PACE in El Paso: What Families Should Know About Bienvivir

What PACE is

PACE, the Program of All-Inclusive Care for the Elderly, is a Medicare and Medicaid program that takes full responsibility for a member's care: primary care, specialists, hospital and nursing facility care, prescriptions, therapy, home care, transportation and day center attendance. One team plans and delivers it.

Bienvivir's history and centers

Bienvivir joined the PACE demonstration in 1992, and CMS and HHSC approved it as a permanent PACE provider in October 2003. Its McKinley Avenue and Carolina Drive centers appear in HHSC's directory as licensed adult day sites:

Who qualifies

Members must be 55 or older, live in the service area, meet nursing facility level of care and be able to live safely in the community with PACE support. People with both Medicare and Medicaid generally pay no premium; others can pay privately.

The trade-offs

PACE works best for people with several chronic conditions who value coordination and are willing to use the program's doctors. It is a harder fit for someone attached to a long-time physician outside the program. Members typically attend the day center several days a week, which suits some people and not others.

How to enroll

Call Bienvivir at (915) 562-3444. Enrollment includes a home visit and assessments by the team, and a state determination of nursing facility level of care. Ask about the service area for your parent's address, transportation and what happens if your parent later needs nursing facility care.

A day in PACE

A typical PACE member is picked up in the morning by program transportation, spends the day at the center with meals, activities, therapy and medical visits, and returns home in the afternoon. Days at the center vary with the care plan; some members attend daily, others a few times a week. Between center days, PACE can send home care aides, and the team adjusts the plan as needs change.

Because one team sees the member often, small changes in health are noticed early, which is part of how PACE aims to prevent hospital stays.

What happens if a member needs a nursing facility

PACE remains responsible if a member needs nursing facility care: the program arranges and pays for it while the member stays enrolled. Families should ask which nursing facilities PACE uses and how decisions about placement are made. Members can leave PACE voluntarily and return to regular Medicare and Medicaid.

Questions to ask Bienvivir

Ask about the service area for your parent's address, how often members see the physician, how after-hours needs are handled, whether transportation covers your parent's neighborhood, what languages staff speak, and how families take part in care planning. Ask to visit a center during the day.

PACE and family caregivers

PACE does not replace family caregivers in the evenings and on weekends, but it shares the load and gives families one place to call. Many El Paso families say the coordination is the main benefit: fewer separate appointments, fewer pharmacies and one plan.

How PACE is paid for

PACE receives a fixed monthly payment from Medicare and, for members who have it, from Medicaid. In exchange, it takes on the full cost of a member's care. Because the program bears that cost, it has a strong reason to keep members healthy and out of the hospital. For members without Medicaid, a monthly premium covers the long-term care portion, and the program explains the amount at enrollment. There are no deductibles or copays for covered services.

Families sometimes worry that the program will limit care to save money. Members have appeal rights, and the team must explain its decisions; ask how disagreements are handled.

Is PACE right for your parent?

PACE tends to fit a parent who has several chronic conditions, takes many medications, has had recent hospital stays, and lives with family or close to them. It fits less well for someone who is fiercely attached to a specialist outside the program or who would refuse to attend a day center. Talk it through with your parent before the assessment, and visit together so the center is not a surprise. If the answer is not yet, keep the option in mind; many families return to PACE a year or two later when needs grow.

How PACE compares with other options

Compared with STAR+PLUS at home, PACE adds medical care under one roof. Compared with assisted living, it keeps a parent at home. Many families consider PACE when a parent's medical needs are complex and family can provide evenings and weekends.