San Francisco Senior Center a Model for Care

Jing Quan Li was in a bind. At age 81, he was still going strong, but his wife was failing and he was running himself down trying to care for her.

Their seven children were proving no help. And the manager of the Chinatown single-room occupancy hotel where the couple lived was increasingly annoyed at Li for being a nuisance--asking too many favors, blowing fuses with too many appliances, forgetting he had something on the stove and setting off fire alarms.

After a dim sum lunch one day in a storefront restaurant, Li pushed his wife’s wheelchair across the street to the On Lok SeniorHealth center to ask about getting some help.

“I was very exhausted,” he said.

A few days later, the two were called in for an assessment by the team of social workers, therapists, doctors, nurses and dietitians who staff the private, nonprofit center.

Within weeks the couple were enrolled in the program, receiving everything from meals to medical care there, returning in a van every afternoon to their hotel. Three years later, they have moved into one of the special studio apartments built atop the center.

What On Lok has provided the Lis is a chance to remain together and live independently.

The odds are good that they will avoid nursing homes if they choose: Out of 750 clients at its six centers in San Francisco--average age 82--fewer than 7% have moved on to nursing homes.

The way the center works is deceptively simple: Senior citizens contract with the center to provide all their services, and the center, under contract with the state and federal government, receives all of a client’s Medicare and Medicaid dollars--about $3,400 a month--in advance.

Considered a model for the future by many senior citizen advocates, the arrangement required a complicated waiver of state and federal laws that typically favor a pay-per-service model.

Since On Lok attained the waiver in 1983, only 11 other organizations across the United States have struck identical deals. Pending legislation in California would allow five more and organizations in the Southland have expressed interest, including Downey Community Hospital and a rehabilitation center in Pomona.

What cannot be guaranteed elsewhere, of course, is the cohesion of the On Lok staff, which begins work at 8 a.m. with a meeting to discuss what has occurred in the past 24 hours and what is on the books for the next 24. Plans are made to alter diets and modify medications, to exterminate mice, contact pastors and tune hearing aids.

On a recent morning, discussion turned to the plight of a client who had been quarantined in his apartment after a positive tuberculosis test. Now on TB medication, he has returned to the center during the day, but his physical condition has slipped; he no longer wants to try during physical therapy.

A health worker asks: Should he be moved to a nursing home? A social worker responds: What else could be done to make him more comfortable? Center Manager Karen Gee quizzes each staff member who has had contact with the man. What do you see happening? What could be changed?

After 10 minutes, consensus is reached: The client is depressed and anxious, in part because he has been incontinent at night. A nighttime aide is prescribed.

Later social work specialist Doreen Der-McLeod describes the interaction as typical of the creativity On Lok can bring to situations because workers know the clients so well. “They are whole persons to us.”