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"We changed the financing and delivery system
to focus on the patient, or as we say, participant.
It's about the active engagement of a person, rather
than having them be a passive recipient of patient care,"
said Hansen, who has worked at On Lok for 22 years and
serves on the national board of the American Association
of Retired Persons. "People still want to have
independence, as much of their life in the community
as possible, and stay connected to traditional bonds."
PACE also offers services not usually covered under
Medicare and Medicaid, such as preventive care, end-of-life
care, recreation, therapeutic activity, meals, transportation,
house cleaning and repairs and, as Hansen said, "just
taking people over to the ballgame or the symphony."
"It's not just a medical or physical care system,"
she said. "It encompasses people's well-being and
mental health."
On Lok, the largest of the country's 25 PACE programs,
has six centers in San Francisco, as well as a new facility
in Fremont, Calif. The centers reflect the Bay Area's
multicultural population, with many different languages
and immigrant populations represented. About 30 RNs
and LVNs are on staff, along with NPs, physicians, physical
therapists, home health and recreational aides.
On Lok's center on Bush Street serves 150 participants.
It offers a full medical clinic, recreation and social
programs, rehabilitation and physical therapy, hot meal
service, as well as residential apartments for those
participants who are no longer able to live at home.
On the roof is a flower and vegetable garden, where
participants tend lettuce, sugar peas, spinach, cilantro
and bok choy. One wall has a small burbling koi fishpond,
and the raised wood beds are decorated with colorful
tiles hand-painted by participants. Down on the street,
On Lok vans pull up to transport participants to and
from the center, as well as deliver meals and provide
services to seniors who cannot leave home.
"It's kind of like participants have a Cheers
bar to go to," Hansen said. "We know about
their idiosyncrasies, what they like to eat, who they
like to sit next to."
The On Lok program started in the early 1970s, when
the Chinatown-North Beach community of San Francisco
saw that nursing homes were infeasible both financially
and culturally for immigrant families and their elders.
"The culture is very much into taking care of
your own," said Arline Hong Siu, On Lok's marketing
project manager, of the Chinese population. "There
is a huge respect for the elderly population. We are
taught from a young age to make sure that we are going
to be taking care of parents and grandparents when they
grow older and not put them into a nursing home situation.
Of course, that's not always possible, but that's the
goal."
Based on the British day hospital model, On Lok opened
one of the nation's first adult day centers in 1973,
and a year later began receiving Medicaid reimbursement
for its services. In the mid-1980s, other organizations
began replicating On Lok's model and, in 1997, federal
legislation established the PACE model as a permanently
recognized provider under Medicare and Medicaid programs.
Now, 36 PACE centers (11, however, are pre-PACE sites
and are not yet receiving full federal funding) in 19
states serve more than 8,000 participants.
To qualify for a PACE program, participants must be
at least 55 years old (the average participant, however,
is 80 years old), live in the program's immediate service
area and be certified by their state to need nursing
home care. Almost 90 percent of participants qualify
for full financial aid, with Medicaid and Medicare paying
a capitated rate that averages about $3,750 a month
per participant nationally.
At On Lok's Bush Street clinic on a recent Thursday
morning, Adrienne Low, ANP, examined participant Johnnie
Ross. The 79-year-old Louisiana native, dressed in a
white T-shirt, denim jacket and blue sweat pants, had
come downstairs from his residential apartment on the
fourth floor to have a leg wound checked.
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