Community Based Care

There are healthcare options that allow older adults to live at home, while still providing important healthcare or personal care support in the community.

Adult Day Care Centers

Adult day care centers are community-based options that have become fairly common. They provide a wide range of social and support services in a group setting. Most adult day care centers are set up in either churches or community centers. Adult day cares are commonly used to care for people who need supervision and help with activities of daily living (for example, patients with dementia) while primary caregivers are at work. They may also serve as a form of respite (or a "break") for caregivers.

Providers of adult day care may offer a variety of services, ranging from basic non-medical care to more advanced medical services. For example, a registered nurse may be available for on-site health services, medical assessment and monitoring, and to help with medication management. In general, adult day care is not covered by Medicare, although some costs may be covered by Medicaid or other insurers.

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

The Program of All-inclusive Care for the Elderly (PACE) is a type of adult day care for frail older adults 55 or older, who require a nursing-home level of care. PACE allows an older person to spend their day at the program and get medical care while caregivers are at work. The goal of PACE is to keep participants in the community for as long as it is medically, socially, and financially feasible. The system uses a team of healthcare providers who know the patient and caregivers well, and who can provide complete care for the patient in a variety of settings, such as at home or in the hospital, an alternative living situation, or a nursing home. It also allows for adult day care, respite care, transportation, medication coverage, rehabilitation (including maintenance physical and occupational therapy), hearing aids, eyeglasses, and a variety of other benefits.

This program pools funds from Medicare and Medicaid (in participating states) to provide these comprehensive medical services. However, participants in the PACE program must meet state-defined requirements regarding their need for a nursing-home level of care. As of 2020, there were 264 PACE programs operating in 31 states serving over 51,000 participants. You can find a program near you by visiting the National PACE Association website.

Home-Based Primary Care (HBPC)

Home-Based Primary Care (HBPC) programs provide care to high-risk, medically vulnerable patients at home. Similar to PACE programs, many of these residents have multiple chronic conditions and require assistance with some Activities of Daily Living (ADL). Due to these problems, most of these residents are confined to their homes and would otherwise have to live in a nursing home. HBPC enables patients to continue living at home while teams made up of physicians, nurse practitioners, nurses, social workers, case managers and pharmacists oversee their care at home. In 2019, there were more than 2.5 million HBPC visits made. More information can be found by contacting the American Academy of Home Care Medicine. See more on the Section titled Home Care.


Last Updated August 2020