Health on the Plains: Episode 5, Setting the PACE for Aging in Rural Kansas with Emilie Rains

59 Min Read

Jan 04, 2024


Wyatt J. Beckman, M.P.H., C.H.E.S.
Photo of Emilie Rains and Wyatt Beckman


On Episode 5, host Wyatt Beckman takes listeners to McPherson, Kansas, to meet Bluestem PACE Executive Director Emilie Rains. We get a look at the innovative PACE model, which stands for Program of All-Inclusive Care for the Elderly, and what it can mean for rural Kansans. Emilie discusses the organization’s unique approach to helping older adults live in their homes and communities, while also providing a hub for health-related services and social engagement. She discusses the specific challenges of health care and in-home support for older adults in rural Kansas.

Episode Highlights: 

  • 4:42 – 9:34: Emilie provides an overview of Bluestem PACE, highlighting its evolution over seven years to expand across multiple counties and how PACE addresses challenges in rural communities, such as transportation, to assist older adults in aging in place.
  • 9:54 – 14:11: Emilie guides us through a day in the life of a Bluestem PACE participant, explaining the “one-stop-shop” facility for medical and preventive health needs. Emilie also notes how PACE extends care into homes and operates as a day center for socialization, meals, and activities in a family-friendly environment.
  • 17:09 – 20:08: Wyatt and Emilie discuss the rich experiences and leadership older adults offer their rural communities and how PACE providers integrate themselves into the life, needs and preferences of the PACE participant to ensure they can continue to show up for their community and remain as engaged as possible.
  • 20:44 – 24:11: Emilie discusses what sets apart rural and urban PACE programs, from the way programs are set up, to the importance of partnerships with providers. She also discusses the challenge of transitioning care for older adults who, in some cases, have had the same doctor for decades and is needing to change care settings.
  • 24:36 – 30:18: Emilie explains the process and components of an individualized care plan for a PACE participant, which includes an interdisciplinary team of providers, the participant and their family. Emilie and Wyatt discuss the role of caregivers in the plan, and how PACE also provides a benefit to those caring for loved ones enrolled in PACE.
  • 30:19- 36:49: Emilie explains how PACE has been shown to decrease ER visits and hospital readmissions the longer a PACE participant is enrolled in the program. PACE has also allowed many participants to improve their health and to remain in the home until the end of their life.
  • 39:22 – 53:22 : Emilie and Wyatt engage in a discussion on the core principles of PACE, focusing on being person-centered, respecting autonomy, and providing dignified care to participants. The conversation extends to the program’s role as a resource for families, facilitating the transition of older family members into care settings tailored to their needs. Wyatt and Emilie also touch upon the cultural aspects of aging in the United States, examining how the experience of aging is perceived by younger generations.
  • 53:22 – 1:01:44: Wyatt and Emilie shift the focus to the payment structure of PACE and the progress made in Kansas to enhance the program’s affordability and accessibility for participants. Emilie looks to the future for what rural PACE expansion will look like for Kansas.

Full Transcript

Voice over  0:00 

This is Health on the Plains, a podcast about rural communities, rural life, and the many factors influencing the health and well-being of rural Kansas. Health on the Plains is a podcast from the Kansas Health Institute, a nonprofit, nonpartisan educational organization, committed to informing policy and improving health in Kansas, through honest nuanced conversations with leaders and doers from a variety of backgrounds. The Health on the Plains podcast offers unique insights into rural health challenges in Kansas and shines a light on the people and organizations working to make their communities healthier, more vibrant places to call home.

Wyatt Beckman 0:42

Welcome back to another episode of Health on the Plains. We’re here in McPherson, Kansas. We’re at Bluestem PACE facility. And we just wrapped up a wonderful conversation with Emilie Rains. She’s the Executive Director here at Bluestem PACE. It’s a wonderful organization doing really innovative and awesome things to help seniors and older adults maintain their dignity and stay in their home if they would like to by surrounding them with all sorts of different services to provide the best care they can in an individualized way. It’s a great conversation, and I hope you enjoy it.

Today, we are here in McPherson, Kansas. And our guest is Emilie Rains, who is the Executive Director of Bluestem PACE. PACE, P-A-C-E, stands for Program of All-Inclusive Care for the Elderly. Before serving as executive director, a role you took on earlier this year,

Emilie was the director of market development and intake for Bluestem PACE. And that role helped grow the program in a variety of ways. You spent time educating adults and caregivers and potential participants and other health care partners about the value of the program. And then you also got to coordinate the intake of new program participants, and build those connections with participants and their families. Emilie is a well respected leader and voice in the space of PACE programs and innovative approaches to provide care and you even recently served on a panel for an event that KHI hosted, focused on person centered care and aging in place in rural communities. Emilie, we are so excited to be with you here today. And to learn more about your work. Thanks for joining us.

Emilie Rains 2:32

Thanks for having me. I’m excited that you are here.

Wyatt Beckman 2:34

Awesome. So today, we’re will be talking a lot about Bluestem PACE programming and the Bluestem PACE program that’s operating right here in here in central Kansas. But the PACE program has a really rich history. And for a little context it the roots of PACE, or what would become PACE go all the way back to 1970s, early 1970s. On the west coast, in the Chinatown, North Beach community of San Francisco, in 1971, there was a public health dentist, along with some other community leaders that saw a need for long term care services for the families whose elders had immigrated to the community from Italy, China and the Philippines. And over 50 years and a lot of work, a lot of support from different foundations and different leaders and some legislative action; that initial innovative approach and desire to meet those needs grew into a really well established program that’s now in 32 states, including right here, right here in Kansas. And here in our state, as of September of this year, there are three PACE organizations offer services to Kansas and 23 counties.

