A group of former hospice and home health leaders have gone all-in on Programs for All-Inclusive Care of the Elderly (PACE) with the launch of an emerging company.

New Jersey-headquartered BoldAge PACE is owned and operated by former Seasons Hospice and Palliative Care CEO Todd Stern, also a former AccentCare executive, and Dan Czermak, founder of Acute Health Systems and Beacon of Life. The company’s chief growth officer, Russell Hilliard, also came over from AccentCare, whereas CEO Mary Austin has worked in the PACE, long term care and geriatrics space since 1986.

The company currently operates four PACE centers located in the Northwest and the Midwest, with two more slated to open before the end of the year. Ultimately, BoldAge PACE plans to build a national footprint.

Hospice News spoke with Hilliard about BoldAge’s PACE model, its plans for growth and how its executives’ experience in hospice, home health and palliative care will inform the company’s development.

Why is PACE an attractive model for home health and hospice companies?

There are a lot of similarities. If you look at where hospice was in the 80s, it feels like that’s kind of where PACE was a few years ago, and it is expanding quite rapidly. Now I would say that PACE is more where hospice was in the 90s. So people are still generally unaware of what PACE is, although it’s expanding. It’s now available in 34 states.

So lots and lots of community education is taking place by the National PACE Association and all PACE providers nationwide at the community level. And then also at the legislative level, our legislators are still trying to understand what PACE is and the value proposition for it. It is a cost savings for the states and for the federal government, and it aligns exactly where older adults want to be. Most older adults want to be at home for as long as possible, if not until the very end of their lives. That’s exactly what PACE aims to do.

Some of BoldAge’s leaders, including yourself, have a background in home health and hospice. Can you elaborate on that?

I think the reason there are so many hospice executives working in PACE, and particularly at BoldAge PACE, is because the story is very similar not only in the community education needs, but also in the building of systems. So I’ve been in hospice for 30 years, and when I started, systems were not very sophisticated — organizational systems, finance systems, even HR, not a very sophisticated business model. And you see that in PACE today as well.

So those of us who rode that wave on hospice, we learned how to develop all those systems for scalability. So those of us who came from Seasons hospice, in particular, we built all of those systems to go from one program in Chicago to a 30-plus state hospice provider in just about 20 years. Those systems are all applicable in a PACE way.

You can see the evolution between hospice and home health, its level of sophistication over the past several decades. That’s exactly what’s happening with PACE, except it’s happening much faster. They’re evolving much faster than we did back in the day at hospice.

Could you expound on how they’re evolving?

PACE is going to explode across the nation. It just makes sense. It’s such an enviable way of providing care for older adults, and it aligns with so many important metrics that all the leaders from all the PACE organizations are having the same conversation: How do we improve scalability? How do we script the interdisciplinary team meeting to make sure we’re covering everything on a consistent basis, so nothing is ever missed?

It’s a huge responsibility when you’re responsible for the entire life of the individual. In hospice, we are responsible for the whole life, but it’s such a short period of time. And in PACE, it’s so much more than that, because we will see them for years prior to their final days of life.

Of course, home health and hospice are part of that. If our participants need home health, we provide that or we contract for it. Same with hospice, either we provide the palliative care and hospice-type services, or we contract with the hospice to provide it. We’re not only the provider of the care, but we’re also the payer source for these individuals. We also pay for those services, so there’s no copay or deductible when a person enrolls.

How many centers do you have and in how many states are they currently located?

We have two operational programs in New Jersey, one serves Monmouth County and the other Ocean County. Then we have two programs in the central region of the U.S., one in Evansville, Indiana; that program opened on March 1. The other program is right across the state line in Owensboro, Kentucky; that center opened also on March 1.

So we have four operational programs today. By the end of 2026, we will add two more. We are anticipating enrolling participants in our Fresno, California, program as of July 1. We’re anticipating enrolling our participants in North Charleston, South Carolina, on Sept. 1.

What lessons from your home health and hospice experience are you bringing to PACE?

As an organization evolves to launch from one local provider to a national provider, one of the things that we experienced is that, at different points, there are different types of growing pains.

Those of us who have already rode that wave from our previous organization, we already know where those pain points are. So our intent now is to call those out ahead of time and then prevent them from being painful. Before, we may not have been able to see around the corner, but we’ve learned sometimes the hard way how to do that.

Here, we’re saying we anticipate that this will be difficult. Let’s talk about it. Let’s see around the corner, and let’s create systems and processes in advance so that they’re not painful growth experiences for us.

What would you say are the biggest challenges in opening up these new centers? I understand it is very cost intensive on the front end.

It’s quite different from hospice and home health in that regard, because we have to build the center. The center also has to include the clinic. So you’re talking about a medical clinic and something that looks very similar to an adult daycare center, and you need about 20,000-square-feet.

The first big challenge, of course, is to get the license to be able to provide the care. Sometimes that’s responding to an [Request for Proposal (RFP)]. Sometimes it’s contacting the state and asking if we submit an application. Sometimes it’s working with the state on an area that they’re concerned about, and we think we might be able to fill that need.

So once that hurdle is overcome, the next one is real estate. And that’s a big hurdle. In some of these markets, real estate is quite easy to come by, but nearly all of those buildings will need a significant remodeling. Anytime you remodel, you’re on a timeframe that’s really based on the construction and how that process goes.

Then of course, you have to build the team. So I would say some of the challenges, in addition to the financial challenges of being able to spend $6 million to $10 million on that initial investment, is finding the right location and recruiting competent staff.

When we opened in Indiana and Kentucky, we actually didn’t have a hard time recruiting, because people were very excited about PACE as a new model of care. So a lot of health care workers were very excited about it, maybe they were fatigued and tired of where they were currently working. This gives them a fresh new approach to providing care.

It can be very demoralizing for a health care provider to have a patient who needs more physical therapy, but they can’t get it pre authorized or approved. That kind of worker does really well at PACE, because there’s no pre authorization. It’s entirely driven by the interdisciplinary team. The idea from a money perspective is that, if you just do the right thing for your participants, you will keep them at home and well, which will save money overall. So who cares if you spend a lot of money for physical therapy? They need that, and that’s probably going to save them a hospitalization down the road.

So it’s looking at the big picture of the holistic health of the individual, rather than nickel and diming their care and that really encourages providers to come work for us because that feels good.

I’ve heard that it takes like two to three years to get PACE centers out of the red. What is your runway to profitability and sustainability?

It could happen sooner; it depends on the situation. We have a joint venture for our Fresno, California program. We have partnered with the owner of a very large adult daycare center in Fresno, and they have about 400 folks coming to their adult day care center every day. They have a wonderful way of providing care, and really rely on family and community in order to do that. PACE fits in beautifully with this model.

We know that not all of those participants in the adult day care center will meet the eligibility requirements for PACE, but about one-third to a half of that population probably will. So that growth trajectory is much faster because of that joint venture.

In a program like we have in Indiana or Kentucky, where we’re not doing a joint venture, and people don’t have a clue what PACE is, we’ve had to put up radio ads, billboards. We’re talking to everybody about what PACE is. The learning curve is slower for that community, and as such that growth trajectory is going to be a little bit slower. So I would say that what you’ve heard about two to three years before they’re profitable is reasonable.