Day care for the frail.

Byline: Robert Z. Nemeth

COLUMN: ROBERT Z. NEMETH

The vans pull up to the entrance of Summit ElderCare on Grafton Street, a place that looks more like an upscale motel than a medical facility. Elderly men and women, some in wheelchairs, pass through a bright reception area into an attractive complex carefully designed to provide quality care for elderly people needing help without staying in a nursing home. Accompanied by Eric H. Schultz, president and CEO of Fallon Community Health Plan, which runs Summit ElderCare, and Karen Longo, executive director, I had an opportunity to visit this impressive place.

"Many frail, old people prefer the dignity and autonomy of remaining in their own homes as long as it is medically possible," Mr. Schultz explained. "Many families want to keep their loved ones at home but they need the care we provide. That is why day care for the elderly has been expanding."

In one recreation room I saw a group of clients (they call them "participants" here) play wheelchair bowling, rolling a large rubber ball at plastic pins amid cheers and laughter. One woman was in a small library, reading. Another was perched in front of a computer. In another activities room participants suffering from cognitive deficiencies sat around in a circle, pitching playing cards into a basket. From time to time, an aide led the group in a singalong. Another aide was preparing the dining room for a catered lunch.

Participants get a lot more than just attention, entertainment and nutritious food. There is primary health-care service at the in-house clinic, provided by an interdisciplinary team of doctors, nurses and technicians, tailoring individual service to the needs of each person. There is extensive rehabilitation therapy, a full phlebotomy lab and a spa for assisted bathing and hygiene. "We often prevent little things from becoming big problems," Ms. Longo said. That includes measures to prevent elderly people from falling, the most frequent cause of serious injuries.

Home health care is an important part of the program. It ranges from meal preparation and medication management to nursing services and light housekeeping. Participants are provided transportation between the home and the care center as well as to medical appointments. Summit HealthCare has a 24-hour hotline and maintains ongoing interaction with participants, their families and health-care providers on the outside. "During the December ice storm we contacted every one of our participants to see whether they needed something," Ms. Longo recalled.

Summit ElderCare is an outgrowth of the Program for All-Inclusive Care for the Elderly model that was initiated in San Francisco's Chinatown. The program is recognized by Medicare and federally regulated. It has more than 17,000 participants nationwide, including 2,000 in Massachusetts. Summit Eldercare, started in 1995, is the only PACE project in Central Massachusetts. In addition to the new Grafton Street location, Fallon operates centers on East Mountain Street in Worcester, Leominster and Charlton, with a total of 600 participants and about 100 Fallon employees, including eight physicians and four nurse practitioners. Numerous services are contracted. Fallon also owns a company that provides home health-care aides. The Grafton Street site has 94 enrolled participants and about 20 Fallon employees. The branch can comfortably accommodate up to 100 participants each day.

"We aim to open a new center every year," Mr. Schultz said. "Currently, we're looking in Milford and Lowell." The facilities are constructed by specification and either owned or leased by Fallon.

The PACE model seems a win-win proposition all around. Most participants are enrolled free of charge if eligible for Medicare or Medicaid. Those not fully covered pay about $3,800 a month to bridge the gap, far less than a nursing home would cost. Moreover, PACE participants come under special financial eligibility rules; unlike those in resident nursing homes, they can keep their assets and still qualify for free care. Fallon collects an average of $6,000 for each participant under its day care.

Ms. Longo cited surveys showing a nearly 100 percent satisfaction rate among participants and their families, with more than 90 percent saying the program has made a positive impact on the quality of their lives. She praised the teamwork of a "skilled and motivated" staff that appreciates the "meaningful work" they perform each day. Dr. David Fields, former clinical chief of geriatrics at UMass Memorial Medical Center, calls his work at the center a "dream job" that allows him to spend as much time as needed to find solutions to complex care issues. "Until the level of medical care is improved everywhere, I just hide out here," he quipped.

At the end of my visit, I came away with mixed emotions. I was saddened seeing the ravages of old age those of us who live long enough must encounter. But I was also heartened by the spirit of cheerful endurance displayed in an effort to cope with the inevitable. In a sense, day care and other provisions for the frail underscore the irony of our modern age: As medical science and technology enable people to live a longer life, society has an obligation to make it as comfortable as possible.

Of all options I've seen so far, the PACE formula seems the best.

Robert Z. Nemeth's column appears regularly in the Sunday Telegram.