Keeping on

As Johnson County’s population gets steadily older, the reality becomes clearer that more people have increasing health care needs.

They have more doctors to see and more prescriptions to keep track of. They require physical and occupational therapy to maintain the skills needed to live on their own.

Even with a family member serving as a caregiver, the needs of an older patient can be too much.

But a new program operating within the county hopes to ensure everyone can get the services they need without having to enter a nursing home.

With the number of Johnson County residents 65 and older expected to increase by 98 percent in the next 15 years, area hospitals are devoting more resources on meeting the changing needs of seniors in the best way possible.

Franciscan St. Francis Health is the first local hospital to offer the Program of All-inclusive Care for the Elderly, or PACE, in Indiana. The program provides nursing-home type services — such as prescriptions, adult day care and transportation to appointments — to patients in their own homes.

The hope is to give seniors the medical care they need with the least possible amount of intrusion into their normal lives.

“Our mission in everything is to help people where they are, and if they’re at home, we want to help them stay there,” said Susan Waschevski, director of PACE for Franciscan St. Francis Health.

According to the Indiana Business Research Center, people 65 and up made up 12 percent of the population in 2010. By 2030, that number is anticipated to jump up to 19 percent and should rise to 20 percent by 2050.

The county currently has 15 nursing care facilities in operation. But if people can get the services and care necessary without having to move into a facility, that would be preferable to both patients and health officials.

That is the aim of PACE.

“It’s developed to provide a way to keep individuals who are nursing home-eligible to continue to live in the community as long as possible,” said Robert Greenwood, vice president of public affairs for the National PACE Association. “Instead of looking at people and determining what their frailties are, then moving them to a nursing home, this lets them stay in the community.”

The Program of All-inclusive Care for the Elderly has roots that go back to the early 1970s, when health care professionals in the San Francisco area started working on a plan to provide health care outside of the nursing home model.

From a single center in California, the program has spread to 108 facilities in 36 states.

Nationwide, 93 percent of participants have been able to get medical care while continuing to live in their homes, Greenwood said.

“What we find is that a lot of people do have some kind of informal caregivers around them, neighbors, spouses, adult children; and as people age and naturally decline, it puts a lot of stress on (caregivers) to fill in the gaps to help them stay in the community,” Greenwood said. “PACE is really adept at filling in those gaps.”

The program is designed for any local residents 55 and older who need nursing home care.

Provided through Medicare and Medicaid, it covers services such as physician care, physical therapy and home-care checkups. If people need incontinence supplies or a temporary stay in an assisted-living facility, that can be arranged as well.

“When someone chooses to enroll in PACE, we become their total health care provider,” Waschevski said. “Anything that you can image that Medicare or Medicaid waiver paying for, we take care of.”

In addition, the program helps with transportation to and from appointments to the podiatrist, dentist and other health professionals.

“Most people can do a little bit for a long time, but if they have to do it all, they burn out very quickly. Our goal is to help support them,” Waschevski said.

To help design an individual plan of care for each PACE patient, an team of caregivers ranging from a registered nurse to a social worker to physical therapists help map the best treatments.

With their assistance, the program helps provide a centralized location for coordinated care, said Dr. Nicolas Priscu, a physician and leader of the interdisciplinary team.

Franciscan St. Francis Health opened its Senior Health and Wellness facility in January to serve PACE patients. The program is open to people living in Greenwood, Franklin, Whiteland, New Whiteland, Bargersville and the Center Grove area, as well as central and south Indianapolis.

The center is where people can come to meet with social workers or other members of the care team. An exercise room, salon and barbershop, and chapel are available for patients.

The hospital registered its first patient in PACE in February. The 89-year-old woman wanted to help build up enough strength in her legs, hips and arms to go shopping at the grocery store without using a motorized cart.

“She comes up to the center two days each week to work with our physical therapists to increase her stamina and endurance,” Waschevski said. “That’s something that Medicaid or Medicare would never pay for, so it’s really neat for our team to do that.”

Five others patients are currently in the process of enrolling in Medicaid, which has to be done before they can sign up. As the program becomes established, the hospital anticipates serving about 275 people on a regular basis.

Because regulations prevent hospitals from advertising or signing up anyone until the day center, interdisciplinary team and all other aspects of PACE have been set up, it usually starts slowly, Greenwood said.

“It usually takes up to a year or year-and-a-half to start making up the losses of output that you’ve had,” he said.

But Franciscan St. Francis Health has made the commitment knowing that the first year will include large costs with little benefits, Waschevski said. The most important thing is that even small numbers of patients start receiving the health care they need in a way that maintains their quality of life, Waschevski said.

“Our goal is to help people to stay at home,” she said.

At a glance

Program of All-Inclusive Care for the Elderly

What is it?

A health care program created for people 55 or older who are eligible for nursing home-level care but prefer to receive their care in familiar surroundings.


  • Primary medical and nursing care
  • Occupational, physical and speech therapy
  • Medications and durable medical equipment
  • Laboratory and diagnostic services
  • All necessary prescription drugs
  • Skilled home care and personal care aides
  • Hospitalization, skilled nursing facility care
  • Care from medical specialists in cardiology, nephrology, opthtalmology, dermatology, orthopedics, surgery, podiatry and more
  • Medically necessary transportation

Areas served: Greenwood, Franklin, Whiteland, New Whiteland, Center Grove area, Bargersville, central and south Indianapolis

How to sign up

Call Franciscan Senior Health and Wellness at 528-7223 and ask to speak to the intake representative. Staff members will call potential participants and their family to explain services and set up an appointment time for a home visit.

If you choose to enroll, services will begin on the first day of the month after you sign the Enrollment Agreement.

More information:

Ryan Trares is a reporter for the Daily Journal. He can be reached at or 317-736-2727.