PACE Programs in San Diego County: How They Work and Who Qualifies

Quick answer: A PACE program in San Diego (Program of All-Inclusive Care for the Elderly) combines Medicare, Medi-Cal, medical care, a day center, transportation and in-home help under one care team. It serves San Diego County adults 55 and older who live in a PACE service area, are certified as needing nursing-home level care, and can live safely in the community with PACE support.

For many families, a PACE program in San Diego is the best-kept secret in senior care. It can keep a frail parent living at home, or in a board and care home, longer and more safely, with one team managing doctors, prescriptions, rides, therapy and home care. This guide explains how PACE works, who qualifies for PACE in California, what PACE costs, which PACE organizations serve San Diego County, and how PACE compares with assisted living.

What is a PACE program?

PACE stands for Program of All-Inclusive Care for the Elderly. It is a Medicare and Medi-Cal program that acts as both the health plan and the care provider. Instead of juggling separate doctors, specialists, a Part D plan, a home care agency and medical transportation, a PACE participant gets one interdisciplinary team responsible for all of it.

A typical PACE care team includes:

• A primary care physician and nurse practitioners
• Registered nurses and a nurse case manager
• A social worker
• Physical, occupational and recreational therapists
• A dietitian
• Home care aides
• Drivers and a transportation coordinator

The team meets regularly, writes a care plan for each participant, and updates it as needs change.

How does PACE work day to day?

Most participants attend a PACE center one to several days a week. A day at the center usually includes transportation from home, a hot meal, social activities and exercise, therapy, and medical visits in the on-site clinic. On other days, PACE may send home care aides to help with bathing, dressing, or light housekeeping.

When a participant needs a specialist, a hospital stay, medical equipment or a short nursing home stay, PACE arranges and pays for it. Families have one phone number to call for nearly everything.

Who qualifies for a PACE program in San Diego?

To enroll in PACE in California, your parent must:

1. Be 55 or older.
2. Live in the ZIP code service area of a San Diego County PACE organization.
3. Be certified by the state as needing a nursing-home level of care, which usually means needing help with several daily activities or having significant cognitive impairment.
4. Be able to live safely in the community, at home or in a residential care home, with PACE services at the time of enrollment.

Medi-Cal is not required for PACE eligibility. People with Medicare only, or with no Medicare, can join by paying a monthly premium. Many PACE participants have dementia; it does not disqualify someone as long as they can be safe in the community with support.

Which PACE programs serve San Diego County?

Four PACE organizations operate in San Diego County. Each covers specific ZIP codes, so check your parent’s address with each one before choosing.

• St. Paul’s PACE: the region’s first PACE program, opened in 2008, with centers in downtown San Diego, Chula Vista, El Cajon and North County.
• San Diego PACE: focused on the South Bay, with sites including San Ysidro and Chula Vista.
• Family Health Centers of San Diego PACE: serving central San Diego from its College Grove location, plus an Oceanside site.
• Gary and Mary West PACE: a nonprofit program in San Marcos serving North County.

If your parent lives in Chula Vista or nearby, our Chula Vista assisted living and El Cajon assisted living pages show care homes near those PACE centers.

What does PACE cover?

PACE covers every service Medicare and Medi-Cal cover, plus anything the care team decides is medically necessary. In practice, PACE coverage usually includes:

• Primary care and specialist visits
• All prescription drugs, without a separate Part D plan
• Day center attendance, meals and activities
• Transportation to the PACE center and medical appointments
• In-home personal care and homemaker help
• Physical, occupational and speech therapy
• Dental, vision, hearing and podiatry
• Lab work, imaging and medical equipment
• Hospital, emergency and nursing home care
• Hospice coordination and end-of-life care

The main tradeoff is the PACE network. Participants must use PACE doctors and contracted providers, except in emergencies, and usually give up their previous primary care doctor.

How much does a PACE program cost in San Diego?

PACE costs depend on your parent’s coverage:

• Medicare and full-scope Medi-Cal: $0 a month.
• Medi-Cal only: $0 a month.
• Medicare only: a monthly premium for the long-term care portion, plus a premium for Part D drug coverage.
• Neither Medicare nor Medi-Cal: a full monthly private premium.

There are no deductibles or copays for services the PACE team approves. Private premiums vary by program, so ask each San Diego PACE organization for its current rate. Families weighing PACE against private home care should also read our in-home care in San Diego overview.

Does PACE pay for assisted living or board and care?

PACE generally does not pay assisted living or board and care room and board. PACE pays for care services, while the monthly fee for housing, meals and personal care in the facility is paid by the family or another source.

That said, many PACE participants live in a licensed board and care home or assisted living community. The facility provides 24-hour supervision and daily help, while PACE provides the medical care, therapy, day center visits, medications and transportation. For families with limited budgets, pairing PACE with one of the smaller board and care homes in San Diego can make round-the-clock care affordable, because the facility fee is lower and PACE covers medical costs. Ask both the home and the PACE program whether they already work together.

Is PACE better than assisted living?

PACE vs assisted living is not an either-or choice. PACE is a care program, not a place to live, so it works alongside home, assisted living, or board and care. Here is how families usually think about the fit:

• Living at home with PACE works well when a family member is present evenings and nights. It is a poor fit when your parent is alone overnight and unsafe.
• Board and care with PACE works well when the home welcomes PACE transportation and coordination. It is less ideal if your parent strongly wants to keep longtime doctors.
• Dementia and PACE works well when day center structure helps and wandering is manageable. When a 24-hour secured setting is needed, memory care facilities in San Diego may be the safer choice.

Our guide to home care or a care facility can help families compare the options.

How do you enroll in a PACE program in San Diego?

1. Call the PACE organization that serves your parent’s ZIP code.
2. Schedule a home visit for an intake interview and a tour of the PACE center.
3. The PACE team completes medical, functional and social assessments.
4. PACE submits the nursing-home level-of-care request to the state.
5. Your parent signs the enrollment agreement. Coverage begins on the first day of the following month.

Your parent can leave PACE at any time and return to Original Medicare or another plan.

What questions should families ask a PACE program?

• Which ZIP codes do you serve, and is there a waitlist?
• How many days a week would my parent attend the center?
• How many in-home care hours do participants like my parent typically receive?
• Which hospitals and specialists do you use?
• Do you serve participants who live in board and care homes, and which homes?
• How do you handle after-hours calls and emergencies?

Frequently asked questions

What does PACE stand for? Program of All-Inclusive Care for the Elderly.

Do you need Medi-Cal to join PACE in California? No. Medi-Cal makes PACE free, but people without Medi-Cal can join by paying a monthly premium.

Can my parent keep their own doctor on PACE? Usually not. The PACE team provides or arranges all care through its network.

Does PACE pay for nursing home care? Yes. When the team determines nursing home care is needed, PACE covers it.

Does PACE pay for assisted living? Generally no. PACE pays for care services, not assisted living room and board.

Can someone with dementia join PACE? Yes, as long as they can live safely in the community with PACE support.

Conclusion: is a PACE program in San Diego right for your parent?

A PACE program in San Diego gives frail seniors one coordinated team for medical care, prescriptions, day programs, transportation and home help, at no cost to most Medi-Cal members. PACE does not pay rent, but it pairs well with living at home or in a board and care home. Check which PACE organization serves your parent’s ZIP code, ask about network limits and in-home hours, and compare the full picture with assisted living before deciding. A free senior care assessment can help you sort out the options.