Keiro CEO: Years of Study Led to Decision

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By J.K. YAMAMOTO, Rafu Staff Writer

Second of two parts

Continuing from the Dec. 19 issue, following is a report on Keiro President and CEO Shawn Miyake’s presentation on Dec. 7 to family members of South Bay Keiro residents. The agency is in talks to have a larger health care organization take over the Keiro facilities in Los Angeles and Gardena due to declining funds and changing demographics and needs in the Japanese American community.

Miyake explained that the board has been doing long-range planning for the next five to 10 years. “They’re looking at census data, they’re looking at what’s going on in the market for senior care, they’re looking at contracting, they’re looking at utilization, how long people stay, revenue, things like that. They’re really taking in a lot. And the two things that they’ve started to really zero in on over the last three or four years has been how is the community changing …

“Everybody here probably has somebody who’s married to somebody who’s not Japanese … When we check the census data, 70 percent of children under the age of 20 are multiracial in our community. So it’s very outmarried. So you can imagine 50 years from now, and if we think this far ahead, do you need a Japanese nursing home? The answer is probably not …

“The other thing we noticed is that people’s preferences are changing … Anybody here plan to spend their last days in a nursing home? The answer is no. Everybody that we’ve surveyed in the last two to three years says the same thing — they have no intention of ever living in a place like this. Their intent is to live at home as long as they can and pass away among family and friends in a place familiar to them.”

Miyake cited the experience of a friend who had surgery for kidney cancer. “He went in, outpatient, they snipped his kidney, they put an IV in him, they sent him home … He said … ‘I was able to sleep in my own bed, my wife was there. I was concerned whether she could take care of me (but) they sent a nurse in immediately after. She took care of me, everything was fine.’

“I’m sure for the hospital and the health plan it was a lot cheaper. But the outcomes were better. What it tells you … is that you have to change your expectations. More of it is on you, it’s about self-management, it’s about owning your own health, being responsible, and if you know that’s true then you should prepare yourself.”

He added, “People are living all over Southern California. I’ve said this before in family meetings as we’ve talked about maybe building another facility. We say, ‘Where should we locate it?’ And everybody says, ‘Closest to where I live,’ and that’s a bad answer … We don’t just live in Little Tokyo or Sawtelle or whatever … That makes it really, really difficult. The board has struggled with that.”

Given the changing demographics and cuts in funding, the board had to re-examine Keiro’s mission, Miyake said. “You can stay in health care … (but) it’s going to become multiracial. Do you think the Japanese community is going to donate money to run a multiracial facility? Their response and the response of the community that supports us said no … we want to stay focused on Japanese. So the board made a choice. They said going forward, we’re going to continue to stay focused on Japanese and the local community …

“If you had picked health care, we would run the facility and it would become very diverse, like any other nursing facility. You probably don’t get as many donations from the Japanese community. That would be a consequence. Now that you’ve picked Japanese, you’re not doing nursing homes. You do one or the other. If you pick Japanese, you have to do something else … You get out of this vehicle and you get into a different vehicle. The mission stays the same, to enhance the quality of senior life in our community.”

Consultation, Experimentation

In the last few years, Keiro has tested possible solutions, Miyake said.

• An adult day health care center and an adult day center were opened in Gardena and Garden Grove. “At the end of the program’s life, there were five people in the program, and they weren’t all Japanese.”

• There was a proposal to build two high-rise towers in Boyle Heights at a cost of millions. “How can you raise that kind of money and how can you borrow that kind of money when the community is changing? … They just abandoned that.”

• The Torrance Inn was purchased with the hope of converting it into an assisted living facility. “We had all kinds of code problems … We went back and forth, but finally we said, ‘Forget it.’”

• The possibility of purchasing land in Orange County was considered, but the cost was prohibitive, as were the locations. “Going to East L.A. is hard enough, but going to Fullerton, really? That wasn’t going to happen.”

Keiro also looked at and consulted with other facilities to see how they dealt with their problems, Miyake said.

• Of three nursing homes serving specific groups, one is “considering opening it up … They’re having trouble filling their beds”; another “just carved out their outpatient clinics and they merged them” with a university hospital; and the third told Miyake, “You have to join a larger health care organization. You can’t stand alone.”

• Three health care organizations are jointly opening a rehabilitation hospital because “they need to collaborate with other partners.”

• Two local providers will be utilizing new nursing home beds in a new part of a hospital, and it’s anticipated that they will use their own partners for additional services like rehabilitation. “We’re starting to see structures like this developing …They’re combinations of health plans, hospitals and doctors, and we’ve never seen them before.”

