History of PACE and On Lok
Serving the elderly for over 45 years, On Lok has grown from its humble roots as an adult day health care center to a complete medical and health-related services program that is now replicated throughout the United States.
On Lok, which means “peaceful, happy abode” in Cantonese, pioneered the model of care known today as “Program of All-inclusive Care for the Elderly” or PACE, which is now a certified Medicare program throughout the United States.
History of PACE and On Lok Lifeways
The PACE model of care can be traced to the early 1970s. On Lok was formed in 1971 in response to community concern for the older adults of San Francisco’s Chinatown, North Beach, and Polk Gulch neighborhoods. Dr. William L. Gee, a public health dentist, headed the committee that hired Marie-Louise Ansak in 1971 to investigate solutions. They, along with other community leaders, formed On Lok Senior Health Services to create a community based system of care.
On Lok Senior Health Services opened one of the country’s first senior day health centers. Elders in these San Francisco communities received hot meals, health and social services, and supervision during the daytime, while returning to their homes in the evening.
On Lok added in-home support services, then primary care services and case management of acute and chronic health services.
On Lok launched a Medicare-funded demonstration of our consolidated model of long-term care through On Lok Senior Health Services. An interdisciplinary team (physicians, nurses, physical and occupational therapists, social workers, dietitians, health workers, and drivers) formulated coordinated care plans and provided all medical care and social services.
On Lok obtained waivers from Medicare and Medicaid to test a new financing method for long-term care: a form of risk-based capitation. In exchange for fixed monthly payments from Medicare and Medicaid for each enrollee, On Lok was responsible for delivering the full range of healthcare services, including hospital and nursing home care – bearing full financial risk.
Congressional legislation made On Lok’s waivers permanent and authorized similar waivers for community-based organizations replicating the model. On Lok’s groundbreaking model of coordinated service delivery and innovative financing began replication under the new name, the Program of All-inclusive Care for the Elderly (PACE).
On Lok completed renovation on the Larkin building, now named the Dr. William L. Gee Center, in honor of its founding Board President Dr. William L. Gee. The National PACE Association, a non-profit membership organization comprised of PACE sites, formed.
30th Street Senior Center became part of the On Lok family of services under an agreement with the California Pacific Medical Center. 30th Street Senior Center provided bilingual and bicultural services to San Francisco seniors since 1979. The existing 30th Street services, including nutrition program, senior services, adult day health center, and Alzheimer’s program, continued.
On Lok’s PACE program, then called On Lok Senior Health, opened two new centers, one through a partnership with the Institute on Aging and a second at the 30th Street location. On Lok now served seniors throughout the City and County of San Francisco.
In the Balanced Budget Act of 1997, PACE became a permanent provider type under Medicare and a state option under Medicaid. Thus, the undertaking that started with a few dedicated people in San Francisco had blossomed to become a nationwide movement whose continued goal is to create a better life for the frail elderly.
On Lok opened its first PACE center outside San Francisco in the City of Fremont, which initially served two orders of nuns, the Sisters of the Holy Family and the Dominican Sisters of San Jose.
On Lok transitioned from waivers to become a permanent PACE provider under Medicare and Medi-Cal. State legislation established PACE as a permanent Medi-Cal benefit.
On Lok changed the name of its PACE program to On Lok Lifeways and adopted a new brand for its five non-profit corporations. On Lok also opened the Mission Center in San Francisco’s Excelsior District and expanded the Southern Alameda County service area to include Fremont, Newark, and Union City.
On Lok opened a new PACE center in the City of San Jose to serve the Santa Clara County service area (not including Gilroy, Morgan Hill, and San Martin).
On Lok opened the Peralta Center, a second PACE center in the City of Fremont, which was developed in partnership with Eden Housing and located in a commercial space with Eden’s 98-unit low-income senior housing project.
Expanding its commitment to serving seniors in Santa Clara County, On Lok opened the East San Jose Center, an alternative care setting to the On Lok Lifeways San Jose Center for On Lok Lifeways PACE participants. The center had previously been an adult day health care center, which served the community for many years.
Over 115 PACE programs are operating in 32 states. On Lok Lifeways serves over 1,400 frail seniors in San Francisco, Southern Alameda, and Santa Clara Counties. The 30th Street Senior Center now serves over 5,000 seniors per year in San Francisco.