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When Low saw that Ross was carrying sheet music and a worn book of gospel hymns, she ducked out of the room to retrieve a tape of a piano concert that Ross sang in. Low popped the tape in a portable player and examined Ross, who hummed along to his own soulful voice in the background.

Low oversees primary care services, in conjunction with clinic physicians. She usually starts her morning by 8 a.m., meeting with the clinic's RNs-who act as case managers-to discuss acute patients and make treatment decisions.

"The nice thing about working here is the multiculturalism and the collaborative practice," Low said. "It's wonderful to work with a whole team where, with the physicians, you really feel like you have their support and they take your input."

Attractive approach

Although the nursing shortage is an ever-present problem in health care, PACE programs have a healthy retention record. "A lot of nurses are more interested in community practice these days and a team environment where you've got colleagues you're working with," Hansen said. "You see your patients over several years. There's a real sense of relationship you have with your participant. You really know them as part of a family."

Margaret Gunzelman, RN, worked at a nursing home for 20 years before discovering the Hopkins ElderPlus PACE program in Baltimore two years ago.

"I love it here. I like the team approach. There are so many people to solve a problem," she said. "Instead of just distributing medication, I get to use my expertise. I get to be more creative than I would be in an institutional setting."

The staff at Hopkins ElderPlus receive continuous kudos from family caregivers of the program's 130 participants, Gunzelman said.

"A lot of families have said they wouldn't know what to do without us. We pay for medication, as well as supplies, which can be so expensive. We've even gone out and put ramps in, microwaves, air conditioners … Whatever it takes to keep them at home," she said. "It's cheaper to pay $150 for an air conditioner than have someone with congestive heart failure in the hospital because it's hot and humid outside."

As Gunzelman points out, in addition to health and career benefits, PACE saves money.

The On Lok program, for example, saves Medicare about 5 percent and Medicaid about 10 percent by having seniors in PACE rather than a nursing facility. Nationally, PACE keeps hospitalization costs down for its seniors.

According to a study cited by the Center for Medicare Education, when PACE participants are admitted to the hospital, they stay an average of 4.6 days, compared with 6.4 days for the Medicare population as a whole.

"Missouri loves us because it is cheaper to keep an individual out of a nursing home and have a PACE program attend to her," said Deborah Bland, MHA, RN, site director for Alexian Brothers Community Services PACE center in St. Louis.

Bland describes her 180 participants as the "frailest of the frail. They are sicker than the average nursing home patient," she said.

"There isn't a day you will come into this program that someone doesn't say, 'These people should be in a nursing home-these people are really sick!' But there's not much we can't handle. We do EKG, pulse oximetry, X-ray, lab services, oxygen therapy. It becomes a day hospital for many people."

PACE is a model that "for many people, really works," said Gretchen Brickson, MBA-MPH. Brickson has worked in various capacities in the field of senior care for years, and now is wading through the state and federal application process to start a PACE center at Downey Regional Medical Center in Southern California.

"You see people's quality of life improve, some of their really serious conditions stabilize, and it helps people live more independently," Brickson said. "The team approach is effective. When you give that much attention, it really makes a difference in people's lives."

Contact Janet Wells at janetawells@hotmail.com