Robert Edmondson describes how his organization created a program that has been reproduced at dozens of health institutions in the US.

On Lok, an organization that provides quality and affordable services for seniors in San Francisco and Fremont, Calif., is celebrating its 35th birthday this year. On Lok’s founders envisioned PACE, the program of all-inclusive care for the elderly. “This model has made us an organization that people in the long-term care business view favorably,” said Robert Edmondson, On Lok’s current and third CEO.

Robert Edmondson, CEO

Under the PACE model, a team that includes physicians, dieticians, nurses, social workers, rehabilitation therapists, and even the van drivers, is central to planning and delivering care.

“The model enables us to understand the participant’s needs fully. The beauty of the model is that it gives respite to the caregiver as it delivers optimal healthcare for the elderly,” Edmondson said. “Let’s say the family is reaching a point where they can’t provide the care they want to give for their family member. We give them
the support they need to better function as caregivers.”

Coordinated care
On Lok is a well-structured organization that comprises five not-for-profit corporations: two housing corporations, an active senior center, the PACE program, and its parent corporation. The PACE program serves individuals who are aged 55 or older, live in a PACE service area, are certified by the state Medicaid agency (California’s Department of Health Services, in On Lok’s case) to need nursing home care, and are able to live safely in the community at the time of enrollment. Although all PACE participants must need nursing home care to enroll, only about 7% of PACE participants reside in a nursing home. If a PACE enrollee needs nursing home care, the program pays for it and continues to coordinate his or her care.

PACE programs have been implemented at dozens of locations across the country and are growing rapidly, said Edmondson. Currently, there are 38 PACE programs in 22 states in the US. “On Lok’s PACE has more than 1,000 participants, and we’re still growing. In the past year, we’ve opened a new center in San Francisco, and we’re proceeding to gradually expand our efforts into new communities,” he said. “Although we started out in Chinatown, we are truly multicultural. Along with the Chinese, Italian, and Filipino communities we served originally, we serve many others now, including the Hispanic, Korean, and African-American communities.”

Edmondson restarted On Lok’s consulting operation, dubbing it On Lok PACE Partners, to assist organizations that want to set up PACE programs. “We have plenty of expertise—we’re the mother ship, the founder of the program,” he said. “We have a lot to offer in terms of helping organizations around the country to establish PACE programs to help seniors in their local communities.”

Because PACE is a center-based model, On Lok’s vans pick up members in the community and bring them to the center for socialization, meals, occupational and physical therapy, dental care, and medical appointments, if necessary. The program, covered by Medicare and Medicaid, saves the government money as it offers efficient, high-quality care for the elderly, explained Edmondson.

“We have a very high customer satisfaction rate,” said the chief executive, noting that very few seniors disenroll. “Most people stick with the program for the rest of their lives. About the only reason they disenroll is because they move away from the service area.”

Edmondson observed that the program’s vast knowledge of its enrollees is a huge contributor to patient satisfaction. “We see each participant an average of two and a half times a week in
our centers and have many of our professionals working with them—social workers, physicians, etc. It’s truly an integrated model of acute and long-term care,” Edmondson said.

Future models
As On Lok continues to grow, Edmondson expects the organization to expand to other geographic areas, specifically in the Bay Area, and will seek opportunities to partner with assisted living organizations. The chief executive is also looking at developing new models of care beyond PACE to include different features and continue innovation in geriatric care—“a PACE 2.0, perhaps,” he suggested.

“Seniors want to age in place, staying in their own homes and community. PACE provides the key for many to do so. Still, PACE is not the answer for every senior. The senior population will swell dramatically in the next decade, so finding additional solutions to meeting their healthcare needs is crucial,” he said.