And the state is awaiting CMS approval to expand the number of counties across the state in which pay services are provided. So PACE is both a program that you can find across the country. But it’s not everywhere. And so we’re really excited to have it here in Kansas and have it here in McPherson area. And in short PACE offers participants an alternative to traditional residential care homes and nursing home facilities by enabling them to stay in their homes. And we’re going to dive into what that looks like here. But before we do that, PACE Bluestem PACE here is part of a broader organization. And I just help folks put it in context. It’s part of Bluestem Communities. Can you tell us a little bit about Bluestem Communities and this region and the communities that you serve here?

Emilie Rains 4:42

Absolutely. So Bluestem Communities has a long history of caring for seniors in your traditional sense of care homes. We currently have two life plan communities. So one is Kidron Bethel Village and that’s in North Newton, and then also Schowalter Villa in Heston. And so about, you know, 10 years ago Bluestem said, you know, we really want to care for seniors kind of in the traditional sense, but also in the sense of folks are starting to want to receive care at home, and really stay in place. And so Bluestem was very innovative. And, you know, in collaboration with the state, opened this PACE program about seven and a half years ago, in an attempt to not only serve folks in, you know, the traditional sense of on a campus, whether that be, you know, independent living or assisted living or health care, but we want to really give folks an option to see in their communities. And so that’s where PACE came in. Opening in 2016.

Wyatt Beckman 5:41

2016. And, and you’ve been with PACE, how long?

Emilie Rains 5:45

Since we opened.

Wyatt Beckman 5:46

Yeah, you’ve seen that seen the growth of the program from from day one?

Emilie Rains 5:51

Absolutely. It’s been a fun adventure to see.

Wyatt Beckman 5:54

And you started to sort of get into to PACE program, and at its heart, it’s, it’s working to meet older adults care needs while remaining in their home. And that’s a big part of, we know, generally, that a lot of older adults prefer to stay in their home, they want to age in the home that they that they built and that they know and that they love. There’s a broader concept around that called aging in place. That’s that’s the idea that it can be defined as the ability to live in one’s own home and community safely, independently and comfortably, regardless of age, income or ability level. So the PACE program really supports that that idea. But before we get into specifics of what PACE looks like here, and Bluestem PACE, when you think about the rural communities here in central Kansas, and and the communities you serve, because you serve the region, there’s multiple counties. What are some of the main challenges are the barriers that that our older adults here in this region face in trying to age in place?

Emilie Rains 7:00

Absolutely. Well, I think one of the things that’s, you know, I wouldn’t say newer, but as the spotlights been put on it through COVID, and post COVID, is really the workforce. So if you think about a senior who goes to their community physician, and they say, “Oh, you could really benefit from some homecare, you could benefit from some assistance with bathing or dressing.” Um, it’s very challenging in rural communities to be able to find agencies and/or individuals who are interested and willing and more importantly, trained to, to provide that care. I think, another barrier is often, you know, when we have to leave our community to get a specific kind of care or therapy can be transportation. So when we’re not driving any longer, or maybe we’re depending on a son or daughter who’s working to get us to appointments, you know, being in a small community where you don’t have bus service, and things like that can be a definite challenge. And then just in general, just the availability of a variety of services, there may be some services available in your community. But you know, having each and every service that you need can be a major challenge.

Wyatt Beckman 8:07

Absolutely. The when we think about older adults in town, like like I grew up, and it’s similar town to where you are, my hometown Ness City and yours Moundridge, just just south of here, 1500 people, 1700 people. That size town is not going to have all the same services that a larger city has. And if you’re an older adult, that has more need for different services. And then on top of that, you have challenges getting to those services, at a certain point staying in your your home, and overcoming those barriers, time and time again, can be really difficult. Absolutely,

Emilie Rains 8:51

It can be really a daily challenge and even one that you know, you and I were still driving, we’re you know, traveling at distances, no problem, it can really be the thing that keeps you up at night, the thing that really causes a lot of concern and can, you know, really create other issues like depression and anxiety and things like that.

Wyatt Beckman 9:10

And so even if, even if, if we have an older adult that is finding a way to make it work, that that strain in that stress can can have other other implications. Even just quality of life can can can be really challenging when you’re having to overcome those all the time.

Emilie Rains 9:29

Yes, it can. It can definitely be something that’s taking away from doing the things you love and want to do.

Wyatt Beckman 9:34

Absolutely. So with all those challenges, we talked about the challenges and the barriers. I want to now get into Bluestem PACE, because I really think when you hear all of those some of those challenges, I think about what PACE program is and what it can be. It seems perfectly suited to step in and help address some of those. So when you think about Bluestem PACE specifically and your communities here and the ways you serve folks. What does it look like to be a participant in Bluestem PACE, what all do through the program?

Emilie Rains 10:09

Absolutely, we’ll try to keep this to our conversation today, because there’s so many things that we could talk about. But in general, you know, Bluestem PACE provides the older adults in our program, the opportunity to stay at home while receiving all the services they need provided through one team and coordinated and delivered to them versus a situation where you’re having to go find services and piece apart them together. So one of the phrases that often gets used for paces we’re a one stop shop, and I love and hate that term. But it really is fitting in that, you know, for seniors who have a complex medical conditions, they’re needing support with their activities of daily living, they might need support, making sure they get their medications and/or are able to take them. PACE provides an opportunity for our folks to partner with us and having those needs met. So when someone’s in our program, you know, we’re providing their medical care, like primary care, but we’re also coordinating specialty care that they need, like if they need to see the cardiologist or another ‘ologist’. We’re providing all their medications, we’re providing durable medical equipment. So if someone needs a walker, or wheelchair, or maybe they need a ramp for the front of their house, you know, those are very challenging to get in an urban setting, but even more challenging in a rural setting. So additionally, you know, folks can be very isolated in rural communities. And so we bring folks into our day center, where they have the opportunity to have a meal together and some meaningful activities. Like bingo is the number one thing we do here. So that’s everyone’s favorite. As well as while they’re here, the days and or they can then have physical therapy and maybe see a dietitian to talk about why they’re losing weight, kind of unexpectedly. So what we do is bring all the services to one place. And then we bring our seniors to that place to receive services, and then also things in their home. So if they need assistance with cleaning, or bathing or getting dressed or, or those kinds of things, our team is able to go out to the home and care for them as well. So we just wrap them up in care.

