Sometimes government really does work right. The United State Marine Corps comes immediately to mind. Another program, new to Randolph County and surrounding areas, is the Program of All-inclusive Care for the Elderly. PACE.
In Randolph County, StayWell Senior Care operates the PACE program. StayWell is a joint venture of Randolph Hospital (lead partner), Moses Cone Health System, and Hospice of Randolph.
As the name implies, once a frail person qualifies for PACE, the program will cover all medical and long term care needs. All medical care (even if the person has to move on to the nursing home) is “locked in.”
However, the main thrust of the program is to provide what I think of as “day care plus” for someone who would otherwise be in a skilled nursing facility. The idea is that it should be less expensive for the government than nursing home care, and for the individual it stalls having to go to the nursing home (you get to go home at night).
Not one of my many institutionalized clients has ever said, “Oh boy! I get to go to the nursing home!”
The Randolph County facility is an extremely attractive new building just to the west of I-73/74 at the McDowell Road exit. In addition to the bright and roomy areas for day activities, rehab, and meals, there is a complete medical clinic. Under the management of StayWell Senior Care, Patricia Shevlin, MD is the on-site medical director and Tracey Murphy is the Executive Director. The staff is friendly and they smile. I would, too, if I worked there.
To qualify, an individual must be over 55 and live in Randolph, Montgomery, or certain parts of Moore Counties. Physically or medically the applicant must qualify under traditional standards for needing nursing home level of care but still be capable of being cared for in the community (that is, PACE) setting. Obviously PACE will not be for the extremely frail or sick person.
No, Medicaid qualification is not necessary. If someone wants to (and can) pay, the private pay rate is about $4,200 monthly.
On the other hand, Medicaid will cover the costs for a qualified individual. The qualification rules are very similar to the regular nursing home rules, but with some adjustments. An explanation of the North Carolina Medicaid nursing home rules can be found at www.masonlawpc.com (click on “Hot Topics”).
First, a successful Medicaid applicant must have total monthly income less than about $4,200. For a married applicant, only the applicant’s income counts; the stay-at-home spouse’s income doesn’t count.
Perhaps the biggest difference in the PACE rules (from “normal” Medicaid) is that in determining how much of the applicant’s income will be paid to PACE before Medicaid kicks in, the applicant will deduct $972.50. The idea is that this amount can be used to cover household expenses since the applicant will be maintaining a home to return to every evening.
Also, as is the case under “normal” Medicaid, if the stay-at-home spouse has monthly income of less than $1,967 enough of the applicant’s income can be diverted to the spouse to get her or his income up to that level.
Finally, Randolph Hospital is a rare hospital that focusses on quality food. Food that any of us would happily eat. Randolph Hospital runs the food operation at PACE. Any questions?
I’m impressed with PACE. Two thumbs up!
Another 27.9% believed that using Medicaid should be OK if someone had privately paid for a period; 23.2% felt it was OK if someone had under a base level of assets. I believe there was plenty of overlap between persons answering the last two, but in any event I think it is clear that 50% or so of you believe that there ought to be some restriction on who actually accesses Medicaid.
my life into “work” and “other.” I am not an elder law attorney by day, and a spouse/father/friend by night. I am what I am, which involves many parts. In some sense I am always “on” and thinking about various work-related issues. On the other hand, various matters that aren’t career-related are never far off my screen. I may show up late and leave early, but I may also work all weekend. I can do that because I run my own firm. Of course, it also occurred to me that I also work harder than I ever did as a young associate.
One of my favorite authors and thinkers, Seth Godin, recently wrote a short little book called Poke the Box. I have ordered it for everyone who works with me, both here in North Carolina and Georgia. Get it.
The difference between a master getting by and a master with a big book of business is a sense of humor. Maybe that comes from spending time outside the box and developing a keen sense of irony. Don’t ever take yourself too seriously. And no matter how hard you worked, don’t forget that other people made it possible for you to get where you are.
Yesterday I saw a piece on CNBC in which a somewhat incredulous young reporter was interviewing a seasoned financial advisor who claimed “$2.5 million is a good start.” I posted it on the 
I am not recommending ignoring the problem, as many seem to be doing. You have to start planning. You MUST avoid what I have sadly seen in my conference room. The couple is in their 80’s, have a home worth $120,000 with a mortgage and a home equity line totaling $100,000. Credit card indebtedness of $30,000. Total income of $2,300 a month. Total expenses (including debt service) of $2,500.