Serving the elderly for over 40 years, On Lok has grown from its humble roots as a senior day healthcare center to a complete medical and health-related services program that is now replicated throughout the United States.

In the Beginning

1971	On Lok began as one of the country's first senior day health centers, a place that took care of older adults in the Chinatown, North Beach and Polk Gulch neighborhoods. Elders in these communities received hot meals, health and social services and supervision during the daytime, while returning to their homes in the evening. Our concern about the fragmented care we saw motivated us to be innovative and start creating our own holistic senior healthcare plan.
1975	In-home support services, then primary care services and case management of acute and chronic health services were added as On Lok provided services.
1979	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.

Demonstrated Success

Not only were our programs innovative and successful, but the cost of care was 15% less than the traditional fee-for-service care system. In 1983, 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. A permanent Medicare and Medicaid waiver followed in 1986, and since that time On Lok has had no cost overruns and has been able to place a percentage of operating revenues in a risk reserve fund each year.

Nationwide Adoption

Also in 1986, On Lok’s ground-breaking model of coordinated service delivery and innovative financing began replication under the new name, the Program of All-inclusive Care for the Elderly (PACE). Today more than 70 organizations in 30 states are in various stages of the PACE model - from start-up to full operation. In the Balanced Budget Act of 1997, PACE became a permanent provider type under Medicare, and states gained the option of paying a capitation rate for PACE services under Medicaid. Thus, the undertaking that started with a few dedicated people in San Francisco has blossomed to become a nationwide movement whose continued goal is to create a better life for the frail elderly.