January marked International Quality of Life Month, which commemorates living our best selves as we age. In other words, we believe we are functioning at our highest physical, mental, emotional, and social levels.
These things are often subjective, always multi-dimensional, sometimes more abstract than concrete, and entirely fluid – they change as we grow older, and what once made us happy evolves or becomes secondary to other needs that take on greater urgency and importance.
As we or those we love get older, we likely will need greater care and more resources geared toward keeping elderly family members healthy, engaged, safe, and happy…all features of a good quality of life.
But, what exactly IS quality of life and how do we define such a complex, dimensional, and important concept? And how does Program of All-Inclusive Care for the Elderly (PACE), equally broad and dimensional, help people maintain it in ways that correlate directly to life-quality metrics?
PACE programs comprise similar, interdimensional and interdisciplinary components as significant quality-of-life measures, meaning that PACE programs can provide essential improvement in quality of life for elders.
PACE Programs: Parallel Components for Quality of Life
PACE is an innovative managed care model that uses an interdisciplinary health care approach to assess the needs of each participant and deliver a comprehensive array of services, all with the goals of keeping seniors healthy and living safely in their own homes.
PACE provide seamless, coordinated health-care services that improve efficiency and outcomes. It is the only program of its kind that integrates Medicaid and Medicare under a collaborative three-way agreement between state agencies and a PACE organization. This fully integrated model of care, with pooled financial resources, allows for greater service flexibility, coordination, and continuity of care. Here’s what PACE can do:
- Provide quality and cost-effective community-based care to older adults who would otherwise require a nursing home or other form of care.
- Create consumer and family member satisfaction.
- Reduce the use of institutional care on average.
- Lead to better overall service usage by participants.
Together, these things mean that PACE addresses many of the same factors considered essential for a good quality of life, such as health, productivity, living conditions, social wellbeing, and overall safety.
Quality of Life
According to its article, Quality of Life Indicators – Measuring Quality of Life by Eurostat: Statistics Explained, quality of life can be thought of in this way:
“Quality of life is a broad concept that encompasses a number of different dimensions…both objective factors (e.g. command of material resources, health, work status, living conditions and many others) and the subjective perception one has of them. The latter depends significantly on citizens’ priorities and needs. Measuring quality of life for different populations and countries in a comparable manner is a complex task, and a scoreboard of indicators covering a number of relevant dimensions is needed for this purpose.
Discussions on how to better measure the progress of societies and their well-being and how to sustain quality of life in the future, have led to several important initiatives. Based on academic research and several initiatives, the following 8+1 dimensions/domains have been defined as an overarching framework for the measurement of well-being. Ideally, they should be considered simultaneously, because of potential trade-offs between them.”
The article identified the following quality-of-life aspects, which are multi-dimensional and interrelated.
- Health. This critical quality-of-life feature can affect a person’s functioning within society and also one’s subjective sense of wellbeing, especially if physical, mental, or emotional disturbances are present. Important aspects include: health-outcome indicators, such as life expectancy; the number of healthy life years; subjective assessments of one’s own health, chronic diseases, and limitations in activity; health determinants (healthy and unhealthy behaviors, such as smoking, alcohol, and diet, and exercise ); and access to health care. Some of these can be thought of as social determinants of health.
- Productive or main activity. Work and quality employment are important, but not all people work (especially the elderly in PACE programs), so other considerations, such as volunteering, crafting, hobbies, etc. are also important.
- Material living conditions. Living standards are measured based on three dimensions: income, consumption, and material conditions (deprivation and housing). Income is central, because this indicator has the most influence on the others within the framework.
- Leisure and social interactions. Social networks are essential to happiness and are directly correlated with life satisfaction. Both quantity and quality of leisure activities matter, as does social interaction. According to the article, “Activities with others (frequency of social contacts and satisfaction with personal relationships) and for others (volunteering in informal contexts), the potential to receive social support (help from others) and social cohesion (trust in others) are included in the framework under this topic.”
- Economic and physical safety. Safety and security are fundamental to quality of life. As the article states about economic safety, “Being able to plan ahead and overcome any sudden deterioration in their economic and wider environment has an impact on their quality of life.” Moreover, being safe from physical violence, as measured by various kinds of local violent crime, is just as important.
- Overall experience of life. Considering measures such as life satisfaction (cognitive appreciation), affect (a person’s feelings or emotional states, both positive and negative, typically measured with reference to a particular point in time) and eudemonics (a sense of having meaning and purpose in one’s life, or good psychological functioning.)
These comprehensive constellation of metrics serves as a better method to measure and benchmark what quality of life actually means, in all of its fullness and practicality. And, while it remains difficult to measure, this approach is intended to provide better insight into quality of life and avoid erroneous or misleading conclusions.
At the Intersection Aging and Quality of Life
In many ways, PACE programs address many of those same dimensions, using an interdisciplinary team to manage the discrete yet related and interdependent factors that comprise both good care for seniors and overall quality of life. PACE programs contribute to or improve upon quality of life for seniors – the ultimate goal.
PACE programs are as complex and challenging as the issues they attempt to resolve, and implementing a PACE program is no simple mandate. Led by partner Jared Duzan, CFE (principal, Indianapolis) and his team, Myers and Stauffer regularly facilitates conversations with state Medicaid professionals about implementing or expanding their states’ PACE programs.
In particular, the PACE team focuses on the development, implementation, and program-monitoring strategies used by successful state PACE programs that target the effectiveness of PACE in improving quality of life for our fragile elderly populations around the county. For more insight into this distinctive program and its components, read our blog post PACE: Program of All-Inclusive Care for the Elderly – Myers and Stauffer: Client-Centered and Quality-Focused Project Management.
A PACE Story: Meet Laura and her mother Mary
PACE has made important and meaningful differences in the lives of Laura and Mary.
Laura and her family felt overwhelmed trying to meet the increasingly complex and expensive needs of her elderly mother. Mary felt increasingly isolated in a life that lacked interest and vitality.
Then Mary joined her state’s PACE program.
“At first I didn’t think I was going to like it, but once I got in there, it seemed like I was the boss instead of they were. I have a lot of friends there, so I enjoy being there.”
“It’s given mom and us a lot of relief of trying to take care of her. She was mad at first because she thought we were taking her away. When she first went until now, it’s a huge improvement.”
We shared Mary and Laura’s story at our 2023 State PACE Forum. Click the thumbnail below to learn more.