If he wants, he can shower, get his hair cut or have his teeth cleaned. Those twice-weekly visits are the highlights of the week for Perez, a 65-year-old retired mechanic who has diabetes and is legally blind.

“The people here are very human, very nice,” he said. “I’m gonna’ ask for three days a week.”

The nonprofit Gary and Mary West PACE center, which opened in September, is California’s newest addition to a system of care for frail and infirm seniors known as the .

The services provided by PACE, a national program primarily funded by Medicaid and Medicare, are intended to keep people 55 and older who need nursing home levels of care at home as long as possible and out of the hospital.

The program is more important than ever as baby boomers age, its proponents say.

“The rapidly growing senior population in California and across the country will put enormous strain on our current fragmented, and often inefficient, health care delivery system,” said Tim Lash, president of Gary and Mary West PACE. California officials consider PACE an integral part of the state’s strategy to upgrade care for aging residents.

The said shows seniors enrolled in PACE cost states 13% less on average than the cost of caring for them through other Medicaid-funded services, including nursing homes.

Perez, like 90% of PACE enrollees nationwide, is a recipient of both Medicaid and Medicare. He’s part of a population that typically has low income and multiple chronic conditions.

PACE participants who do not receive government medical benefits can pay out of their own pockets. At Gary and Mary West, the tab ranges from $7,000 to $10,000 a month, depending on the level of care.

Nationally, 50,000 enrollees participate in PACE programs at over 260 centers in 31 states. In California, PACE serves vulnerable seniors at 47 locations.

PACE programs nationally offer all services covered by Medicare and Medicaid, and nurses, primary care doctors, social workers, dietitians, drivers and personal care attendants, as well as physical, occupational and recreational therapists. PACE enrollees commonly have conditions such as vascular disease, diabetes, congestive heart failure, depression and bipolar disorder.

About two-thirds of PACE participants have some degree of cognitive impairment. The Gary and Mary West center is no exception, which is why it has alarms on all the doors. If participants become agitated, they are led to the “tranquility room,” a softly lit space with an ocean soundtrack and a recliner.

On weekdays, participants can arrive at the center as early as 8 a.m. and stay until 4:30 p.m. A PACE driver provides transportation to and from the center, as well as to appointments with outside specialists.

The center goes a step further than most other PACE programs: It offers dental care. Staff dentist Karen Becerra said some of her patients have cried for joy when they learned they were going to have their teeth fixed or replaced.

“These are folks who have terrible teeth,” Becerra said. “And if they have painful mouths, they have poor nutrition.”

Perez is missing teeth, but he was all smiles when he talked about his upcoming dental appointment. “They’re going to put new ones in,” he said.

The center opened with money donated by San Diego billionaires Gary and Mary West, telemarketing and telecommunications entrepreneurs. They’ve donated about $11 million to establish PACE centers around the country.

The center in San Marcos is spacious and cheery, with sofas and chairs scattered about and plenty of natural light. It’s meant to feel “like a friendly inviting living room,” said Dr. Ross Colt, a retired Army colonel who joined Gary and Mary West PACE a year ago as the primary care physician on staff.

Enrollees can repair to a patio to get fresh air or tend herbs in planter boxes. And they can participate in activities such as bingo, coloring and Trivial Pursuit, led by a recreational therapist.

Just down the hall from the main lounge are patient exam rooms decorated with photographic murals of sunsets and seascapes.

Center participants can get physical and occupational therapy in a rehabilitation gym, and the facility has a spa where they can shower or get their hair done.

The executive director, Renata Smith, recalled a woman whose husband had been bathing her with a garden hose before she joined PACE. “We’re talking about basic human dignity here,” Smith said. “The spa makes participants feel good about themselves.”

PACE programs also send personal health care aides to the homes of participants.

Twice a week, an aide named Sylvia Muro picks up Perez at his home and takes him out to shop for groceries. Sometimes they stop at McDonald’s for pancakes and sausage.

Colt said participants come to him for checkups about once a month, but he can see anyone with a medical problem on a moment’s notice.

Unlike doctors in private practices, “I have the luxury of seeing them for an hour if I need to. And I can bring them back tomorrow if I need to,” he said.

Such access can save a diabetes patient from missing an insulin injection and avoid a costly hospital admission.

“That’s what the benefit of this model is,” Colt said. “The patient doesn’t want to go stay in the hospital, the family doesn’t want them to, and society doesn’t want them to.”

Smith, the center’s executive director, noted another important benefit: “the comfort of social interaction and something to wake up to every day.”

This article first appeared on Ñî¹óåú´«Ã½Ò•îl Health News and is republished here under a .

