Five Questions With: Joan Kwiatkowski

"PACE is proven to save the state money (Medicaid) because we care for individuals who meet nursing home criteria yet remain living at home.":

Joan Kwiatkowski is the CEO of CareLink Inc., a nonprofit health management services organization comprised of post-acute and community-based health providers across the state. She also serves as CEO of the PACE program, which is an integrated care model that serves frail elders who choose to remain living in the community despite clinically qualifying for institutional care. She has served on the faculty at Boston University in the School of Social Work and has published in the areas of case management, integration of health care and community and hospital collaborations. She has presented at many national conferences on related topics. In addition, she has held adjunct professor status at Tufts Medical School where she was clinical manager for the Behavioral Health Division and Geriatrics at the Family Practice Residency Program affiliated with Northeast Health Systems.

PBN: What is the underlying philosophy of PACE?
KWIATKOWSKI:
PACE provides the right care at the most opportune time to help frail individuals remain living in the community safely. PACE is about creating options, being flexible and helping clients set realistic goals to keep them safe in the community using a personalized team of caregivers (including community partners) and creating one centralized, coordinated and dynamic care plan. With over 40 years of experience, this national model has proven its value.

PBN: Does PACE save the state of Rhode Island and the federal government any money, and, if so, how much?
KWIATKOWSKI
: PACE is proven to save the state money (Medicaid) because we care for individuals who meet nursing home criteria yet remain living at home. The cost of their care in the community is, overall, less than the cost of a nursing home placement. Research indicates that PACE defers nursing home placement by at least three years and sometimes it even helps avoid placement altogether. While we value the role that nursing homes play in our community, we also feel that nursing homes are a precious resource that should be utilized only by people who truly need the services they provide. By deferring just one nursing home placement annually, the state can save $40,000.
As for Medicare dollars, overall PACE clients have a shorter length of stay in hospitals, less adverse events such as medication errors, higher compliance with flu and pneumonia immunizations, and report a better quality of life than traditional Medicare beneficiaries. I would say we save both the state and federal government money through appropriate use of services when needed and improve the emotional well-being of clients – which we know has a cost.

PBN: Is there an individual whose care and story serves as an emblem of PACE’s work, whom you think of sometimes?
KWIATKOWSKI
: One of the most rewarding aspects of the PACE model is seeing how the team can support someone whose care in the traditional health care system was marginal and through PACE, their health and, really, their life was improved. In health care we all have stories of gratitude to tell, but in my 30 years as a professional, the PACE stories are by far the most moving.
I think of the one client who came to me to say that while PACE could not cure her illness, we did cure her loneliness, her pain, and her feeling of hopelessness. What she needed was not something that she could have gotten through the traditional health care system.
When I’m thinking of success stories, I also reflect on the positive impact that our model has on caregivers – the children, the spouses, the partners – who have made a promise to their loved ones to keep them at home. Our one-stop approach to care makes it possible for them to keep that promise and to remain active caregivers.
We have doctors and hospitals tell us that our clients are too sick to live safely in the community, yet they are amazed at what we can provide to support and stabilize the most challenging situations while fulfilling the client’s wish to remain at home (the heart of our delivery model). We are not a solution for everyone, but we are a solution for those who will benefit from a team approach and want to remain in the community.

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PBN: In what ways are these the best of times for elderly people?
KWIATKOWSKI
: There are more choices for care and services than ever before. Every aspect of care in the long-term care system is dedicated to improving and providing client-focused care. For the first time, those in acute care and primary care see the long-term care system as a resource and as a lifeline for their patients. If we can collaborate to improve care of older adults who are frequent users of the healthcare system, we have the chance to improve quality of life for everyone, regardless of their age or degree of illness.

PBN: In what ways are these times especially challenging for elderly people?
KWIATKOWSKI
: I think there are many challenges being faced right now. So many seniors lost retirement savings in the recent recession that they had diligently saved for their personal care needs. We’re also all facing an ever-changing health care system that’s too complicated for the average person to understand. Some older adults have too many case managers who are driven to help but end up adding complexity to their everyday life. Sometimes we as health care professionals try so hard to improve care, but we inadvertently make it more complex and less responsive. Given the growth in the older population, especially here in Rhode Island, it’s our challenge to work with our clients to build a more responsive and flexible system that continues to provide quality care to directly address patients’ individualized needs.

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