Wyatt Beckman 12:23

I will say when we when we walked in, I love that you mentioned the bingo and the enjoyment that folks get from that, because when we walked in, we had a chance to see some of the space we’re in here. And we walked by a table and saw the bingo cards and people were playing, playing other card games. And I think there’s there’s an immense value in that social interaction I would imagine in the in the community. And we’re noticing as well that people are wearing shirts, that say Bluestem PACE, because they’re proud to be connected with and be part of the it’s almost like a community that you’re in a community with the care providers as well. And that feels very different than than other ways you receive care. I don’t wear a shirt for the hospital I go to and I need a scheduled appointment.

Emilie Rains 13:14

One of the things that is different about PACE is that you know what brings an individual to PACE maybe that they’re having more falls or they are needing assistance with showering or, you know, they’re forgetting to take their meds or maybe they can’t even get to the pharmacy to get their meds. So things bring people to PACE. I think what keeps people at PACE is the community and really the family environment. So folks don’t even realize how much they need interaction and relationship with others until they get here. And they are looking across the table at someone and say, they’re my age too. And they’re struggling with diabetes, or they’re struggling with heart disease that’s really you know, causing shortness of breath and keeping them from doing those things they wanted to do. So it’s finding that commonality amongst each of us, even though we’re here for a different reason, I feel like we stay for the same reason, which is the connection and that quality care that we can give because we we form relationships. Yeah, you know?

Wyatt Beckman 14:12

That relationship piece, that partnership pieces is something that that I hear in how you talked about and I see in the programming and you really seems like the PACE program is intentional that this is a partnership between the person receiving care of the participant between the care team, even with the family members, because you mentioned there could be a variety of ways that that sort of people start to get connected with or come into the program. So could you talk about that partnership approach and what what that means and how that’s a really important piece of this?

Emilie Rains 14:50

Absolutely. So everyone in the PACE program is qualified based on the state of Kansas assessment to be able to live in a long term care facility. So you know, they have lots of needs. So the partnership comes in, in that I’m staying at home, it’s challenging, we have a lot of barriers to overcome together. And so when we have a participant and their family, maybe who are committed to doing their work, to stay safe at home, we come alongside and do our work. And it just is a really a perfect combination of working together to stay at home. Because doing that sometimes is more challenging than looking at, you know, a place where you’re just cared for 24/7.

Wyatt Beckman 15:32

So there can be some additional, additional challenges or, or unique things to think about in staying at home, and it necessitates that everyone be sort of participating together. But it sounds like for the folks that do decide to participate, there’s enough benefit from that, that it’s worth doing, even when there’s maybe more investment from the whole team, that it’s some bigger benefit than than the alternative.

Emilie Rains 16:05

Absolutely. So I think the kind of person that PACE attracts, if you will, and there’s plenty of these folks in Kansas, I consider myself one of them, is, you know, really pick yourself up by the bootstraps really maintain our independence, I mean, none of us want someone telling us, You know what to do, when to do it, how to do it. And so I think, in PACE, it provides an opportunity for our participants to receive as individualized care as possible, you know, in their home environment, in collaboration with their team. And it really takes that mindset that I’m going to pick myself up by my bootstraps to stay at home, when it gets challenging, when it gets hard, maybe when our mobility changes, or, you know, weren’t needing more care. So that get it done, get it done, individual, independent spirit that so many Kansans have really fit perfectly with PACE, because we can work hard together to keep folks at home where our family will come see us more readily where our dog is, you know, in that place, we’ve lived for maybe 50 or 60 years.

Wyatt Beckman 17:09

Absolutely. And another another piece of that, that I when I think about allowing people to remain in are supporting them and enabling them to age in place in the home that they built. It not only allows that individual in that family to maintain that sense of place and connection to the home they built in their, their pets or their their favorite room that they’ve made just just exactly the way they want. And there’s memories attached to the place. And it allows all of that. But I think about especially in really small communities, those older adults that have been there for years that were the former mayor, former president of the Rotary Club, or the they used to be a teacher, or they maybe still are doing some of those things, but they, they have such an impact on the community. And they’re such a voice and a leader for the community, that allowing them to remain in their home, in a lot of cases also means allowing them to remain in the community itself, when the alternative is a care provider that’s in another city. So is that part of − Do you see that that as part of the benefit to have a program like PACE?

Emilie Rains 18:29

Absolutely. And one of the things that we notice, or folks are sometimes concerned about is, you know, I’m gonna come to the PACE center, but I’m, you know, but during the day, I’m involved at my senior center, or I, you know, help babysit for Bible school, or I, you know, am involved in some other way, we always help people know that we are not trying to just keep them at home, but also in their community. So you know, there are some folks that are after active members of their communities, some that are active in as much of a capacity as they can be, and really bringing, you know, the wisdom and relevance and the context to their communities. And keeping that keeping that going. You know, in our small town, there’s folks that we see at all the basketball games that, you know, graduated 55 years ago, and if we didn’t see them there, we would notice their absence, our kids would miss them being there. And I think that that’s something in our culture as we become more digital, and we’ve come together through through technology and also have separated a little bit. What’s alive and well in small communities is the intergenerational aspect. And that’s not only something that’s important to us here at PACE, but inclusive communities to really be remaining in our communities, providing the options to be able to remain engaged as engaged as possible.

