What is a Care Plan?

The Care Plan is a document which contains the IDT's (Interdisciplinary Team’s) recommendations of how to care for you to ensure you are completely safe and comfortable at home with maximum independence, because isn’t that what we all want? The care plan is developed after your first medical assessment, and will include some of the following services:

• Number of home care hours per week
• Home care including but not limited to laundry, light cleaning, bathing or shopping.
• The number of physical or occupational therapy visits per week
• How often we recommend you come in to the PACE center each week
• Which days we recommend you visit PACE each week

It will list any specialist appointments we will be providing such as eye doctor, podiatry, psychologist….even treatments for unique situations.

Your care plan will be presented to you by your social worker after you have been assessed by our Interdisciplinary Team and approved by the State. You are encouraged to discuss your care plan with the social worker if minor adjustments to your care plan are desired. For example, should you prefer different days of the week, we can adjust these things. Care plans are constantly updated and changed to include more or less services as your medical condition changes. You will be assessed regularly to ensure we are providing the care you need.

What if it is my visit day but I don’t want to come in?

If you choose not to come in, please call the PACE center at 619.677.3800, Monday – Friday 8:00 am – 4:30 pm TTY: 1.800.735.2922 (hearing impaired) OR 619.677.3800 after 4:30 pm and leave a message with the answer service. If you have a specialist appointment set for the day in question, please consider how important your specialist appointments are before cancelling. We want to keep you in the best health possible.

What if I am not feeling well?

If you are not feeling well, just call us at 619.677.3800 or TTY: 1.800.735.2922 (hearing impaired). If you are calling during regular business hours (8:00 am to 4:30 pm), you will be transferred to our clinic staff who will assist you. If it is after hours – even the middle of the night or weekends call the same number: 619.677.3800, TTY: 1.800.735.2922 (hearing impaired), Our nursing staff are available 24 hours a day, 7 days a week. And isn’t it nice that you can speak with a nurse who already knows you and has access to your latest medical information 24 hours a day!

My neighbor wants to know more about PACE...

If you enjoy PACE and know a friend or neighbor who may benefit, just let anyone in the day center know and they will have the enrollment staff meet with you to arrange a visit day. We appreciate every referral!

When I had In-Home Supportive Services (IHSS ) I was getting a lot more home care hours...

The care plan may include home care hours, hours at the center, visits to specialists and even shopping and meal preparation. All of these hours are provided to you based on your medical need. While the actual home care hours may be less than IHSS, PACE total hours are often more than that of IHSS, because we do so much more for you. The care plan will include services to ensure you are safe and happy at home. If you do not agree with your care plan, please discuss this with your social worker. We want to provide you with a mutually satisfactory care plan that keeps you safe and comfortable at home. Here at PACE, we are concerned for your overall health and ability to function in the community.

What if I have a Share of Cost with Medi-Cal

If you have a Medi-Cal SHARE OF COST, you will receive a monthly invoice from St. Paul’s PACE. If our Social worker has met with you and has determined that you are not able to pay your monthly share of cost due to personal budget constraints, please remember that we will still be sending you a monthly invoice. This is a Medi-Cal requirement.