45] PACE, great.
Kathy Worley:
Like Dr. Sellers has said, our medical director, "Once you join PACE, it's till death do we part, like a marriage." It's a relationship that we grow and trust, build that trust with each other. But if something comes up and you think you would be better served in a different way, then fine, we want to make sure that you're successful in your next journey. We've had people that would move out of our area and perhaps we could refer to another PACE, but if there wasn't one available, we want to make sure that their next primary care team knows about them. So we'll offer records and make sure they have an appointment when they leave and things like that, because we just want what's best for that person. And when we can be beneficial and the family and patient or participant wishes to be with PACE, we want to continue that.
Kate Justice:
Yeah. I think that that's incredibly valuable, or invaluable maybe is the correct word there. You can't put a price on that ability to work together with those teams of providers in those communities. So let's scoot back to something you said just a few minutes ago. You mentioned very briefly that even during COVID, you've been able to provide services for people, and that was at the height of things last year. Clearly, we are still very much in the middle of pandemic times, and unfortunately as much as we would love to be able to just sweep that under the rug, I think we're still dealing with that in a lot of aspects that's going on. Almost two years now that we've been dealing with this new, different way of life that we're dealing with COVID. So how are you all embracing maybe changes in your care or your programming, or how do you communicate those types of things to your participants?
Kathy Worley:
Yeah. For a short while when COVID was beginning, of course we did have to change most of our care from in-center to at-home. And our homecare program just grew and because they didn't need the CNAs here at the facility, so more went in the home to take care of folks. We did home visits from the clinic, did a lot of phone calls daily as a team just to reach out and make that connection with our folks, seeing if they needed anything. Our transport team was still on the road, taking supplies and taking folks to and from appointments if they needed to go. But since the Centers for Disease Control has kind of learned more about the virus and we've had the immunizations now and we've offered that and a lot of our folks of course took those, we just now follow the CDC recommendations.
Kathy Worley:
Our numbers of people coming in the center have had to be decreased due to needing to be six-feet apart, wearing mask. We are very well aware of that type of airborne droplet precaution with folks just to protect them for potentially being exposed with others. Staff always wears our mask. We wash our hands. We check our temperatures. We go through the same protocols every day. It's almost became the new normal. So now patients or participants can come to PACE. We do see people in the clinic. Though I still make home visits if folks can't come. So it's based on individual care needs and what they're able to do. A lot of folks though, loneliness is such a big problem with a lot of our elders. And so coming to the center, even if it's once a week, does provide them a lot of benefit that appeal can't give. So we are noticing that need and holding that to a high priority as well, just doing it as safely as we can.
Kate Justice:
Yeah. Kathy, I love that in everything that you're saying today, I can so hear the passion of what you do and how pleased you are with this program and the participants that you get to meet and participate with as well. I also love that really this is just fitting right in with Centra's mission to partner with people to live their best lives. And you guys are doing an exemplary process of that through PACE. And so just thank you so much for all you guys are doing. And I think one of the things that we wanted to do this podcast during this time of the year is we get a lot of people that talk about the winter season and maybe even the holiday times being a harder time of the year when they are caring for aging loved ones or loved ones that might have a more difficult health situation. And we think of the holiday season, a lot of times, as this very merry and bright and happy and joyful thing. And it is in a lot of ways, but for families that are dealing with some of these healthcare issues with loved ones, or just navigating the different aging waters and that sort of thing, it can be a very isolating and lonely time. So what would you say to those families who are maybe navigating some of those feelings during this time of year?
Kathy Worley:
I'm so glad you asked. So prior to my being a nurse practitioner here at this site, in Gretna PACE, I've been caring for my elderly mother for about 20 years now. And so once I've started with PACE, it was such an eye opening experience to learn more about what our community can do for folks and what are the other assets in the community we could get involved with. There's also a community support group for dementia as well. So learning that... My mom actually became a participant here at PACE, which was beautiful too for socialization. She was isolated, depressed. And so it really maximized her functioning while she was coming here. Unfortunately with aging, we do anticipate a gradual decline in our functional ability based on everyone's individual health concerns. But now my mom has had to be admitted to a local nursing facility because she needed that 24-hour care that PACE would no longer be able to provide. But families, having to negotiate with other family members, how to provide that care, it's very stressful.
