Future
now

September 11, 2013 -- Today I shadowed the charge nurse at an eldercare clinic. I saw the future of eldercare and it is named On Lok.

It is based on common sense. First, for both quality of life and for cost control, let's "age in place", that is, stay at home. Nobody wants grim institutional corridors, lousy processed food in dining halls full of strangers, and over-sedation by sullen, underpaid flunkies.

Second, center the care around the patient. On Lok calls them participants. Nurses there nurse but they also coordinate care, much like case managers in traditional hospitals but with long-term relationships. Participants and staff get to know each other as they work together week after week, with vans bringing them to and from the clinic, home care nurses coordinating with families for medication administration and safety monitoring. A full staff of medical professionals -- a couple of doctors, three or four nurses, an occupational therapist, a physical therapist, a psychologist, a psychiatrist, and several more -- organize their schedules around the participants at the clinic rather than for their own convenience (the opposite of most health care).

And third -- perhaps this is really first -- is humanity. Staff and participants build real relationships, getting to know each other's foibles and preferences. In nursing school we were taught not to display affection for patients. At On Lok they hug.

When I'm old and near helpless, perhaps demented or otherwise reduced in function, I hope I'm fortunate enough to be cared for by such an organization. On Lok has it right.

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