A Program of All-Inclusive Care For Elderly Improves Five-Year Survival Compared to Alternative Home- and Community-Based Care

Community-based care is preferred to nursing-homes [NH] for people needing long-term care [LTC]. Community-based care under waiver [HCB] is widely available, while PACE is an option in 30 states. PACE is prepaid, capitated, comprehensive care integrated by center-based teams. We assess five-year survival of PACE v. HCB and NH entrants, controlling for mortality risk. Subjects (n= 2081) were residents of two SC counties admitted 1998-2003 to HCB, PACE and NH. Data were derived from state and program assessments, utilization and vital records. Subjects were followed until death or 5-year survival; those lost for the event or surviving < 5 yrs on 8/8/2005 were censored. Analyses included admission contrasts, and event curves tested with log-rank statistics. Mortality risk was assessed by the PPI (Carey et al. JAGS 2008; 56: 68-75). Mortality risk for PACE (72.6% “high-to-intermediate”) was greater than for HCB (58.8%), comparable to NH admissions (71.6%). NH median survival was 2.3 years. PACE median survival was 4.2 years, v. 3.5 in HCB (log rank= .394; p=0.53). With stratification, the PACE advantage over HCB is significant (log rank = 5.941; p=0.015). Intermediate and high risk admissions are most likely to benefit (intermediate risk: PACE median survival = 4.7 years v. HCB 3.4 years; high risk: PACE 3.1 v. HCB 2.0 years). Adjusting for risk, PACE produced a substantial survival advantage compared to HCB. That the benefit is most apparent in the ≥ intermediate-risk suggests the particular importance of integrated, team care for the older, disabled participants more commonly admitted to PACE.