Wyatt Beckman 19:51

Absolutely. We talked a little bit about thinking about some of our really small communities and some of the the culture and Some of the things that that PACE can support continuing and those intergenerational connections in those relationships. I want to sort of broaden out to thinking about PACE programs, and how the PACE program you operate here serves several counties. And it’s your base here in McPherson, which, for people from Ness, and my hometown, Ness City, probably feels like the bigger place. But from a national standpoint, it’s still pretty small, it’s pretty rural, but you especially serve some really rural areas and smaller communities as well. And I imagine you do some work in connections with other PACE programs in bigger cities and nationally, I’m curious to reflections on on what you see about unique opportunities and challenges for PACE programs in our rural communities versus the more urban communities.

Emilie Rains 20:57

So one of the ways that a rural PACE is really set apart from an urban PACE, I believe is partnerships with other providers. You know, not only does the PACE program, does rural need to lean on, like additional transportation providers, but we also lean on community based physicians. We know in rural settings, we meet folks who have had the same doctor for 30, 40, 50 years, and really transitioning their care is challenging on multiple fronts. Willingness number one, you know, I can understand if I had a doctor for 50 years, I sm probably not leaving them. And also, just the continuity of care, you know, to help seniors age in place, that continuity of care cannot be overstated. One small change can really throw things off. And so we have partnered with some community based physicians to be able to keep those relationships intact, while also surrounding that individual with more care. And I think in a rural setting, that is very important, because of those, you know, the long standing relationships that exist. So I think partnerships with providers help, you know, bridge the gaps of relationship, and they also bridge the gaps of just service availability. So making sure that we have the services out to the farmer, the stretch like Sterling, Kansas, or, you know, as North is north of Salina or or south to, like the Sedgwick county line. So we really create a network of specialists, a network of hospitals that we work with if we need lab or we need imaging or, you know, so we’re not bringing everyone here to McPherson for imaging, we’re partnered with our local hospitals, so we can do that. So I would say partnership is the one thing that sets urban and rural apart.

Wyatt Beckman 22:46

Yeah, that that’s really interesting. And that, that resonates with with a lot of, of my experience that we had a physician in town that was served multiple, you know, generations, by the, by the time he eventually retired. And I imagine if I had a family member that was considering participate in PACE that would be really important to maintain that that relationship. But what sounds really unique in in a lot of ways innovative is it’s a both hands, how do you maintain the relationships and the resources and build on what’s here and connect it with additional resources. And that opens up a whole new level of care that you’re able to provide?

Emilie Rains 23:33

Absolutely. So if you think about a community clinic, you know, they’re going to order a new medication, they’re going to maybe recommend some physical therapy, but the scope of how much we can make sure a person follows up with that is pretty limited. And so when we partner with a local physician, we’re able to, you know, make sure we get those medical records, we see they’ve ordered a new medication, they’ve ordered therapy, they’ve maybe ordered some would they like to have somebody you know, consider for assistance with showering, you know, our team can then say, okay, and we’re going to jump in and help support in that way. So really being that safety net, not only for our participants and families, but the other providers that we work with.

Wyatt Beckman 24:11

Yeah, and you every time you’re providing an example of what this looks like, it sounds slightly different. And I think that that’s a big piece of this too, is it’s really individualized. And one of the things you that’s part of the program is is an individualized care plan can. So can you tell me how someone comes in and they, they’re eligible and they come into the program? What does it look like to develop that individualized care plan and who all is involved in making that?

Emilie Rains 24:42

So I think one of the unique features about PACE is that it is an interdisciplinary care plan. So when folks come into our PACE program, they are assessed by two handfuls of people. So they have an assessment with our physician with a clinic nurse with a nurse in their home with social worker with our transportation folks just to meet with them and see what that’s going to look like they have assessments with our PT and our OT, our recreational therapist, and our dietician. So this whole group of individuals meets and interacts with our participants and their family. And really gleans what, from my perspective as a PT or an OT or dietitian, what can I bring to the table to help support this individual? So then our interdisciplinary team, which is what that group of individuals is referred to, they come together and say, you know, what do we need to do to help this individual be successful at home? Based on our own viewpoint, get that all on paper, make sure they are in harmony together, and then we meet with the family to say, Does this sound right? Does this kind of reflect what we talked about? And this whole interdisciplinary disciplinary plan is based on their goals and objectives. So when they come to see us here, at PACE, we’re going to say, “What, Mr. Jones, what is your goal?” What’s really important to you, because for us, as medical professionals, what might be important to us, and what might be important to Mr. Jones are oftentimes two different things. So we want to marry those together and make sure that we are truly meeting his needs. And then we go on to the next. So the blessing of PACE that whatever our participants needs are specifically, we can meet them there. But we can also grow as their needs change. And so we’re constantly assessing, you know, what are the needs? How are we serving them? Are we meeting their needs, it’s a collaborative living process. It’s not a defined document, it’s really an assessment that continues throughout their lifespan here at PACE.

Wyatt Beckman 26:45

And I imagine if I were on my own working with a with a family member, trying to replicate, pulling together all that expertise on my own. That’s 10, 20 different appointments that might be traveling all over. And you’re bringing that all together, all under one roof or the one stop shop. I just imagine that that is a burden that’s taken off of a family that maybe before that was trying to navigate those things on their own.

Emilie Rains 27:21

Correct, we have, you know, caregivers that will reach out and say, you know, I’m almost out of vacation for this year. I’ve taken off so much time or, you know, the doctors made these recommendations, but I’m having struggles, piecing it together. And so when folks come to PACE, it is a good it’s that collaboration and the support, not only at the participant, but but their family. You know, my in laws happened to be in this program. And as much as I know about PACE and had been working with seniors for seven years, to have the support of the team to say is what I’m seeing about my mother in law. Is that concerning just to me, a layman, or is that concerning to the team and what can we do to support?

