Advancing Behavioral Health Integration in the Program of All-Inclusive Care for the Elderly (PACE)

TL;DR

This paper introduces a framework to better integrate behavioral health services into elderly care programs, addressing challenges like workforce shortages and funding issues.

Contribution

A novel conceptual framework for integrating behavioral health into PACE programs, supported by nationwide data and practical strategies.

Findings

60% of PACE participants experience behavioral health comorbidities, with depression being the most common.

Workforce shortages and funding limitations are major barriers to behavioral health integration in PACE.

Successful strategies include telemedicine, interdisciplinary teams, and external partnerships.

Abstract

Older adults enrolled in the Program of All-Inclusive Care for the Elderly (PACE) face significant barriers to accessing behavioral health (BH) services despite high rates of BH comorbidities (60%). Integrating BH into PACE programs is critical to achieving truly comprehensive, person-centered care. This poster introduces a conceptual framework for Behavioral Health Integration in PACE (BHI-PACE) and presents current BH practices and challenges within PACE Organizations (POs) from a nationwide assessment. A mixed-methods sequential explanatory approach was used to assess BHI across POs. This study employed (1) a national survey distributed to 148 POs (38 responses, representing 119 PACE sites and 25,806 participants) and (2) semi-structured interviews with 15 POs (representing 58 sites and 10,029 participants). The BHI-PACE framework comprises four domains: (1) Person/Family-Oriented Care, (2) Clinical Functions, (3) Workforce to Support Clinical Functions, and (4) Structures to Support Clinical Functions. Key findings highlight that 60% of PACE participants experience BH comorbidities, with depression (92.1%), behavioral and psychological symptoms of dementia (57.9%), and anxiety disorders (55.3%) as the most common referral reasons. Workforce shortages, insufficient funding structures, and limited integration of BH specialists into POs were identified as primary barriers. However, successful integration strategies include the use of telemedicine, interdisciplinary team collaboration, and formalized external partnerships. This work contributes to both theory and practice by presenting a replicable framework for BH integration in complex care settings for older adults. It informs future policy initiatives, workforce development strategies, and implementation research aimed at improving BH outcomes in aging populations.