Kathy Worley:
And so I have an empathetic feeling for other caregivers in dealing with that, and all I can say is that perhaps PACE will help you be able to keep your parent at home or loved one at home for a little longer. Perhaps, if that family member wishes to be there in their home and age in place, we can have families brainstorm about what other resources could be there. It's never wrong to call and ask questions. I encourage folks to call if you're a friend of the family. Or if you go and visit your family and you realize there has been a decline, then perhaps we can do some of that filling in the gap, as you said, where we can do those assessments and see if there really is a need that we can help out with. So it never hurts to ask questions.
Kathy Worley:
If we're not a good fit, we're not going to sell our program to you, but we want you to know the reality of what PACE is like and what we can and can't do. There's some things we can't do, but if we are a good fit, then by all means, let's give it a try. It may mean that in one day, your loved one may need to go in a facility for whatever changes or needs there is, but they've been blessed with a few more years in their home. So that's a positive.
Kate Justice:
I love, love, love the way that you phrased that, that there is... It never hurts anything. It is never a wrong reason to have to call. I reminds me of the teachers and professors I've had growing up that I was always like, "This is a dumb question," and they're like, "There are no dumb questions," but it is never not a good opportunity. I hate to use the double negative there, but there will always be a good opportunity to call and ask a question. It doesn't hurt anything. So I love that you phrased that that way. Kathy, would there be anything else that you would want to share with people listening today about the program or just a word of encouragement before we wrap up today?
Kathy Worley:
Just some positive thoughts. Participants, when they join PACE, come in with a lot of individualized needs, histories, but the outcome is so rewarding as a nurse practitioner and for the patient too, or for the participant too. We have folks that have lived so isolated or alone and had major health concerns that I have no doubt they probably would have died earlier, but by coming to PACE and having that medical oversight in a new way or different way without having to go to the doctor's office every three to six months, but actually us laying eyes and seeing them frequently, they've had actually had a quality of life. We become like an extended family. They enjoy their CNAs coming in and taking care of them. They enjoy the staff here. They laugh. They tell stories. It's just so refreshing the opportunities people have to really share.
Kathy Worley:
We learn from our participants as much as hopefully they learn from us. But to share those stories, we've had such positive outcomes that I just know this program, its model works. Now, we're not perfect and we are learning every day. The challenges that come up, like PACE with COVID and there'll be another challenge. We've had to work through things and we've changed how we do things, but I think that's just a sign of growth and opportunities to learn. And I really hope that people that hear this will open up their thoughts about PACE and when it might be a benefit for them or if they know anybody that it could be a benefit, just tell somebody else, because word of mouth is the best way to get that word out. And like I said, we're a diamond in the rough. I don't think we're kind of a hidden gem. People really don't seek out or get the true benefit until you really see it and experience it.
Kate Justice:
Yeah. Yeah. I completely agree with that statement - a diamond in the rough. I have been here for a little over six years now and I'll be really honest, I didn't even know what this program did until just a few years ago when I was starting to work on the websites some with it. So very exciting things that you guys are doing, just really neat care opportunities that you are giving to these participants in the program, helping them be actively involved in their own care model, being, like you said, an extension of the family to them, that is just such a distinct thing to be able to offer in the healthcare industry. And so once again, Kathy, thank you so much for calling in and talking to me today and taking the time out of your schedule to do that. And thank you so much for just sharing the details about this really needed program.
Kathy Worley:
Well, thank you, Kate. I appreciate it.
Kate Justice:
And we will continue to have information available for you. If you're listening to this and you think that this might be a program that would be for you or a family member or even a friend, as Kathy mentioned before, feel free to visit our website at centrahealth.com/PACE, and that's P-A-C-E. And you can also view any of our content on centratoday.com and see a full transcript of this podcast. So we look forward to talking to you next time.