At Home Care for the Elderly

To the Editor, New York Times:

Re “Rethinking Nursing Home Care, Even With Vaccines” (news article, May 9):

Families don’t have to decide between caring for aging parents at home with help from hired aides or sending them to live in nursing homes.

Since the 1970s, Medicaid has paid for people 55 and over to receive nursing home-level care outside of nursing homes through a care model known as Program of All-inclusive Care for the Elderly, or PACE. PACE is widely recognized as the gold standard of care for keeping nursing home-eligible seniors healthy and safe in their own homes, while offering comprehensive medical care, social activities, meals and other support at PACE centers, almost always at far lower cost than institutional care.

Inexplicably, however, PACE has never received the support and promotion it deserves from the federal and state agencies that administer Medicaid. As a result, many families remain unaware that such an alternative is even available.

It’s time for policymakers to establish clear plans for reducing the number of seniors who are living in nursing homes unnecessarily and would be better and more safely cared for in their own homes.


LYNN — After a year of relying almost completely on telehealth, the virtual health platform at Element Care PACE in Lynn has expanded to incorporate avatars, personal reminders and a variety of meeting options for elderly patients.

At Element Care — a nonprofit healthcare organization serving seniors living at home — the telehealth options have evolved into a daily tool for behavioral health services, rehabilitation services, care management and nutrition counselling.

Dr. Joanna Duby, who practices at Element Care, said they have managed to contract devices through Grandpad, which incorporate video visits with family and friends to relieve social isolation, virtual meetings of groups like Alcoholics Anonymous (AA), and events including comprehensive healthcare and social services — available in languages such as Spanish, Portuguese, Khmer, Creole, Russian, and Albanian.

“The participants can use this to connect with different types of health care personnel but also with their families,” Duby said. “They can listen to music and connect with other people that they’ve allowed access to the device, so it’s really the whole package. We can give them healthcare through it and they can also have socialization and activities.”

Element Care uses a system called, where participants can make their own avatar —  usually a cartoon dog or cat — that will remind them to take their medication, exercise or walk around, and other daily reminders. Duby also said the participants can tell the avatar when they’re not feeling well and the doctors can then video call them through the avatar.

“People are using them and enjoying them so far. The uptake has been great,” Duby said. “It takes a little bit of getting used to, obviously, and a little bit of training, but at each of our centers we have people that are champions of this and they help the participants use the devices.”

Duby said some participants can have two to three interactive sessions per day, which are available to Grandpad users through Zoom calls. Duby reports that all of the sessions she’s observed seem to be well attended.

Some of the available sessions include bingo, rehabilitation groups, and behavioral health groups.

“They can access a doctor or nurse practitioner and have their health sessions, but they can also do fun group activities so that they’re kept engaged,” Duby said.

The elderly community has been secluded within the last year out of caution related to COVID-19, so Duby said this resource is huge; she says it brings back some kind of social interactions for her elderly patients.

Element Care began distributing the Grandpads late last summer, and Duby said there were more than 300 participants by December.

“A good percentage of our population has them now,” Duby said.

Element Care has continued providing services throughout the pandemic, with nurses making home visits and someone from Element Care calling and checking in with the patients at least every other day.

Last summer, Duby said the rehabilitation department began performing more home visits, and now Element Care sees 10 to 15 people in-person daily at the day centers. Duby said they are slowly bringing people back into the centers as more of the population is getting vaccinated and capacity restrictions are easing.

Although Element Care is returning to some in-person operations, Duby said they plan to continue using the Grandpads because they are “a great way to keep in touch with people.”

“I think we’ll keep a hybrid form when some people come in in-person, but there’s always going to be some stuff through the telehealth devices as well,” Duby said. “Now that we have it, I don’t see us going back.”