Behavioral health integration in the Program of All-Inclusive Care for the Elderly (PACE): A scoping review

Alexa Fleet; Daniel Shalev; Brigitta Spaeth-Rublee; Taryn Patterson; Liane Wardlow; Alya Simoun; Meril Tomy; Harold Alan Pincus

doi:10.1111/jgs.18416

Behavioral health integration in the Program of All-Inclusive Care for the Elderly (PACE): A scoping review

J Am Geriatr Soc. 2023 Sep;71(9):2956-2965. doi: 10.1111/jgs.18416. Epub 2023 May 29.

Authors

Alexa Fleet¹, Daniel Shalev², Brigitta Spaeth-Rublee¹, Taryn Patterson³, Liane Wardlow³, Alya Simoun¹, Meril Tomy⁴, Harold Alan Pincus^{1

5}

Affiliations

¹ Behavioral Health Services and Policy Research Department, New York State Psychiatric Institute, New York, New York, USA.
² Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA.
³ Chronic Care Research, West Health Institute, San Diego, California, USA.
⁴ University of California at Irvine Medical Center, Irvine, California, USA.
⁵ Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA.

PMID: 37246856
DOI: 10.1111/jgs.18416

Abstract

Background: The Program of All-inclusive Care for the Elderly (PACE) is a community-based care model that delivers collaborative care via an interdisciplinary team to meet the medical and social needs of older adults eligible for nursing home placement. Fifty-nine percent of PACE participants are reported to have at least one psychiatric disorder. PACE organizations (POs) function through an interdisciplinary model of care, but a behavioral health (BH) provider is not a mandated role on the interdisciplinary team. Published literature regarding how POs integrate and provide BH services is limited; however, the National PACE Association (NPA) and select POs have made significant contributions to behavioral health integration (BHI) efforts in PACE.

Methods: PubMED, EMBASE, and PsycINFO were searched for articles published between January 2000 and June 2022; hand-searching was also conducted. Research articles and items involving BH components or programming in POs were included. Evidence of BH programming and initiatives at the organization and national level was summarized.

Results: This review reported on nine primary items addressing BH in POs from 2004 to 2022. It found evidence of successful BH initiatives in PACE and identified a gap of published information given an evident need for BH services in the PACE participant population. Findings also indicate the NPA works to advance BH integration in POs with a dedicated workgroup that has produced the NPA BH Toolkit, BH training webinar series, and a site coaching program.

Conclusions: In the absence of PACE-specific BH delivery guidelines and guidance from the federal or state level for PACE programs, BH service inclusion has been developed unevenly across POs. Assessing the landscape of BH inclusion across POs is a step toward evidence-based and standardized inclusion of BH within the all-inclusive care model.

Keywords: Program of All-inclusive Care for the Elderly (PACE); behavioral health; interdisciplinary care team model; long-term care.

Publication types

Review
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Frail Elderly
Health Services for the Aged*
Humans
Long-Term Care
Skilled Nursing Facilities