activities · 11
what they do
direct service · 11
- In-Home Care Services for SeniorsDelivers in-home care including personal care (bathing, meal prep, light cleaning), medication management, and monitoring of medical conditions by trained professionals to support safe independent living for seniors enrolled in PACE.
- Medical and Non-Medical Transportation Non-Emergent Medical Appointment TransportationProvides door-to-door transportation for seniors to medical appointments, day centers, and off-site medical services, including morning pickup and afternoon return home, ensuring access to care and social programs.
- Nutrition and Meal Support Congregate Meals for SeniorsProvides nutritious meals through daily three-course lunches at day centers and supports grocery shopping and food access via home care staff for enrolled seniors.
- Operate PACE (Program of All-Inclusive Care for the Elderly) program PACE Comprehensive Elder CareProvides a comprehensive managed healthcare model for low-income seniors, integrating primary and specialty medical care, prescription drug management, physical and occupational therapy, home care, hospice, social services, nutritious meals, and transportation to medical appointments and social activities. The program is delivered through an interdisciplinary team approach and includes 24/7 emergency nursing support.
- PACE Managed Healthcare Program for Seniors PACE Comprehensive Elder CareProvides a comprehensive managed healthcare program for low-income seniors through the Program of All-Inclusive Care for the Elderly (PACE), delivering integrated primary medical care, specialty services, prescription drug management, therapies, dental care, hospice, and social services. Services are delivered via an interdisciplinary team and include 24/7 nursing support for emergencies.
- Physical and Occupational Therapy Services Home-Based Rehabilitation TherapyProvides physical and occupational therapy services to help seniors regain strength, maintain mobility, and support independence, delivered either on-site or through referral networks.
- Senior Day Center Services Resident-Led Social & Recreational ProgrammingOperates day centers that provide social engagement, live entertainment, cognitive and physical activities, and a three-course lunch daily to promote well-being and independence among senior participants.
- Social Work and Case ManagementOffers access to trained social workers who assist seniors with navigating personal challenges, completing paperwork, locating resources, and coordinating care through regular interdisciplinary team meetings.
- Social and Recreational Outings Resident-Led Social & Recreational ProgrammingOrganizes and facilitates social outings for seniors, including trips to the beach, Balboa Park, and other local attractions, to promote engagement and quality of life.
- Specialty and Hospital Care Coordination Healthcare Provider Network CoordinationContracts with hospitals (Scripps, Sharp) and specialty providers to ensure PACE participants receive necessary hospital and specialty care, coordinating transportation and escorts when needed.
- Telehealth and 24/7 Medical Support Telehealth Consultations & Virtual CareOffers virtual telehealth appointments for immunocompromised participants and maintains 24/7 nursing support for medical emergencies year-round to ensure continuous care access.
strategies · 16
how they think
Theories of action extracted from this org's own source material. Click any to see the full field of orgs running the same approach.
- Advocacy and Care Coordination for Participants patient_advocacy_modelActs as a healthcare advocate for seniors by centrally coordinating all aspects of care through an integrated team, ensuring seamless access and reducing burden on participants and families.
- Aging in Place with Independence-Preserving Home Care aging_in_placeSupports seniors in remaining at home through personalized, home-based assessments and care planning, viewing home care as essential to maintaining independence and improving quality of life for older adults with chronic conditions.
- Assisted Transportation with Senior-Specific Safety Design door-to-door_transportation_with_assistanceProvides door-to-door, assisted transportation using wheelchair-accessible vehicles and drivers specially trained to meet the unique needs of older adults, ensuring safe and reliable access to care centers.
- Geriatric Specialty Care Integration geriatric_specialty_careCenters care delivery on geriatric medicine specialists to provide targeted, age-specific medical treatment for older adults with chronic conditions, ensuring clinical expertise informs all aspects of care.
- Geriatric Specialty Care with Targeted Eligibility geriatric_specialty_careFocuses on seniors aged 55+ with chronic conditions using a geriatric medicine–centered model and a comprehensive eligibility framework based on age, geography, safety, and state-determined care needs to ensure appropriate enrollment in PACE services.
- Integrated Care Network and Service Delivery integrated_care_networkOperationalizes a closed network of PACE-provided or authorized providers to deliver seamless, coordinated healthcare and supportive services, enhancing continuity and reducing fragmentation.
- Integrated and Holistic Care Delivery integrated_care_modelOperates a closed network of PACE-provided or authorized providers to deliver integrated medical, therapeutic, social, and support services in one location, while taking a whole-person approach that addresses medical, emotional, and social dimensions of senior health.
- Interdisciplinary Team-Based Care Model interdisciplinary_care_modelProvides person-centered, coordinated care through an interdisciplinary team led by geriatric specialists, integrating medical, social, and therapeutic services with regular team-based care planning to support the overall well-being of seniors.
