PACE (Program of All-Inclusive Care for the Elderly)

PACE stands for Program of All-Inclusive Care for the Elderly. It is a care program for older adults who need a lot of help but still want to live at home. One team handles almost everything: doctor visits, medicines, a day center, help at home, rides, and hospital or nursing home care if it is ever needed.^1,5

For a family caring for someone with dementia, PACE can replace a long list of separate doctors, agencies and bills with one team and one plan. It is not right for everyone, and it is not offered everywhere. This page explains who can join, what it covers, the trade-offs, and where PACE is in Virginia.

What PACE is

PACE is a joint Medicare and Medicaid program. Federal rules describe it as prepaid, all-in-one care for frail older adults. Its goal is to help them live in the community as long as it is safe and practical.⁵

Each PACE program has a PACE center. It works much like an adult day health center. Participants come for the day. They eat meals, join activities, and see the doctor, nurse and therapists in the same building. PACE adds care in the home and visits to outside specialists as needed.⁵

Because the program gets a set monthly payment for each person, it has room to be flexible. Besides regular Medicare and Medicaid services, it can pay for other care the team decides the person needs.^5,7

About 200 PACE programs serve more than 98,000 people in 33 states and Washington, D.C.⁶ In Pennsylvania, PACE is called LIFE.⁷

Who qualifies

Federal rules set four main conditions. A person must:^1,2

1. Be 55 or older.
2. Be found by the state to need nursing home level care. This is about how much help the person needs, not whether they want a nursing home.
3. Live in the service area of a PACE program. Programs serve specific ZIP codes.
4. Be able to live safely at home with PACE's help when they join.

You do not need Medicaid or Medicare to join. Most participants have both, but anyone who meets the rules can enroll and pay privately.² The program checks each year that the person still qualifies.²

What this means for dementia. Many people in the middle stage of dementia need help with bathing, dressing, medicines and safety. That kind of need often meets the nursing home level of care. A diagnosis alone does not decide it. The state's screening looks at daily needs. See middle-stage dementia for what this stage often looks like.

What PACE covers

PACE must cover every service Medicare and Medicaid cover. It also covers anything else the team decides you need to stay as healthy as possible.^1,5 Services include:^1,5,7

• Primary care and specialist visits
• Prescription drugs and many over-the-counter medicines
• Day center care with meals and recreation therapy
• Nursing, personal care and home care
• Physical, occupational and speech therapy
• Dental, hearing, vision and foot care
• Lab tests and X-rays
• Mental health counseling and social services
• Nutrition counseling
• Hospital care and emergency care
• Nursing home care when it becomes medically needed
• Rides to the PACE center and to medical visits

If you have Medicare, your drug coverage comes through PACE. If you sign up for a separate Medicare drug plan (Part D) while in PACE, you will be taken out of PACE.¹

The care team

Each person has an interdisciplinary team (a group of different kinds of health workers who plan care together). Federal rules require the team to include at least:³

Source for the table: federal PACE rules.³

The team meets often, usually daily, to talk about how each person is doing.⁵ The team works with the person and the family to write a care plan.⁷

What it costs

Cost depends on which coverage the person has.¹

Source for the table: Medicare.gov.¹

For people who pay privately, the long-term care premium equals what Medicaid would pay the program for that person.⁵ That can be a large amount, so ask each program for its exact price.

In every case, there are no deductibles, copays or coinsurance for any care, drug or service the PACE team approves.¹ The monthly amount stays the same no matter how much care the person needs.⁷

One important catch. If you get care outside PACE that the team did not approve, you may have to pay for it yourself.⁷ Emergency care is covered.¹

Medicaid has income and asset limits. See Medicaid and long-term care and what Medicare covers in dementia.

Trade-offs to weigh

PACE works very well for some families and poorly for others. Think about these points before you join.

Sources for this comparison: Medicare.gov, Medicaid.gov and the National PACE Association.^1,5,7

Changing doctors. For many families, this is the biggest decision. If a loved one trusts a longtime doctor or neurologist, ask whether that doctor works with the PACE program. Often they do not.

Hospice and end of life. PACE gives medical, drug and emotional support at the end of life. But a person who wants to use the separate Medicare hospice benefit must leave PACE to do so.⁵ Ask the program how it handles comfort care. Read more about hospice care for dementia.

Leaving PACE. Joining is voluntary. You can leave at any time, for any reason. It takes effect on the first day of the month after the program gets your notice.^4,5 The program must not nudge someone to leave because their health has changed.⁴ Plan ahead for how other coverage, such as a Medicare drug plan, will start again.

How to join

1. Check whether a program serves your ZIP code. Use the National PACE Association's program finder, Medicare.gov's plan finder, or call your state Medicaid office.^1,6
2. Call the PACE program. Ask for an information visit. You join through the program itself, not through a Social Security office.⁷
3. Get the state screening. The state must confirm that the person needs a nursing home level of care.²
4. Tour the PACE center. Meet the staff, and watch how they work with people who have memory problems.
5. Review the enrollment agreement. The person (or their legal representative) signs it to join. Enrollment usually starts on the first day of a month.^5,7

If you are the legal decision-maker for a person who cannot sign, bring your power of attorney or guardianship papers.

PACE in Virginia

In Virginia, PACE is run through the Department of Medical Assistance Services (DMAS), the state Medicaid agency. It serves adults 55 and older with long-term health needs or disabilities who meet the nursing home level of care.⁸

Screening. Virginia law requires a long-term services and supports (LTSS) screening for anyone requesting PACE.⁹ A screening team meets the person face to face. It fills out the Virginia Uniform Assessment Instrument, a standard form about daily needs and health.¹⁰ Screening teams include local departments of social services and health departments, and hospital discharge staff.⁹ If the person is at home, ask your local department of social services how to start. If the person is in the hospital, ask the discharge planner.

Where PACE is. As of October 2026, DMAS lists these sites. Each one serves certain ZIP codes only. Call to check your address.⁸

Source for the table: DMAS PACE provider page.⁸

Northern Virginia. Cherry Blossom PACE in Alexandria serves ZIP codes in parts of Alexandria, Arlington, Fairfax County and Falls Church.⁸ Many other parts of Northern Virginia, such as Loudoun and Prince William counties, were not on its ZIP list at last check. If PACE does not serve your area, ask about the Medicaid home and community waiver, adult day care and in-home care.

New PACE sites can open only when DMAS invites applications, so the list changes over time.⁸

Questions to ask a PACE program

About dementia care

• How many of your participants have dementia? What training do staff have?
• How do you handle wandering, agitation or a person who refuses to come to the center?
• Is there a quiet space for people who get overwhelmed?
• Can you help us plan for later stages?

About doctors and services

• Who would be the primary doctor? Can we keep any current doctors?
• How do we reach the team at night or on weekends?
• How many days a week would the person attend? Can that change?
• How do you decide on home care hours?

About cost and leaving

• What would we pay each month, if anything?
• What happens if we need care while traveling?
• How do comfort care and hospice work here?
• If we leave, how do we restart other coverage?

Where PACE fits among care choices

PACE sits between living at home with scattered help and moving to a facility. It may suit a person who can still live at home, has a caregiver nearby in the evening and at night, and would enjoy a day program. If PACE later finds that home is no longer safe, it can arrange and pay for nursing home care.^1,5

To compare costs across options, see what dementia care costs. For help choosing, see how to choose a care place. Caregivers carrying a heavy load can also read about caregiver burnout.

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.