Wyatt Beckman 28:05

We talked about the quality of life improvements that can bring. And when you think about as a family member of someone, I imagined that it can also provide some benefit to that person that was being the caregiver, or even if they weren’t a caregiver, just as the the neighbor, the family member, the loved one, just knowing that there are more people that are behind you or with you to help make sure that your loved ones cared for it. That sounds like a really amazing benefit.

Emilie Rains 28:37

Absolutely, to know, if you’re caring for a loved one, chances are, it’s your first or second time doing that. You know, we don’t take care of a lot of, we don’t have eight grandparents typically, you know, but our team takes care of only seniors all day long, every day, year after year after year. And so if we combined the experience in this in this building, we’re talking hundreds of years of experience taking care of seniors. And so it is just that little relief of knowing we’re in this together. Our families and participants have a 24 hour on call. They can call us anytime. And they’re not talking to somebody in Kansas City or in Chicago, giving them support over the phone. They’re talking to our team, who they know, who’s been in their homes, and it’s just a really great opportunity to take care of folks in their home or age in place safely. As safe as possible we like to say here.

Wyatt Beckman 29:36

Yeah, and I think when we when we’ve had had these conversations and in our podcasts that one one common theme with with rural communities is how much it means to show up in person and to be in person and to be here and be part of the community. You made that example if it’s when you call, it’s not someone far away, in another big city that doesn’t have the context. It’s someone that’s, that’s been here, that’s part of the community that’s been in your home. And that trust, I think, probably supports the care that you provide as well.

Emilie Rains 30:17

Absolutely. So one of the things that we see when folks are new in PACE is they may have, like routine visits the ER or like hospital readmissions, you know, what they’re experiencing a lot of that. And, you know, for us who aren’t medical people, you know, if you’re having a sign or symptom, you maybe could take care of it in the morning, but you’re so worried about it, that you, you know, end up in the ER, or maybe you really do need to be at the ER, because you’re not able to see your doctor often enough. The trust and the longer a person’s in the PACE program, interestingly enough, the data shows that drops off. So you know, when we know we have that that trusted person, we can call on the phone, we can triage the situation, we can have a nurse go out overnight, we can go out there on Christmas Day, whatever, it really helps us stay in the home and community and out of the hospital in the ER. And as we have new and different germs flying around, it’s really great to be able to only be in those environments, if necessary. And so we’re good partner as well to our local ERs and our local hospitals to say, you know, “Are we caring for a person with a with a long term view versus just looking at the next thing?” Yeah.

Wyatt Beckman 31:28

And the, I think, sometimes when we’re when we’re thinking about providing care, or collaborations or partnerships, it can be easy to overlook the importance of trust. But trust is like the foundation upon which a lot of really important stuff happens. And when you have that foundation of trust, be more likely to reach out more likely to share this is how I’m feeling this is what matters to me, this is what I’m dealing with. And the more vulnerable you are and the more willing you are to share that and you know that the person will receive it well, and it will be acted upon, that can help was set up some of those benefits. So mentioned readmission is one of the potential benefits that you’re seeing. What are some of the other things that you see coming out of as a sort of successes and benefits of a PACE program, we talked about quality of life, the sort of burden that you that carry that can go away, but what are some of the other benefits that come with participating?

Emilie Rains 32:30

Absolutely. So PACE and Bluestem PACE specifically is able to assist 97% of the folks in our program, with aging at home through the end of life. And I think that is one of the biggest successes, you know, when somebody enrolls in PACE and they want to live at home as long as possible, when as long as possible is through the end of life. That is that is the ultimate goal. When we have someone passed away at home, we are all celebrating that that was able to happen. Other things we are seeing, you know, our therapy in PACE is done a lot differently than in traditional Medicare where you you know, are seen for a certain amount of visits. After a certain event that happens, we’re able to do our therapy, PT and OT on a much more ongoing basis, our payment structure is set up so that we can, you know, we don’t receive reimbursements for individual events, we are a capitated payment or a flat rate payment structure. So one of the things that we see is that our individuals are able to receive and participate in therapy and then also supervised exercise for a lot longer. So we’re able to, you know, increase mobility, we may have somebody come in in a wheelchair and you know, in a in an appropriate amount of time we’re working with them on walking or maybe walking with an assistive device. So we’re not just maintaining a baseline, but we’re helping individuals become more independent than when they came to us. And so we’re also seeing, you know, hospital readmissions are being very, very low. Also, ER visits being very, very low, but also really taking a look at just single events. You know, we had an individual enrolled in our program, who, you know, had been in the ER about four times the previous month to her enrollment. And that had been happening every month for almost a year she’d had you know, about 40 ER visits. And I know that sounds to you, and I like a lot but she enrolled in our program. It was here almost five years before passing away and had two ER visits. So you know, when you just have access to that care, we’re very preventative and anticipatory so we’re trying to treat situations when they are a minute new and small, so that we can prevent some of the you know, infections and falls and things like that that happen when we don’t get preventative care.

Wyatt Beckman 34:54

Absolutely. Wow, that yeah, that what a great example of some of the successes and there’s, I imagine some of that it is you’re able to, if you’re in the home, you’re having so many frequent conversations, you really have ability to have to be eyes and ears and see and identify and prevent things that you don’t have, if it’s more of the traditional, here’s our care facility, you come in whenever you want to. And sometimes it’s later than we’d want to see you. And then we provide that treatment. And it’s just a different, different approach than what we see in a lot of other care that’s provided.

Emilie Rains 35:33

Absolutely, and that matters so much for individuals in staying in the community, you know, we can identify a urinary tract infection with just a few small things. And typically, they’re not identified until someone’s in the ER, feeling really horrible. And then they’re gonna be in the hospital a few nights. So we can identify that early, keep them at home, keep them comfortable, and really, you know, keep folks as as comfortable as possible, you don’t want something to get out of hand and end up in the ER, you’re usually miserable by the time you get there.

