PACE programs and grocery or nutrition support for people aging in place

Introduction

If you or your loved one want to keep living at home instead of moving to a nursing home, food and nutrition are just as important as medications and clinic visits. Getting enough nourishing meals, safely prepared and matched to your health needs, can be challenging when you have mobility limits, chronic conditions, or a fixed income.

Programs of All Inclusive Care for the Elderly, known as PACE programs, are designed to help older adults get comprehensive health care and support while staying in the community. That support can include meals, nutrition counseling, and sometimes meal delivery or help with groceries when your care team decides those services are medically necessary.

This article explains how PACE program food benefits work, how they relate to Medicare PACE meal delivery, and how PACE vs nursing home food and housing compare. It also offers practical steps you and your caregivers can take to ask for help with groceries and nutrition support.

What is a PACE program?

Programs of All Inclusive Care for the Elderly (PACE) are special health plans for adults age 55 and older who need the level of care usually provided in a nursing home but want to keep living in the community.

PACE is a joint Medicare and Medicaid program that:

• Combines all your Medicare and Medicaid services into one coordinated program
• Uses a team of health professionals, called an interdisciplinary team (IDT), to coordinate your care
• Provides services at a PACE center, in your home, and in other settings when needed

According to Medicare, PACE covers all Medicare and Medicaid covered services and anything else your PACE care team decides you need to improve and maintain your health. This list specifically includes meals and nutritional counseling, alongside medical care, home care, and transportation.

To enroll in PACE, you must:

• Be at least 55 years old
• Live in the service area of a PACE organization
• Need a nursing home level of care as certified by your state
• Be able to live safely in the community with help from the PACE program

If you qualify and enroll, PACE becomes your main source of Medicare and Medicaid coverage. The program takes on responsibility for your full set of services, including food and nutrition related care that is part of your health needs.

Why nutrition support matters when you are aging in place

As you age, your nutrition needs change. Older adults often need more protein and certain vitamins and minerals, even while appetite, taste, and energy for cooking may decrease. Health conditions like diabetes, kidney disease, heart disease, and swallowing problems can also make it harder to choose, prepare, and eat safe and balanced meals.

Trusted federal resources for older adults highlight that good nutrition can help you:

• Maintain strength and muscle
• Support immune function
• Reduce risk of chronic disease complications
• Improve energy and mood
• Recover better after illness or hospitalization

For many Medicare and Medicaid beneficiaries, nutrition is also a social and financial issue. Federal agencies point out that nutrition insecurity is one of the most common health related social needs, especially among people with low incomes or complex health conditions.

If you are aging in place, you might struggle with:

• Getting to the grocery store or carrying bags
• Standing in the kitchen long enough to cook
• Opening containers, using knives, or lifting heavy pots
• Affording enough healthy food each month
• Eating safely because of chewing or swallowing problems

PACE programs are designed to recognize these challenges. Because they provide integrated medical and long term services and supports, they are allowed to include meals, nutritional counseling, and related services in your plan of care when those are needed to maintain or improve your health.

How PACE programs support food and nutrition

PACE benefits are not one size fits all. Instead, your interdisciplinary team (IDT) reviews your health, living situation, and daily routines, then builds a plan of care that can include food and nutrition support tailored to you.

In many programs, PACE food benefits can include:

• Meals and snacks at the PACE center
• Help with meal planning and managing special diets
• Nutrition counseling with a dietitian
• Assistance with supplements or medically necessary nutrition support
• Meal delivery or coordination with community meal programs when needed

Exactly what you receive depends on your medical needs and what your PACE team recommends, not on a fixed “meal benefit” amount.

Meals at the PACE center

PACE centers usually offer adult day services that combine medical care, social activities, and meals. Federal Medicaid guidance and national summaries of PACE benefits list meals and nutritional counseling among the standard services available to enrollees.

