By Miami Senior Advisor Care Team · September 15, 2026
“She needs a nursing home” is not always the end of the conversation
The sentence usually arrives from a hospital discharge planner or a primary care physician, and it lands the same way every time. A mother in Westchester has had her third fall in four months. A father in Plantation has congestive heart failure, diabetes, early dementia, nine medications he manages imperfectly, and four specialists who have never spoken to one another. Someone in a white coat says the words nursing home, and the family starts touring buildings.
What almost nobody says in that conversation is that meeting the clinical standard for nursing home care is not the same thing as having to enter one. Florida operates a program specifically for people who clear that bar but would rather stay in their own home — and that would rather not spend down a lifetime of savings to a facility. It is called PACE, and in more than two decades of operation in South Florida it remains one of the least-known options in senior care.
This guide explains what PACE actually is, who qualifies, what it pays for, what it costs, the tradeoff that makes it wrong for some families, and how to start the process in Miami-Dade, Broward, or Palm Beach. It is worth reading even if you ultimately choose something else, because understanding PACE clarifies every other option on the table.
What PACE is, in plain language
PACE stands for Program of All-Inclusive Care for the Elderly. It is a permanent program under both Medicare and Medicaid, and Florida has operated PACE organizations for years under the oversight of the Agency for Health Care Administration and the Department of Elder Affairs.
Here is the structural idea, and it is genuinely different from anything else in senior care. In the ordinary system, a frail older adult has an insurer over here, a primary care doctor over there, three specialists elsewhere, a pharmacy, a home health agency that visits twice a week, a Medicaid long-term care plan, a daughter who drives to appointments, and no single person who sees the whole picture. Care is fragmented by design, and the family becomes the integration layer.
PACE collapses all of that into one organization. The PACE program is simultaneously the insurance plan and the care provider. An interdisciplinary team — typically a physician, nurse, social worker, physical and occupational therapists, dietitian, recreational therapist, home care coordinator, personal care aides, and drivers — assesses the participant, builds a single care plan, and then actually delivers it. The same team that decides your father needs three home visits a week is the team that shows up. There is no prior authorization argument with a distant insurer, because the insurer is sitting at the table.
Most PACE models are anchored to a PACE center, which functions as a combined adult day health center and outpatient clinic. Participants attend on a schedule set by their care plan — for some that is several days a week, for others much less — and the center is where primary care, therapy, meals, socialization, and monitoring happen. Transportation to and from is part of the program. If you have been researching adult day care programs in Miami-Dade and Broward, think of a PACE center as that model with a full medical practice and a long-term care benefit attached.
Who qualifies: the four tests
PACE eligibility is narrower than most families expect, and all four conditions must be satisfied.
- Age 55 or older. This is federal and it is firm. PACE is one of the few senior programs that does not wait for 65.
- Living in the PACE organization’s approved service area. This is the requirement that quietly disqualifies the most people. Service areas are defined by ZIP code, they are not coterminous with county lines, and they change as programs expand. Never assume coverage from the county name alone — confirm the specific address.
- Certified as needing a nursing home level of care. In Florida this determination is made independently by the Department of Elder Affairs CARES program — Comprehensive Assessment and Review for Long-Term Care Services. CARES staff conduct their own assessment; the PACE organization does not self-certify, and neither does your physician.
- Able to live safely in the community with the services PACE provides.
Those last two read like a contradiction, and understanding why they are not is the key to understanding the program. PACE exists for the person who is clinically sick enough to justify institutional care but whose barriers to staying home are practical and solvable: nobody to manage nine medications, no way to get to dialysis, no one to notice the weight loss, no help with bathing, no eyes on the house between family visits. Supply that scaffolding and the person is safe at home. Withdraw it and they are not. PACE is the scaffolding.
Note also what is not on the list. A dementia diagnosis is not by itself a qualifier, nor a disqualifier. What matters is the level-of-care finding and the safety judgment, which is why a family in the early stages of cognitive decline should read our comparison of memory care versus assisted living in Florida alongside this one — those are different questions with different answers.
What PACE covers
The honest short answer is: essentially everything, provided the interdisciplinary team authorizes it. PACE is required to furnish all Medicare-covered services and all Medicaid-covered services, and it may furnish additional services the team determines are necessary. In practice South Florida participants receive:
- Primary medical and nursing care from the PACE physician and clinical team
- Specialist care, hospitalization, and emergency services
- Prescription drugs, without the separate Part D plan and its coverage gaps
- Physical, occupational, and speech therapy
- Laboratory work, imaging, and diagnostics
- Durable medical equipment — walkers, wheelchairs, hospital beds, oxygen
- Skilled home health and personal care aides in the home
- Adult day health center attendance, meals, and nutritional counseling
- Transportation to the center and to medical appointments
- Social work, caregiver support, and home safety modifications where indicated
- Skilled nursing facility care if it eventually becomes necessary — the program does not discharge a participant for needing more
- End-of-life and palliative care
That last pair deserves emphasis. PACE is designed to follow a person through decline rather than hand them off at each stage. If a participant does eventually require permanent nursing home placement, PACE arranges and pays for it and the team stays involved. Families who have been through a Medicare skilled-nursing benefit expiring at day 100 understand exactly how unusual that is. Our explainer on what Medicare does and does not pay for covers the gap PACE is filling here.
What PACE does not cover is anything the team has not authorized, and any care obtained outside the network other than genuine emergency care. That is not a loophole; it is the design, and it leads directly to the tradeoff.
The tradeoff: you give up choice of doctor
Every family evaluating PACE should sit with this paragraph before anything else.
