Re: co-care agreements?
From: Wendy Willbanks Wiesner (
Date: Wed, 25 Jan 2017 19:01:58 -0800 (PST)
Muriel at Shadowlake wrote:

"At some point, residents with serious physical or cognitive issues should
expect to sell their house and move to senior
living/assisted living.  In fact in the last couple of years, four singles
or couples have done just that, and two more residents are about to leave
as well because of their increasing age-related physical limitations."

Muriel, Mary, Dyan, Sharon et al:

I suggest considering the PACE program as communities put their Aging in
Place Plan together.  The program is designed to address precisely the
issues that you highlighted in the above quote, Muriel.  Here are the


PACE (Programs of All-Inclusive Care for the Elderly) is a Medicare (and
Medicaid) program that helps people meet their health care needs in the
community instead of going to a nursing home or other care facility.

The program offers a team of health care professionals providing
coordinated, comprehensive care, including a geriatrician who oversees
medical care provided by a team of physicians, nurses, therapists and
social workers.  The program also provides home health workers and sends
contractors to make a participant's home safer and more accessible.


If you have Medicare, you pay:

A monthly premium to cover the long-term care portion of the PACE benefit
(no premium if you qualify for Medicaid).

A premium for Medicare Part D drugs.

No deductible or copayment for any drug, service, or care approved by your
health care team.

If you don't have Medicare or Medicaid, you can pay for PACE privately.


To qualify you must

1)  Be 55 or older.

2)  Live in the service area of a PACE organization.

To date, there are 121 programs in 31 states with the program rapidly
growing.  See the National Pace Association (NPA) at for
up-to-date information.

3)  Currently need, or be "at risk" for needing nursing home-level of care
(assessment criteria varies by state).  Common criteria include needing
assistance preparing meals, dressing and/or bathing; chronic medical
conditions are also considered.  Exemptions may apply.

AND most relevant to cohousing communities IMHO--

*4)  Be able to live safely in the community with help from PACE.*

*The willingness of residents in cohousing to provide mutual support--so
that residents can "live safely in the community with help from PACE"--will
influence whether an individual can meet this PACE criteria or not.  *

What needs to happen next for cohousers wanting to age in place with PACE
is to work through a few community-level test cases (to my knowledge this
has not been done in either a coordinated or even an ad hoc way yet).
I've identified NM as a good test case because the state and its
vertically-integrated hospital system provider is a recognized pioneer with
the PACE program, and thus influences others.  This same hospital system
will be providing health care automation to the State of NC, so NC is an
interesting possibility as well.  CO is also a sensible and strategic
choice, given work done with the Director of the Denver Office of Aging and
the ED of the Colorado Gerontological Society, where together we've all
been on a housing workgroup focused on Community Wealth Building (cohousing
being one very impactful way to build Community Wealth).

*Please let me know if your community is interested in being a test case,
either in NM, NC, CO or in one of the other 31 PACE program states. *

*Muriel, there's a PACE program out of Roanoke that may cover Blacksburg.
Refer to <>. *

*Dyan, a program out of Holyoke that covers Western MA: <>.*

*Sharon, no PACE currently in DC.*

Those communities interested in being test cases could clarify PACE
Qualification Criteria #3 and #4 (above), as they relate specifically to
cohousing.  Having a range of test cases would give us a better opportunity
to capture the unique choices that cohousing communities are making today--
on what we know is actually a continuum of "mutual support".

Now speaking in general terms, cohousers will need access to the
comprehensive medical care that PACE provides, but often not need
transportation/meals on an everyday basis, nor the more extensive
housekeeping/maintenance/checking up associated with the larg(er),
traditionally isolated single family home, nor the "social activities" that
are part of PACE programs.

*This means potentially reducing the cost/increasing the ease of providing
care in cohousing, giving PACE providers a clear incentive to work with
cohousing communities and their residents.  *

At the very least, if your cohousing community is not currently covered by
a PACE program, it is possible that your community could participate in a
development phase PACE program.  Thus cohousing could be considered in the
program from the get-go.


Wendy Willbanks Wiesner
Executive Director
Partnerships for Affordable Cohousing (PFAC)

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