The Centers for Medicare & Medicaid Services (CMS) PACE manual requires PACE organizations to ensure that each participant receives nourishing, palatable, well balanced meals that meet daily nutritional and medical needs. Meals must:

• Be prepared by qualified food service staff
• Conserve nutritional value, flavor, and appearance
• Be prepared in a form designed to meet individual needs
• Be served at safe, appropriate temperatures

This means that if you attend a PACE center, the food you receive there should meet basic nutrition and safety standards and can often be adapted to your health conditions and preferences.

Home meals, groceries, and Medicare PACE meal delivery

In Medicare in general, ongoing meal delivery is usually not a standard benefit. However, PACE is different because it combines Medicare and Medicaid and is required to provide any medically necessary service, including meals, when your care team decides it is needed for your health.

That can include:

• Providing meals at the day center on days you attend
• Arranging meal delivery to your home when you cannot safely cook or shop
• Coordinating with local home delivered meal programs funded by the Older Americans Act or other agencies
• Building grocery and meal help into your personal care and home care services

PACE organizations must make sure that the amount, duration, and scope of services are participant specific and described in your plan of care. Food and nutrition supports, including meal delivery, can be part of that plan when they are needed to maintain or improve your health.

It is important to know:

• There is no single nationwide rule that every PACE enrollee automatically receives daily meal delivery.
• Instead, your eligibility for Medicare PACE meal delivery depends on your health needs, safety at home, and what your interdisciplinary team prescribes.
• Some participants may receive regular home delivered meals, while others may primarily receive meals at the PACE center plus help with grocery access and cooking.

If you are struggling with getting or preparing food, telling your PACE team clearly about the problem is essential. They cannot add meal delivery or grocery support to your plan unless they know it is an issue.

Nutrition counseling and medical nutrition therapy

Nutrition is more than calories. Many older adults have conditions such as diabetes, kidney disease, heart failure, or swallowing problems that require specific diets or texture modified foods. National guidance on PACE benefits lists nutritional counseling as a standard covered service.

In practice, this often means that:

• A registered dietitian or nutrition professional assesses your nutritional status
• You receive counseling on what and how to eat for your conditions
• Your diet is coordinated with your medications, physical activity, and other treatments

Federal resources for older adults emphasize the importance of choosing nutrient dense foods, watching portion sizes, getting enough fluids, and adjusting meals for dental or swallowing issues.

Your PACE dietitian can translate those general recommendations into a plan that fits your kitchen, your budget, and your cultural food preferences.

Special diets and advanced nutrition support

Some participants need more intensive nutrition support. CMS regulations and guidance require PACE organizations to:

• Provide substitute foods or nutrition supplements if you refuse or cannot tolerate regular meals, or if you are not consuming enough calories and nutrients
• Provide nutrition support such as tube feedings or parenteral nutrition when indicated by your medical condition

This is especially important if you are recovering from surgery, dealing with advanced illness, or have severe swallowing problems. PACE is responsible for coordinating these services, whether they are delivered at the center, in your home, or in another care setting.

PACE program food benefits compared with nursing home food and housing

Many families ask how PACE vs nursing home food and housing compare, especially when they are deciding between staying in the community and moving to a facility.

PACE vs nursing home food and housing

In a PACE program:

• You continue living in your own home or with family.
• Housing costs (rent or mortgage, utilities) remain your responsibility.
• PACE covers medically necessary services, including meals at the PACE center and other food related support that your team includes in your plan of care, such as nutritional counseling and sometimes home delivered meals.
• You may also be connected with community nutrition programs for older adults, such as congregate meals and home delivered meals funded under the Older Americans Act.

In a nursing home:

• You live in the facility, and room and board (including meals) are typically included in the daily rate.
• Meals are provided on site, often in a dining room, with menus and diets managed by facility staff.
• You have less responsibility for shopping, cooking, and kitchen safety, but you also have less control over your schedule and environment.

