Courtesy of On Lok Inc.	More NurseWeek Features   Smoke-Free Zone   Nurses and patients tackle nicotine addiction   Bloodless Survival     Surgical techniques to use when transfusion drops out of the equation
Debbie Dang, MD, examines a patient (above). The idea behind On Lok is to break out of the institutional nursing home model by providing a nexus of comprehensive care that allows participants to remain living in their homes for as long as possible.

In an art deco-era building on the edge of San Francisco's bustling downtown, a group of elderly women and men sit in a circle doing gentle and graceful chi gung stretches. They move their arms, hands and necks, listening to the instructor call out exercises in Cantonese and English, with music playing softly in the background. The scent of lavender, sage and marjoram wafts from a nearby aromatherapy machine. Sunlight pours in from 10 tall windows and, overhead, enormous, elegant light fixtures hang from the high ceiling.

The airy room is occupied by other seniors, some playing cards, mah-jongg or dominoes, others working at computers or reading the newspaper, some sitting quietly, gazing at fish in the aquarium, colorful parakeets twittering in their cage or the array of art lining the peach-colored walls. One woman is having her nails clipped. Another is giggling while receiving a hand massage.

What looks like a spa for the elderly is the recreation and social center for On Lok Senior Health Services, an innovative health care program for senior citizens.

At On Lok, all of the 850-plus participants qualify for nursing homes. Most folks use canes, walkers or wheelchairs to get around, most are frail and financially strapped and all have multiple health problems. But the idea behind On Lok-and the growing number of similar programs around the country-is to break out of the institutional nursing home model by providing a nexus of comprehensive care that allows participants to remain living in their homes for as long as possible.

These Programs of All-Inclusive Care for the Elderly, or PACE, also provide innovative career opportunities for health care staff, offering professional collaboration, flexibility and job satisfaction sometimes lacking in acute or long-term care settings.

"What we are often taught in nursing school is to focus on the total person, to take a holistic look," said Jennie Chin Hansen, MS, RN, executive director at On Lok. "Here, we are able to do that, to focus on the well-being of the individual who is ready for a nursing home, but would rather be in their own home. We have designed a virtual nursing home in the community."

On Lok-which means happiness and peace in Cantonese-forged the way in the early 1970s by developing a model to serve seniors with what Hansen calls "one-stop shopping for medical care."

For most of the nation's elderly and indigent population, Medicare and Medicaid pay for specific services. But it is a fractured system that often leaves patients and their family members with the daunting task of coordinating medical care, services, transportation and meals-or choosing a nursing home.

PACE is a separate plan that collects the bulk of its funding directly from Medicare and Medicaid. Participants enroll in the program and receive preventive and primary medical care at a PACE center, as well as dental care, audiology, optometry, podiatry and speech therapy. If participants require medical care outside the scope of the center, hospitalization or must move into a nursing home, that is also covered by PACE.

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