Wyatt Beckman 36:05

That that’s a an amazing benefits for that participant and their family. When we think about our health care system, and the other health care providers, especially in rural communities, if if the ER is responding to something that could have been prevented, it is not able to respond in the same way to something else that maybe is couldn’t have been prevented. And I, I one of my parents is an EMT, head of EMS. Now if the ambulance is over here, it can’t be over there. And if we can prevent the things that can be prevented and save those resources for when it really is that that emergency, then that’s a benefit to the entire healthcare system.

So I want to I want to ask, sort of go into something that we’ve mentioned and talked about in a couple of different ways in it, it makes me think of a song that I really like. And then artists I really like. His name is Colter Wall. He’s actually a Canadian singer, but he’s from the Canadian Great Plains, and a lot of his music touches on the themes and the life we have in places like McPherson and Moundridge and the surrounding communities. He has a song titled “Plain to See Plainsman.” And in the song, it’s this narrator sort of reminiscing on on his home and who he is and his identity. And he’s talking about his travels across the country and all the people he’s met and he’s speaks very highly of the south and the north and the east and the west. But, but the hook or the chorus really shows, you know, what, what he cares for at his core, and who he who he sees himself as. It begins with “let me die in the country that I love the most. I’m a plain-to-see plainsmen,” and the chorus ends with “this plain-to-see plainsmen is longing for home.” And when I when I think about the alternative to what you enable, with a PACE program, I can imagine some folks that could could identify with that if they had to move to somewhere else to receive care, leave their home, weave their community, that that they loved, and that they’ve built up. And there’s a loss that comes with that it might be a great place that you receive care having to move to a home or facility but there’s still a loss of of your home and your identity and, and all that you built. When you think about the rural communities here. And you sort of hear that that line and think about the the sense of, of connection to what what people have. How important is that that dignity, that autonomy and identity, enabling people to maintain that by staying in their community in their home?

Emilie Rains 39:19

I think those things are the most important. And one of the things that those of us who work with, you know, those aging in rural communities need to be acutely aware of and need to be reminded of often is that, you know, it’s that same independent spirit of, you know, being able to pick yourself up yourself up by your bootstraps, raise your family farm for many, many years in all conditions that we need to honor and really put at the forefront because each of us individually, whether it’s remaining at home or you know receiving a certain type of care and really be Being able to have your voice be heard in what you want for yourself is so, so important. And something that as I work with individuals, often acknowledge is maybe being overlooked, I think in the best intentions, you know, by family, by providers by, you know, by friends, it’s so important that the voice of the person receiving care is heard, at whatever level they’re able to make it heard. And those of us caring for seniors should be really, you know, the advocate and facilitator of making sure that voice, that voice is heard, what is the person who is receiving care want, and what’s important to them, because in rural communities, what’s important, may be so different than what’s important in a big city, or to even their neighbor, you know, what we each and individually feel like is important, should be honored. And I want that for myself in the future. And so really just trying to be acutely aware that when we’re caring for people, and when we’re potentially caring for people, really ensuring that their voice, you know, is at the table, and, and really is what matters.

Wyatt Beckman 41:19

And there’s something you if you do that, that inherently recognizes their dignity and their autonomy, and says that, you know, what you care about matters. And we’re going to prioritize that. And you gave some examples earlier that that may look as relatively simple as I love going to the high school basketball games, I have a spot that I sit and it’s on the fourth row on the right, and I want to be able to climb up those stairs and get to my seat, right? And how do we as a care team, combine the different services to maintain that ability as long as possible. But you don’t get to that unless you say what matters to you.

Emilie Rains 42:07

Exactly. You will never know what matters unless we ask the question. And so we remind each other often, you know, maybe we’ve had somebody in our program for two or three years, and things are changing. And maybe we’re like, goodness, it seems like you know, we’re not communicating as well, it’s like, has what matters change, because sometimes it does. And so it’s just reminding each other, you know, that as we’re caring for a person, you know, their needs, thoughts, preferences might change. And it’s really our responsibility to make sure we are aware of that, and really maintaining that and making sure that we’re helping those folks meet their goal, they want to crawl to the fourth row, we’re gonna make sure that we prioritize therapy, and exercise and good nutrition and making sure we’re on medication, they’re on medications that aren’t going to cause dizziness or things like that. So it’s really that, that approach of surrounding a person and helping them reach their goals together.

Wyatt Beckman 43:05

And you talked about how, in doing that you as a care team, and you have to remind yourself to really put that front and center. And it makes me think about, and I think that I would need to do the same to I was in that situation. And part of why I think I have to do that so intentionally is perhaps that our culture in the US more generally, maybe doesn’t do that with our older adults today. I’m wondering, as you’ve worked with, with families with older adults, your reflections on on more broadly, how we see our older adults in our communities, and maybe how that lines up with, with what you’re trying to do with Bluestem PACE? And maybe what what is missing sometimes, and how we approach supporting them?