PACE is designed for people who can still live safely in the community with support. Nursing homes are designed for people who need 24 hour supervision, more intensive help with daily activities, or skilled nursing that cannot realistically be provided at home.

From a “food and housing” perspective, the key difference is that PACE wraps services, including food support, around your existing home, while nursing homes bundle food and housing together inside the facility. PACE program food benefits are meant to keep you well enough to stay at home whenever safely possible.

Who qualifies for PACE and its nutrition benefits?

If you qualify for PACE, you qualify for its food related benefits as well, because those are part of the overall PACE package.

You may be eligible to enroll in PACE if you:

• Are at least 55 years old
• Live in the service area of a PACE organization
• Need a nursing home level of care, as defined by your state
• Can live safely in the community with the help of PACE services

Costs depend on your coverage:

• If you have Medicaid, you typically pay no monthly premium for the long term care portion of the PACE benefit.
• If you have Medicare only, you may pay a monthly premium for the long term care portion and for prescription drug coverage.
• There are no deductibles or copayments for any care or service that your PACE team approves, including meals and nutrition services that are part of your plan.

There is no separate application for PACE program food benefits. Instead, once you are enrolled, your food and nutrition needs should be evaluated and addressed through your interdisciplinary team and plan of care.

How to talk with your PACE team about grocery and meal support

If you are enrolled in a PACE program and worried about food, it is important to say so clearly. Your team cannot adjust your services if they do not know what is happening at home.

Consider sharing if you:

• Have skipped meals to save money or because you are too tired to cook
• Have lost or gained weight without trying
• Have trouble chewing, swallowing, or using utensils
• Feel unsteady in the kitchen or worry about falls when cooking
• Rely on snacks or takeout instead of balanced meals
• Struggle to get to the grocery store or carry groceries home

Your PACE team can consider:

• Adding meals at the PACE center or increasing how often you attend
• Referring you to home delivered meal programs funded under the Older Americans Act, which provide congregate and home delivered nutrition for seniors and focus on reducing hunger and malnutrition
• Including help with meal preparation and grocery tasks in your personal care or home care services
• Connecting you to local food assistance programs highlighted by federal nutrition resources, such as SNAP and senior nutrition programs listed on Nutrition.gov
• Arranging nutrition counseling to help you adapt your meals to chronic conditions

Bringing a caregiver, family member, or Understood Care advocate to your care planning meetings can help you remember details, ask questions, and follow through on next steps.

Working with caregivers and family on meal planning

Caregivers and family members are often the people who see day to day challenges with food and groceries.

You can work together by:

• Making a simple list of meals you enjoy that fit your health needs
• Planning a basic grocery list that covers a few balanced options for breakfast, lunch, dinner, and snacks
• Identifying kitchen tasks that feel unsafe for you, such as lifting heavy pans or using sharp knives, so others can help
• Using frozen vegetables, pre chopped produce, canned beans with reduced sodium, and other convenient options to shorten prep time
• Keeping nutrient dense snacks available if you tire easily during meals

Federal nutrition resources for older adults emphasize that small changes, such as choosing more nutrient dense foods and managing portion sizes, can add up to better health and energy.

Ask your PACE dietitian or nurse to help turn these ideas into a written plan that fits your budget and local food options.

Frequently asked questions about PACE program food benefits and Medicare PACE meal delivery