Because PACE is both the payer and the provider, participants generally must use PACE physicians and the PACE contracted network. If your mother has seen the same cardiologist on Kendall Drive for fifteen years, or your father trusts exactly one internist in Hollywood and no other, that continuity usually ends at enrollment unless those physicians happen to contract with the PACE organization. For some families this is an acceptable price for coordinated care that finally works. For others it is disqualifying, and there is no wrong answer — but it should be a decision, not a surprise discovered in month two.
Two related points. First, the day center is central to most PACE models, and seniors vary enormously in how they receive that. A socially isolated widow in Hialeah may find it transformative. A private man in Boca Raton who has never joined anything may experience it as an imposition. Ask how many days per week the care plan would call for, and be candid with the team about what your parent will actually tolerate.
Second, enrollment is voluntary in both directions. A participant may disenroll at any time and for any reason. The practical consequence is that Medicare and Medicaid coverage must then be rebuilt separately, which takes time and coordination, so the exit is real but not frictionless.
What it costs, and how PACE compares to SMMC Long-Term Care
Cost depends almost entirely on Medicaid status. A participant who qualifies for Medicaid, or who is dually eligible for Medicare and Medicaid, generally pays no monthly premium for PACE. A participant who has Medicare but does not qualify for Medicaid pays a monthly private-pay premium covering the share Medicaid would otherwise fund, plus a premium for prescription coverage. Someone with neither may pay privately for the entire program. Critically, inside the program there are no deductibles or copayments for services the team authorizes — no coinsurance surprise after a hospitalization, no drug tier to argue about. Premium amounts change, so confirm current figures directly with the PACE organization serving your address.
Because Medicaid status drives so much of this, most South Florida families researching PACE should be working the Medicaid question in parallel. Start with our guide to Florida SMMC Long-Term Care Medicaid eligibility, and if your parent’s income appears to exceed the limit, read how a qualified income trust works before concluding they do not qualify — that single instrument changes the answer for a great many Florida applicants. If a spouse remains at home, the community spouse protections matter enormously.
The comparison families most need is PACE versus SMMC Long-Term Care, Florida’s managed long-term care program. They are alternatives, not complements: a person cannot be enrolled in both. Under SMMC LTC, a managed care plan arranges long-term care services while the participant keeps ordinary Medicare and their own outside physicians. Under PACE, one organization replaces both programs and delivers everything itself. SMMC LTC reaches all of Florida and preserves doctor choice; PACE is deeper and better integrated but exists only in specific service areas, and Florida authorizes a limited number of PACE enrollment slots, so availability is finite. If your family has already been navigating the SMMC LTC waitlist and enrollment process, it is worth asking whether a PACE slot in your ZIP code is the faster path.
PACE in South Florida, and how to start
Miami-Dade and parts of Broward are served by Florida PACE Centers, affiliated with Miami Jewish Health — the oldest and most established PACE organization in the state, with a service footprint that includes communities from Aventura and Miami Beach south through Coral Gables and Homestead, and reaching into southeastern Broward around Hallandale Beach, Hollywood, and Dania Beach. Palm Beach County and the Treasure Coast are served by Palm Beach PACE, operated by MorseLife Health System in West Palm Beach, which also covers Martin, St. Lucie, and Okeechobee counties. Northern and western Broward coverage is the area most worth verifying directly rather than assuming, since that is where service-area boundaries have historically been drawn tightest.
The practical first step for most families is a call to the Florida Elder Helpline at 1-800-96-ELDER (1-800-963-5337), which routes to your regional Aging and Disability Resource Center — the Alliance for Aging for Miami-Dade and Monroe, the ADRC of Broward County, and the Area Agency on Aging of Palm Beach and the Treasure Coast. They can confirm whether your address falls inside a PACE service area and start the referral. You can also contact a PACE organization directly; they will screen eligibility and, if it looks promising, initiate the CARES level-of-care assessment.
Three pieces of preparation make that call go faster. Have a current medication list with doses. Have a short factual summary of the last twelve months — hospitalizations, falls, ER visits, diagnoses, and what specifically is unsafe at home right now. And have a clear picture of income and assets, because the Medicaid question will come up immediately. If a hospital discharge is what set this in motion, our guide to getting a South Florida discharge right covers the clock you are working against.
Be realistic about timing. Between the service-area check, the CARES assessment, the Medicaid determination if one is needed, and slot availability, PACE enrollment is a matter of weeks rather than days. It is a strong option for a family planning ahead and a difficult one for a family that must move a parent by Friday.
When PACE is not the answer
PACE is a genuinely good program, and it is wrong for plenty of families. It is wrong when the address falls outside the service area, which is simply arithmetic. It is wrong when the person cannot be kept safe at home even with substantial support — nighttime wandering, exit-seeking, and aggression in advanced dementia frequently point toward a secured setting regardless of how good the day program is. It is wrong when preserving a decades-long relationship with a particular physician matters more to your family than integration. And it is wrong when there is no home to stay in, or when the housing itself is the problem.
In those cases the honest comparison is between the other options, not between them and PACE. Our side-by-side on in-home care versus assisted living in South Florida is the right starting point for someone who needs support but not a facility, and assisted living versus skilled nursing in Florida is the one to read when the level-of-care question is genuinely open. If the person you are caring for is refusing all of it, that is a common and separate problem, and our guide on a parent who refuses assisted living addresses it directly.
If you want help sorting out which of these fits, that is what we do. Our advisors work across Miami, Fort Lauderdale, Boca Raton, and West Palm Beach, and across every level of care from in-home care and assisted living to skilled nursing. Our service is free to families — we are paid by provider partners only when a placement is made, never by you. State and county contacts are collected on our Florida resources page, and you can tell us about your situation here. Hablamos español.