- Interdisciplinary Team-Based Care Model interdisciplinary_care_modelDelivers person-centered, comprehensive care through a coordinated team of geriatric specialists and professionals who collaboratively assess, plan, and manage medical, social, and therapeutic needs to support overall well-being.
- PACE Program Model for All-Inclusive Eldercare Program of All-inclusive Care for the Elderly (PACE)Delivers comprehensive, all-inclusive care through the Program of All-inclusive Care for the Elderly (PACE), integrating medical care, social services, nutrition, transportation, and home care to enable low-income seniors with chronic conditions to remain safely in their homes.
- PACE Program Model for Elder Care PACE_program_modelProvides all-inclusive care through a coordinated model that integrates medical care, social services, nutrition, transportation, and home care to enable low-income seniors to remain safely in their homes, using the Program of All-inclusive Care for the Elderly (PACE) as the foundational service model.
- Patient Advocacy Through Coordinated Care patient_advocacy_modelActs as a healthcare advocate for participants by coordinating all aspects of medical and supportive services through an integrated team, ensuring seamless and personalized care delivery.
- Person-Centered, Independence-Preserving Home Care person-centered_home_careSupports seniors’ ability to live independently at home through personalized care planning, in-home assessments, and tailored services that prioritize autonomy and quality of life.
- Specialized Transportation with Senior-Responsive Support door-to-door_transportation_with_assistanceProvides door-to-door, assisted transportation using wheelchair-accessible vehicles and drivers specially trained to meet the physical and emotional needs of older adults, improving access and safety.
- Targeted Enrollment Based on Clinical and Social Vulnerability PACE_eligibility_modelUses a comprehensive eligibility model focused on seniors aged 55+ with chronic conditions, living in the community, and requiring state-determined levels of care to ensure services reach those most at risk of institutionalization.
- Whole-Person Holistic Care Approach whole-person_careAddresses medical, social, and emotional dimensions of health simultaneously to support comprehensive well-being, recognizing that aging involves interconnected needs beyond clinical treatment.
named programs · 9
what they call their work
Adult (Senior) Day Care Services
Social and recreational activities provided at wellness centers to support mental and emotional well-being, available during medical visits or as standalone participation.
Home Care
In-home support with activities of daily living such as bathing, meal preparation, medication management, and light cleaning, provided by trained nursing staff.
PACE Day Center
Adult day center services at wellness centers offering socialization, nutritious meals, recreational activities, and live entertainment for enrolled seniors during medical visits or for social engagement.
PACE In-Home Care
Home-based support for activities of daily living including bathing, meal preparation, medication management, and light cleaning provided by trained nursing staff.
PACE Medical Care
Comprehensive medical services including primary and specialty care, prescription management, lab and imaging, and hospitalization coordinated through an interdisciplinary team specializing in geriatric care.
PACE Program
Comprehensive medical and social services for seniors aged 55+ to enable them to remain living independently in the community rather than in a nursing facility. Includes primary and specialty care, transportation, home care, adult day care, and prescription drug coverage.
PACE Transportation
Door-to-door transportation from home to medical centers and appointments, including escorts for off-site services and social outings to local attractions like Balboa Park and the beach.
Specialty Medical Care
Access to audiologists, dentists, optometrists, podiatrists, and psychologists through PACE-contracted providers, coordinated by the primary care team.
Transportation Services
Door-to-door transportation to medical appointments and social outings, including assistance at the door and wheelchair-accessible vehicles.
relationships · 11
who they work with
- California Department of Health Care Services Government — Determines level of care eligibility for St. Paul's PACE participants.
- Medi-Cal Government — Primary payer for services; St. Paul's PACE coordinates coverage for participants with Medi-Cal or Medi-Cal and Medicare.
- Medi-Cal Government — Primary public insurance program used to cover services for participants.
- Medicare Government — Federal health insurance program used in combination with Medi-Cal to cover participant services.
- Medicare Government — Primary payer for services; St. Paul's PACE coordinates coverage for participants with Medicare or Medicare and Medi-Cal.
- Scripps Partner — Contracted provider for specialty and hospital care services.
- Sharp hospitals Partner — Contracted provider for specialty and hospital care services.
- St. Paul's PACE Partner — Operates senior day centers and wellness centers in San Diego in partnership with Community Eldercare of San Diego.
- St. Paul's PACE Partner — Operating entity for COMMUNITY ELDERCARE OF SAN DIEGO's PACE program in San Diego
- St. Paul's PACE San Diego Partner — Provides transportation services in partnership with COMMUNITY ELDERCARE OF SAN DIEGO as part of the PACE program.
- St. Paul’s PACE Partner — Provides in-home care services in partnership with COMMUNITY ELDERCARE OF SAN DIEGO.