• At the 2011 Healthy Aging Partnership, convened by Keiro in partnership with the USC Davis School of Gerontology and Japan’s Ministry of Health, Labor and Welfare, “their conclusion was that there no health system in any country that was sustainable, that the money that was out there was not enough, and there’s too many people in the baby boomer generation coming …They believe that all care is moving into the home … and that Keiro needs to do more things in the community that help people stay home.”

In the long term, because of the funding situation, “you’re forced to increase your diversity,” Miyake said. “You have to now accept anybody who needs a nursing home … Years ago, you could just pick Japanese and take them. Today they say, ‘Anybody who lives in these zip codes that we serve, you serve.’ And you’re going to want to serve them because you’re not going to have enough Japanese. You need to serve everybody.”

Miyake predicted that there will be no new developments during the holidays, but next year “things will continue to move forward as they do … There’ll be a press release and it’ll say we’ve picked this partner, this is how it’s going to happen, there’s a 90-day escrow … We’ll do an e-blast to everybody (on Keiro’s list) with those time frames.”

He reiterated, “On Friday if we announce something, on Monday it looks the same.  Obviously, over time things are going to change, but it shouldn’t be dramatic.”

The organization’s website, www.keiro.org, has minutes of the Dec. 7 meeting as well as answers to families’ questions.

Since he can’t visit the Gardena site on a regular basis, Miyake said that South Bay families can also direct questions to Administrator Howard Hiyoshida, who participates in management meetings on Mondays.

Full disclosure: The writer’s father is a resident at South Bay Keiro.

Keiro's main campus in Boyle Heights. (Rafu Shimpo photo)

Keiro’s main campus in Boyle Heights. (Rafu Shimpo photo)

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2 Comments

  1. One solution is sell of the independent and assisted living and keep the nursing home. (Adult children can possibly take care of ambulatory parents. Nursing home elders require intensive caregiving and is best delivered in a concentrated site.

  2. There will still be a Japanese community in 2076!!! Its up to the 30% (and immigration).

    Although 70 percent of the under 20 is multiracial, that still leaves the 30% who are pure Japanese. When this 30% reach their 80s it will be 60 years from now or 2075. a dozen presidents come and gone and laws affecting health will evolve or change to reflect the changing needs in health care delivery. The notion of pure race today beaten down by slogans of diversity may come back. The 30% pure Japanese may observe how multiracial experiment is a failure and reject multiracialism. If 90% of the 30% reject multiracialism and contribute to a predominately pure Japanese next generation 1) the Japanese community will be preserved and 2) the 30 % of today will need the all Japanese nursing home.

    Remember, the Issei were Japanese. The Nisei tried to beat prejudice and racism by becoming 110% Anglo Saxon. The Sansei and beyond are now questioning this assimilation and considering going back to being Japanese but bilingual. The Yonsei may be the generation to feel the responsiblility of preserving their Japanese heritage and

    The question is NOT will there be a need for a Japanese nursing home. The question is HOW LARGE .

    Decline in Anglo Saxon culture.
    Remember that the US in the 1040s and 1950s was at the peak of its artistic, economic and military strength. Anglo Saxon culture was just assumed to be superior without question. The Nisei abandoned their heritage and may have been ashamed also but never questioned America and the opportunities.

    Japanese Culture in ascendance.
    Fast forward a mere 40 years to 1990 and big cracks in Anglo Saxon culture appear. US education drops from the top 10 to 35th , longevity to 40th, for the first time the next generation will be poorer than their parents. For the first time children may not live longer than their parents. Trade balance goes from positive to negative and economic opportunities for the middle class just vanish. The West now looks East for solutions.
    For the Yonsei, the assimilation model may be rejected as they witness a continuing racism white america and mixed race Japanese-XXXX, hapas or hafus disappearing into the larger white community. For the pure Japanese Americans, there appears to be a strong desire to affiliate with the Japanese community and not the white community. This is a complete reversal from the Sansei generation.

    Is the Multiracial experiment over?
    I believe so. I believe the Japanese community in the US may actually grow. Yes, I said grow from current levels. The 30% could reject the white assimilation model, English and interracial unions. Never before has being white been so negative and Japanese so positive. The Japanese live the longest and Japanese food not only is healthy but come into favor with the West. Japanese products exceed the US in quality as the US struggles standard of living declines as a result of diversity.

    Conclusion:
    It is too early to give up on the Japanese community in the US. Immigrants and their children try to assimilate in order to survive. The succeeding JA generations can now verify from themselves that the assimilation/ intermarriage path is the correct one. OR the wrong one. I believe the 30% will hold true to their Japanese heritage and reject the assimilation/intermarrage model.

    Further, aging at home is not an alternative for every Nisei. Only a few lucky aging Nisei have adult children available to provide 24/7 care. Most adult children would rather work or travel in retirement.

    So we are back to keeping all Japanese Nursing homes open for business. It may not be as difficult as you think!!

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