Ramon Fuentes Jr. has finally begun settling into a living facility with the help of Denver, participating in activities and befriending a lady, and his daughter hopes the 75-year-old can spend the rest of his days there.
Then came the news that the program they were counting on to cover his bills after he spent most of his savings on care might not be around when he needs it.
The Federal Program for Comprehensive Care of the Aged, or PACE, is for people age 55 and older who would qualify for the standard of care provided in a nursing home, but who could also stay safely at home if they had adequate support. Medicaid pays a set price for the services they receive, which are provided by another agency. Some clients live in subsidized living facilities, with PACE coordinating their medical care and providing support that those facilities may not provide.
PACE providers have contracts to serve certain geographies, but InnovAge — the company responsible for much of Denver’s metro — has been Banned from accepting new clients Since December. Inspections found InnovAge centers were understaffedand that clients did not consistently receive basic services such as insulin injections, wound care and assistance in getting into and out of bed.
InnovAge is the only PACE provider for Adams, Arapahoe, Broomfield, Denver, Jefferson, Larimer, and Pueblo counties and for part of Weld County. About 3,500 people were registered at six company centers in Colorado when registration was frozen.
While people currently enrolled in the PACE program continue to receive services through the program, others who wish to join do not have this option unless they move to a county with an active provider. They can also rely on traditional Medicaid but may have to uproot loved ones if the facility they live in does not accept it.
Cameron Crawford, owner Older placement next steps The agency, which serves Front Range communities from Boulder to Colorado Springs, said the registration freeze has created a “rapidly growing” problem, and families don’t have many options other than moving their loved ones to nursing homes or to other counties.
“The InnovAge freeze creates a bottleneck and Denver doesn’t have enough Medicaid-assisted Memory and Living Care beds to make up for the frozen InnovAge beds,” she said. “This presents a particular problem for anyone who needs safe memory care.”
Fuentes’ daughter Rebecca Edmonds, of Castle Rock, said a friend who works in hospice care warned her that her father would not be able to enroll in PACE for the foreseeable future. He was eligible for traditional Medicaid, but the facility he was living in did not have state certification to cover its residents.
Edmunds said Fuentes suffers from PTSD from his service in the Vietnam War as well as cognitive impairment, and this combination makes it difficult for him to adjust to the new environment. Moving him from Denver to Lark Springs, a supported living facility in Colorado Springs, wasn’t ideal, but she was worried that if she waited any longer, there wouldn’t be a bed in a suitable home.
“If you want to be selective about where you send your loved one, you might only have one or two options,” she said.
It is not clear how many families face a similar choice. Bonnie Silva, director of the community who lives in the Colorado State Department of Health Care Policy and Finance, urged families who were unsure of their options to contact the Single Point of Entry agency that coordinates senior care. In the Denver area, this Rocky Mountain Humanitarian Services.
“If they’re not connected to their local single entry point, we need them to do that,” she said.
They always begin by advising new clients about their options, said Georgia Edison, chief program officer for Rocky Mountain Human Services. She said services provided in people’s homes may be an alternative for those who want to register for PACE.
“The goal of all of our long-term service programs is to help people maintain as much independence as possible while remaining in their homes and communities,” she said.
Silva said InnovAge was required to identify all potential clients they were working with who were still spending their assets to qualify for Medicaid and PACE, so they could do one-on-one outreach. She said just letting InnovAge start accepting new customers again is not an option, because they haven’t given existing customers what they need.
“We want to make sure they get good care,” Silva said. “We want to see sustainable progress.”
Sarah Rasmussen, a spokeswoman for InnovAge, said she refers families who come seeking help to other options, including single point of entry agencies. The state and federal Centers for Medicare and Medicaid Services will determine when InnovAge can receive new clients again, so a timeline cannot be given at this point, she said.