• What are typical PACE program food benefits?
  Most PACE programs provide meals and snacks at the PACE center on days you attend, along with access to nutritional counseling. Your interdisciplinary team can also add services such as home delivered meals, help with grocery shopping, or meal preparation support when these are medically necessary for your health and safety.
• How is PACE program food support different from nursing home food and housing?
  In a PACE program you continue living at home, and food support is added around your existing housing. You may receive center based meals, nutrition counseling, and possibly meal delivery based on your care plan. In a nursing home, room and board are part of the facility stay, and meals are provided on site as part of the daily rate. PACE is designed for people who can remain safely in the community with support, while nursing homes are for people who need 24 hour facility based care.
• Does Medicare PACE meal delivery mean everyone gets free meals at home?
  Not necessarily. PACE programs must cover meals and other services that your team decides are medically necessary, but there is no rule that every participant receives home delivered meals every day. Some enrollees may receive meal delivery for a period of time after an illness or hospitalization, while others may get most of their meals at the PACE center and use community programs or family support for groceries at home.
• Can PACE help pay for groceries as well as cooked meals?
  PACE benefits are based on medical necessity, not general income support, so your team focuses on whether lack of food or safe cooking is harming your health. When food access is a health related need, they can use services such as meals, nutritional counseling, home care assistance, and referrals to community nutrition programs to help. They may also connect you to programs like SNAP and Older Americans Act nutrition services that assist with food costs or provide free or low cost meals.
• How do PACE program food benefits work with community senior meal programs?
  Many communities offer congregate and home delivered meals funded under the Older Americans Act, as well as other senior nutrition services. Federal agencies describe these programs as ways to reduce hunger, food insecurity, and malnutrition while also promoting socialization. PACE teams can help you apply for and coordinate these services so they complement your medical care and PACE services.
• What should I tell my PACE team if I am losing weight or skipping meals?
  Tell them exactly what is happening: how many meals you miss, whether you feel too tired or short of breath to cook, whether you run out of food before the end of the month, or whether you have pain or difficulty chewing or swallowing. This information helps your team decide if you need meal delivery, more frequent meals at the center, nutrition counseling, or referrals to other food support programs.

References

• Medicare. PACE (Program of All Inclusive Care for the Elderly). Available at: https://www.medicare.gov/health-drug-plans/health-plans/your-coverage-options/other-medicare-health-plans/PACE Medicare
• Medicare. Quick Facts: Program of All Inclusive Care for the Elderly (PACE). Available at: https://www.medicare.gov/publications/11341-quick-facts-program-of-all-inclusive-care-for-the-elderly-pace.pdf Medicare
• Medicaid.gov. Programs of All Inclusive Care for the Elderly (PACE) Benefits. Available at: https://www.medicaid.gov/medicaid/long-term-services-supports/pace/programs-all-inclusive-care-elderly-benefits Medicaid
• Centers for Medicare & Medicaid Services (CMS). PACE Manual, Chapter 6: Services (including meal requirements). Available at: https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/pace111c06.pdf CMS
• Medicaid and CHIP Payment and Access Commission (MACPAC). Understanding the Program of All Inclusive Care for the Elderly. Available at: https://www.macpac.gov/publication/understanding-the-program-of-all-inclusive-care-for-the-elderly/ MACPAC
• Nutrition.gov. Older Adults. U.S. Department of Agriculture. Available at: https://www.nutrition.gov/topics/nutrition-life-stage/older-adults Nutrition.gov
• Nutrition.gov. Nutrition Programs for Seniors. U.S. Department of Agriculture. Available at: https://www.nutrition.gov/topics/food-security-and-access/food-assistance-programs/nutrition-programs-seniors Nutrition.gov
• Administration for Community Living (ACL). Nutrition Services. Available at: https://acl.gov/programs/health-wellness/nutrition-services ACL Administration for Community Living
• Administration for Community Living (ACL). Nutrition Requirements of the Older Americans Act (OAA). Available at: https://acl.gov/sites/default/files/nutrition/NutritionRequirementsOAA.pdf ACL Administration for Community Living
• Center for Health Care Strategies. Medicaid Nutrition Supports: Implementation Innovations. Available at: https://www.chcs.org/resource/medicaid-nutrition-supports-implementation-innovations/ CHCS

This information is for general education and does not replace medical advice from your own clinicians or care team. If you are considering PACE or have questions about PACE program food benefits, talk directly with your local PACE organization or a trusted advocate.