Emilie Rains 43:59

Yeah, absolutely. I think one of the things that is so important is we see at some point, the role of you know, the parent, who they’ve got us into this world, provided for us raised us up with our values and our, you know, beliefs and maybe even a mission in life or a calling. And we’re really receiving from them wisdom and direction and just all the things we’re kind of looking to our parents, right. And then in our communities at some point in time, there’s like the tipping point of where what I perceive a lot is an in a meeting with a family that has a 93 year old mother and a 68 year old daughter and almost the perception of that role has changed and shifted from the mother to the daughter of saying, “Mom, you need to do this and this would be good for you,” and really the challenge that exists in facilitating a conversation with mother and daughter to really knowledge that even though some support is needed, that that individual the mother is still has the autonomy is it mean, the dignity is maintained so that we’re not taking more control and more independence than needed from those who have come before us, our elders in our communities. So I think that translates from the family dynamic, also to the community dynamic of you know, we have the up and coming generation and, and they’re going to take over and make things better. And I think there’s in the making things better, there is another loss that exists of how things were and how we got to where we are, you know, we wouldn’t be able to make things better if things hadn’t been made better and transitioned and established in these communities for the last 50 years, the last 100 years, the last 150 years. So there’s some level of respecting how we got here. And the folks who, who helped us achieve this, before we transition to this is what’s next in our communities or in our families. And so I really try to look at when we’re meeting with folks, and you can kind of feel that dynamic coming to kind of name the elephant in the room a little bit to say, goodness, mom, when was it that you handed over the reins, you know, and then just have a conversation about, you know, what are the things you know, you that are super important for you still to have the reins on, you know, maybe your need, nobody wants help with a shower, but maybe you acknowledge it’s time for help with the shower, what are the things that you still that you’ve got, that you don’t need any help with, and just to kind of engage those folks in the conversation of like, goodness, I could still do this. And I can still do that. And you know what, you still need to listen to me about this or that, you know, and really help families and communities to say, there’s so much wisdom and knowledge and context and nostalgia related to this generation of individuals that I feel privileged and honored to care for. We’re not those, those are stories that we’re not going to be able to replicate. You know, in the future, we were just yesterday hearing about one of our employees who doesn’t know how to use a rotary telephone, and how out in the day center, they were talking about that. And not only did they get on the rotary telephone, but then we were talking about the party lines, and the country and all those kinds of things. And, you know, all of these things that will be lost some day when we’re no longer talking about the party line, or the rotary phone, or, you know, the fact that our kids now can text when they’re three or four years old, or eight or whatever, you know, back in the day, you know, they walked to school, uphill both ways, you know, and where’s that lost? And so we tried to here at PACE. And then so as we work with families to really honor that, and not allow that to be lost in the process. So really holding our elders up in esteem, as opposed to kind of moving on to the next best thing.

Wyatt Beckman 48:14

When we know that generally. And as as we get older, as we age, there, some things will become harder. And if someone’s able to be eligible for the PACE program, they have a certain level of need. But it’s, it’s being able to say, yes, some things are harder, and there’s some loss here. But that doesn’t mean that we should sort of discredit or not acknowledge and not appreciate all that you still bring to the community, all the that you still bring to the family, all that wisdom that you have. It sounds like the the PACE program, really, that you all have here at Bluestem PACE really tries to center that. And it goes beyond just we have services, healthcare services and services that we can provide. But there’s, as you said, you’re sitting down having these conversations, helping families and loved ones sort of see how how this all comes together and shift maybe how they’re viewing this aging experience together. Have you seen other examples where maybe that like a before and after where that that perspective of aging or perspective on on what life looks like shifts as a result of participating?

Emilie Rains 49:38

Yeah, I think one of the definite things is the definition of Safe at Home. You know, when you’re caring for mom or dad or grandma. We have these ideas for ourselves about what Safe at Home looks like. And oh, it’s time it’s time to do something else. We’re too worried. You know? That’s something else is placement outside of the home, typically. But I think as we think creatively, you know, to speak positively of technology, we have so much technology these days that we can place in a home and that we do place in a home to say, you know, grandma, if staying at home is the most important thing for you. And I’m telling you, when they say, “You’re not here to take me somewhere,” I mean, with tears in their eyes, we’re not going to. No, we’re not going to take you somewhere, we’re going to help you as much as possible stay here, we can kind of educate the family to say, goodness, there’s lots of technology that exists that can help grandma stay at home longer, that we might not even consider without kind of a team saying, what would you think about some cameras in the home? What would you think about some monitors on the doors? What would you think about? So I think, you know, as we think about safety at home, we think about as safe as possible, what is what is the family and the participant willing to accept a safety, if it helps them achieve their goal of saying you’re homeless, you’re not going to take me somewhere, or you know, we’re going to help you stay here as long as possible. And there’s lots of ways that we can help you can help you really do that. So we think it’s a lot of his education of the options that exist in between staying at home aging in place with no help, kind of wild west style and out of home placement.

There’s so many cool services and technology and help that exists. In the meantime, we call it the runway here at PACE, our runway is long. When you join PACE, we’re going to give you as little as the runway as possible, because we want as much of the runway as possible for the future, there’s just so much can be done. So I think it’s education of what’s possible. With families who’ve never done this before. Again, they’re caring for mom or dad for the very first time, or mom or dad or saying, Gosh, I need help. For the first time, I don’t want to even tell anybody that I need help. It’s because we don’t know what exists to help. So it’s our job. And I think the job of other senior care providers to really educate people about what exists. So they know what all the options are. No PACE is the only option in senior care. But we are a option, and we are the best option for some folks. And so we just have to educate about the option. And know and believe in trust that their families and their the participant themselves or other other care providers are going to help educate us about what’s out there to care for Mr. Smith, in the best way for him.

Wyatt Beckman 52:35

And that’s a, I just have that that image of you come into a person’s home. And their perception is it’s either or. I’m either here, or I’m in a off site, or out of home facility or placement. And so it that either or, they fight and there’s a lot of fear and a lot of concern that that they can’t stay in their home. And you’re able to say no, that’s not that’s not what we’re are trying to do. And but that takes education, like you said it, if that’s how we’re viewing that time in life, and that aging process is either or, then that looks and feels very different than what you the option you have with with Bluestem PACE. And you mentioned something earlier about the payment plan and payment plans and reimbursement can get really technical, but in general, what the way the model is set up that allows you to provide whatever level of service is needed. It’s not sort of dependent on we provide certain number, this certain amount of hours, it’s we have the payment for person we provide you whatever you need, we pull all that and it is is that accurate? How is that different than than maybe what, what it would look like with a different approach and not not in that sort of payment approach?