“We continue to work closely with CMS and the state of Colorado to address their findings,” she said in a statement. “InnovAge looks forward to once again opening our doors to PACE-eligible participants in our Colorado communities, and we will remain focused on providing high-quality care to every senior student currently enrolled in PACE.”
“Too Big to Fail”
Jodi Gaylor, of Omaha, Nebraska, said her sister-in-law, Sharon Gaylor, had to move to three different facilities in the Denver area last year, trying to find one that would provide the memory care she needed and that would take her cover.
Gaylor said an InnovAge representative encouraged her and her husband, Harry, to sign Sharron on the show, so they moved her to a facility that had contracted with the company. She did not enter prior to the PACE enrollment freeze, and had to continue on traditional Medicaid, which requires another step.
Gaylor said Sharon appeared happy at the Arvada facility where she landed, but the process was stressful. She said the recruiters they worked with didn’t always have accurate information, and some facilities didn’t say whether they took clients for PACE or traditional Medicaid.
“It’s very confusing,” she said.
Silva estimated that about 200 assisted living facilities in the Denver area participate in traditional Medicaid, though she did not know how many clients were accepting new clients. She said the state is trying to make it easier for more facilities to be registered so that its residents can stay put while they run out of their own payment funds. These efforts include waiving the application fee and assigning an employee to sponsor it.
“We’re going to do a kind of white glove experiment,” she said.
Silva said the state was already moving to require subsidized living facilities that contract with PACE to be approved by Medicaid, a process that began about a year ago. If the facilities choose not to do so, they can only receive residents who can pay for their own care.
Dave Lewis, who owns 14 small assisted living facilities, estimated that his facilities have five residents who expect PACE to take over coverage of their care now, and another five will be in that situation in the near future. He said only one of his facilities accepts Medicaid, and he does not want others to receive certifications, after disagreements over whether they can get a camera in a common area and whether room keys should be issued to residents with cognitive disabilities.
Lewis said he thought InnovAge was “too big to fail,” and thought the state would appoint a management company to improve it without suspending new registrations. He said Tru PACE, which operates in Boulder and Weld counties, is expanding into the northern part of the metro area, but the need to hire staff and set up centers means it can’t just jump to market.
Lewis said he told Tru PACE, “You need to get to Lakewood, because I have people in Lakewood who are running out of money. We’ve been working with them. Families have been rocking. But I definitely expect some relocation to come.”
Tru PACE representatives did not respond to messages from The Denver Post seeking comment about any expansion plans.
“This stressful and painful situation”
Nicole Zamparelli-Schiavone, chair of the Colorado Assisted Living Association, said PACE agencies are easier to work with than the state, especially since they handle residents’ Medicare and don’t require lengthy inspections. For some facilities, it’s not feasible to comply with the Medicaid building’s fire safety requirements, and the documentation and billing process is “cumbersome,” she said.
The certification process, she said, “can be very expensive, and therefore it takes a lot of work to keep up with Medicaid regulations.”
Zamparelli Schiavone said Colorado doesn’t have enough nursing homes available for all the people who need it. In one case, she said, a person who needed more care than the living facility they were in could wait 115 days to get a bed. While many nursing homes technically have beds available, they do not have enough staff to care for more residents.
The family shortage has left some families wondering what they would do if their loved ones run out of money before PACE resumes registration in Denver.
Ellory Hartnett, of Englewood, said she expected PACE to take over her father’s place in a living facility with help from Denver after he spent most of his assets, although he was not yet registered. If PACE doesn’t have new members in Denver by the time its savings run out, it will have to find a facility that accepts traditional Medicaid. She said she’s taken care of him at home before, but that’s not an option at this point.
Hartnett said her father, Lonnie Hartnett, suffers from dementia, and changes to his routine are hard on him. For now, she’s trying to raise his money to keep him in a house where he’s happy for as long as possible. But it is not a permanent solution.
“I planned his finances around that, so I’m concerned,” she said. “It’s a mistake to put families who are already in this stressful situation through more.”