On Lok is a well known national model of long-term
care for the frail elderly in the United States. It is the prototype for
PACE—Program of All-Inclusive Care for the Elderly. On Lok began
as a programme addressing local needs in 1973, then evolved to a
national demonstration project, and in 1997 became a permanent
federal- and state-funded programme. As a health plan and health
services provider, On Lok serves the frail elderly through
neighbourhood-based community centres that offer primary care, adult
day health care, and home care. On Lok’s interdisciplinary teams
provide psychosocial and medical case management, rehabilitation
therapies, nutrition services, recreational therapies, and transportation
services. Seniors and their families partner with On Lok in decision
making on care plans, establishing advanced planning directives, and
documenting health care wishes. We illustrate a case providing an
overview of the On Lok long-term care model, focussing on end-oflife issues and comfort care plans enabling a Chinese elderly man to
maintain his quality of life and dignity till death.

Mode of access: Internet.