Emilie Rains 54:05

Absolutely. So for most individuals in our program, and right now I can speak of 100% of individuals and Bluestem PACE. Our services covered 100% between Medicare and KanCare. So if a person’s listening, you know and they’re here in Kansas and they have Medicare and KanCare or Medicaid. The state has come so far, the legislature has made so many amazing improvements over the last seven years to where PACE, the PACE program throughout Kansas is paid for 100%. So we are reimbursed by Medicare/Medicaid at a flat rate payment structure, which is different than a doctor’s office. If you go to a doctor’s office and you have a visit and you have bloodwork done, and you also have some imaging, you know they are going to receive three reimbursements for your visit. Here at PACE where we get a monthly reimbursement and then it’s really our responsibility and we’re held accountable to make sure we’re caring for a person, 100% of their medical needs. And so but on the payment side for the individuals, you know, folks that are with Medicare and Medicaid, have no cost for our program, and really get, you know, just 100% access to care at no cost, no premiums, no co pays, no doughnut holes, none of that. So, you know, it’s just a really great option for folks saying, you know, I want to stay where I’m at. And I have, you know, Medicare, Medicare, Medicaid, and that’ll pay for it at 100%. A lot of folks come to us and say, I don’t, I don’t, I don’t know how I would pay for PACE. And we can help educate them in the process and walk them along receiving some entitlements that maybe they haven’t. Again, getting KanCare is very challenging for someone who only has done it once in their life. But we do that often and can really help folks. And so, you know, the state of Kansas has made some major positive movement in supporting PACE at a high level, through making sure folks can access PACE at no cost here, you’re in Kansas.

Wyatt Beckman 56:05

Amazing, and that I just think about the complexity that that often surrounds receiving care and payment and billing and what does my insurance cover what doesn’t cover and just the the, again, the weight that is taken off your shoulders, when when it’s that simple for the participant, and there isn’t that cost attached is a an amazing benefit.

So you started and I want to sort of end with with broadening out. So you started to talk about what the state of Kansas has done. And you all serve six counties here in the region, and you have a specific service area. But I imagine and in all your your years of experience, you’ve thought about what what growth of PACE could look like for for the state and for other rural communities. So, if you had to say, or to imagine what it would take to grow PACE across the state and have something like Bluestem In other parts, what do you think it would take for for us as a state or for those other communities to try and try and do do what you are doing here?

Emilie Rains 57:19

Yes, I think one of the most exciting things is hearing that, that we’re looking at expanding into new service areas here, I think, you know, the thought has been for a lot of years, you know, the service areas we have are the most rural we can go you know, to make bringing folks into a centralized data center makes sense, I think to be successful in PACE moving forward to the even more frontier areas, we would need to consider probably partnering with some local senior centers to provide some of the day center services, which a lot of them are being done already with the PACE program, obviously providing staff to help provide the care that we do in those places, as well as probably looking at some type of mobile units for the providers. So you know, when you think about we serve McPherson, Marion, Harvey Rice, Reno and Saline counties, McPherson’s here in the center, and so we can bring everyone in, everybody’s about 45 minutes away from the center or less, a lot of them are less but you know, in your more more rural spaces and frontier spaces, you know, it would need to be considered to probably bring our clinic, which is our provider, and nurses and things like that more out on the road where they would visit these smaller centers, on certain days, and at certain times. So we would need to create more of a, you know, we need to provide, create more of a network that is not just ancillary services, but also our main services, which are our physicians, our therapists and things like that. And I think you know, the PACE providers here in Kansas, are creative enough and innovative enough and we partner on a deep level, we have a lot of communication meetings, collaborations, we work together on legislation. So I think the providers that exist here can really have the collaboration that it takes to take PACE to more rural spaces. And through kind of outside the box thinking, I think that’s one of the things that PACE does exceptionally well is we think outside of the box, we’re not limited to some of the other rules and regulations, we are highly regulated. I have no concerns about that. But we are given, the, really the freedom to think outside the box and do things that aren’t done other places, and try things you know, and also reinvent ourselves as as the needs happen. I think the COVID 19 pandemic taught us that is that you know, we were doing things one way and within two days, we’d flip them completely inside out, you know, and so if we’ve learned anything over the last three or four years is that we are a lot more agile and resilient than we think and no. And so we just need to really lean into that space as we think about growing PACE in Kansas, it is possible with the right partnerships and the right support at multiple levels.

Wyatt Beckman 1:00:18

Absolutely. And I love that you − I think there is a lot of innovation in our rural communities. And there’s a lot of resources that are there, that, as you said, we we have to think creatively and build on the resources that are there and connect them with with additional resources, and bring the great minds and great organizations like the one you have here to those challenges, and I think we can see a lot of growth, but I’ve I’ve thoroughly enjoyed hearing about Bluestem PACE. It was great to come into your into your space and to hear about the the impact you’re having on people’s lives and and PACE provides a lot of care and services and specific services that mean a lot. But I think that just the overall benefit in terms of quality of life and honoring people’s dignity and allowing them to stay part of their communities. I think that just means the world to to the future, vibrancy of the rural communities that we want to see. And I’m excited that we got to hear about what you’re doing here and I’d love to see how

Emilie Rains 1:01:40

It’s been so great to have you all here and share our PACE with you.

Wyatt Beckman 1:01:44
Thank you.

Voice over 1:01:44

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Health on the Plains Production Team

Wyatt J. Beckman, M.P.H., C.H.E.S., Host

Theresa Freed, M.A., Producer, Editor

Emma Uridge, C.H.E.S., Field Producer, Coordinator

Stewart Cole, Editor, Graphic Designer

About Kansas Health Institute

The Kansas Health Institute supports effective policymaking through nonpartisan research, education and engagement. KHI believes evidence-based information, objective analysis and civil dialogue enable policy leaders to be champions for a healthier Kansas. Established in 1995 with a multiyear grant from the Kansas Health Foundation, KHI is a nonprofit, nonpartisan educational organization based in Topeka.

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