But since being diagnosed with metastatic breast cancer in 2013, an event that forced her into retirement, Shanahan has discovered that not all of her doctors are as attentive to such requests.

Getting copies of her records has been, as she puts it, “a colossal pain.”

With few exceptions, federal law requires that health care providers make copies of medical records available within 30 days after patients request them and, when possible, in the format they desire. Under California law, providers have to hand over the records if they are being sent directly to the patient.

But many patients, who may have records scattered across doctors’ offices, labs, hospitals and clinics, say responses from health care providers can range from sluggish to churlish. Assembling the records can be onerous.

Earlier this year, Shanahan turned to a Silicon Valley startup called , which requests medical records on behalf of cancer patients and redacts them for clarity and legibility.

Shanahan logged on to the company’s website and signed an electronic consent form, handing over to Ciitizen the task of requesting her records from multiple providers. The company emails her when a record is ready for her to view.

Ciitizen does not charge patients for gathering their medical information. Rather, it hopes to make money “in the near future” by taking a transaction fee for “matching third-party researchers with patients who wish to share their records,” said Deven McGraw, Ciitizen’s chief regulatory officer and former head of health care privacy policy at the U.S. Department of Health and Human Services. She said the company plans to offer its services to people with other serious illnesses in the future.

On Tuesday, Ciitizen, based in Palo Alto, Calif., released an update to a report card it first published in August that uses a five-star system to rate how health care providers comply with federal rules governing record requests. The scorecard, which Ciitizen plans to refresh every few months, can be viewed online at .

It shows that of the 210 providers from whom Ciitizen has requested patient records so far — including hospitals, doctors and specialty clinics nationwide — 51% have only one or two stars, meaning they were noncompliant or required significant intervention by the company to comply.

Ciitizen also published a , based on the scores of those 210 providers plus telephone surveys of nearly 3,000 health care institutions, that found that more than half of providers were out of compliance with federal patient data access rules.

That is in line with a by Yale University researchers last year showing that many top U.S. hospitals were not in compliance with patient records rules.

“Cancer patients do not have the time or energy to make two to three phone calls and argue with their providers,” McGraw said. “We did a lot of arguing. We encountered so many roadblocks.”

In a , Seema Verma, administrator of the Centers for Medicare & Medicaid Services, called the Ciitizen scorecard “a powerful tool for patients” that “will hopefully spur competition amongst providers to make patient data more readily accessible.”

Lois Richardson, vice president and legal counsel of the California Hospital Association, said the scorecard is too new to assess whether its findings are significant or just a collection of anecdotes based on a small number of records requests. “It could be either; I just cannot tell,” she said.

Some consumer advocates say enforcement of laws governing medical records accessibility is ineffectual.

“There have never been any cops who will go around and bust a hospital for failing to produce the data,” said Dave deBronkart, a pioneer of the patient access movement.

DeBronkart, 69, beat the odds after doctors gave him 24 weeks to live following a diagnosis of metastatic kidney cancer 12 years ago. Along the way, he has butted heads with the medical establishment over his health records.

When he was invited to speak at a medical conference in Toronto in 2009, the organizers asked him the title of his speech. He replied: “Just call it ‘Give Me My Damn Data.’”

That phrase quickly became a rallying cry, a , a meme, a coffee cup, a , and even a rap: “Give me my damn data/’cause it’s my life to save/give me my damn data /just like e-patient Dave.”

DeBronkart and others in the medical data access movement applaud Ciitizen’s report card but believe the real game changer will be a new federal rule that could eventually allow patients to see their medical data on their cellphones as easily as they can see their bank accounts.

“What we have been striving for is starting to happen,” deBronkart said. “For the first time in 10 years of advocating for patient access to our medical information, I am excited and optimistic.”

The new rule is expected to begin rolling out in 2020, a CMS spokeswoman said. It will require health care providers doing business with Medicare and Medicaid, and in the federally run Affordable Care Act marketplaces, to share their patients’ data through apps that are compatible with an international standard for sharing health care information known as FHIR (Fast Healthcare Interoperability Resources).

Unlike current federal law governing records access, the new rule will have some teeth, federal officials say. Just how it will be enforced is still being hammered out, but it will likely entail financial penalties.

Some patient advocates worry about consumers’ privacy when their medical data is shared so widely online. “Of course we want consumers to be more empowered, but it does seem like we’re rushing into this idea,” said Dena Mendelsohn, a senior attorney in the San Francisco office of Consumer Reports, adding that there are not yet laws in place to protect patient privacy.

But Shanahan, the breast cancer patient and former OB-GYN, said it should be her decision.

“I’m the patient,” she said. “I’m saying, share my freakin’ information.”

This article first appeared on Ñî¹óåú´«Ã½Ò•îl Health News and is republished here under a .