VOX POPULI: A Doctor’s Perspective on the Sale of Keiro

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Landscaping at Keiro's main campus in Lincoln Heights. (J.K. YAMAMOTO/Rafu Shimpo)

Landscaping at Keiro’s main campus in Lincoln Heights. (J.K. YAMAMOTO/Rafu Shimpo)

By KENJI IRIE, MD

“When I become old, I will receive good care at Keiro.”

This is the sentiment shared by many (including myself) in the Nikkei community of Southern California. I was stunned to hear the news that Keiro, a non-profit organization that is a vital part of our community, was now on sale. I feel that a source of my own future security is being threatened.

Keiro Nursing Home at Lincoln Heights was founded in 1969. I started caring for my patients there 32 years ago in 1982.

What has been amazing me at Keiro is not only the fact that the residents can watch those NHK TV programs, have classes of singing Japanese songs and enjoy some Japanese foods (although I admit these are very important elements of living at Keiro). The three most significant characteristics at Keiro that I have witnessed in the past three decades, as compared with other facilities, are:

1) Keiro residents are not screaming for help because they are frustrated or in pain.

2) There aren’t foul smells of urine and feces.

3) The residents seldom develop decubitus ulcers (bed sores). Even if they come in with these wounds, they heal at Keiro.

This has been possible because of the meticulous care rendered by the Keiro staff. Without doubt, their ways of caring for residents stem from their respect for the elderly. This, I believe, is the essence of care at Keiro. As a Nikkei physician, I would like to express here my personal appreciation for the Keiro staff’s dedicated services on daily basis over years.

I think there are three major reasons that have made such Keiro care a reality:

1) We have capable bilingual staff (not necessarily born in Japan).

2) We have so many caring volunteers.

3) We have had so many donations (average is $2 million a year, according to the Keiro survey) that have given financial support to various activities.

If Keiro is sold to a profit-making private company, it would become very difficult to maintain these vital assets.

First of all, people would not donate to a profit-making company.

Secondly, volunteers would be discouraged.

Lastly but most importantly, some (or many) capable staff would have to leave Keiro due to payroll reduction or layoffs under a profit-making management within a few years, even if they are rehired at the time of the ownership change.

The name “Keiro” might survive, but the essence of Keiro care will be lost.

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With a lot of concerns on my mind, I attended a meeting for physicians in December 2013 held by the Keiro CEO, Mr. Shawn Miyake. His explanations on the sale did not clarify my concerns.

Mr. Miyake’s explanation was as follows (from what I was able to comprehend):

• The seller of the Keiro facilities, which include the Keiro Nursing Home, South Bay Keiro Nursing Home, Intermediate Care Facility, and Keiro Retirement Home, is the Keiro Board. The board has the right to sell the facilities. The buyer will be a big company that operates many nursing homes. As of today (12/11/13), no agreement has been reached.

• The reason to sell Keiro is anticipated financial difficulties from changes in the new health care laws (Obamacare). Approximately two-thirds of residents at the two Keiro nursing homes are covered by Medi-Medi (Medi-Care plus Medi-Cal). The reimbursement for these residents would be cut into half under Obamacare and that would result in huge financial damage for Keiro.

• Under Obamacare, Keiro must accept residents from the surrounding communities. This would change the current state of mostly caring for Nikkei elders.

• The board has requested approval from the district attorney to sell Keiro. With the DA’s approval, there is no legal problem with the sale. The Nikkei community does not need to approve it.

• The board does not think the change of ownership would entail a loss of culturally sensitive care. Most of the representatives from the potential buyers expressed interest in and understanding of the Japanese culture. The board also can advise them to rehire a large portion of the current staff.

My initial reaction to the meeting was a feeling that the Keiro Board should have consulted with the Nikkei community, which includes Little Tokyo Service Center, Little Tokyo Business Association, Pioneer Center, Japanese Chamber of Commerce, Kenjinkai Kyougikai and others. After all, Keiro has been and still is one of the biggest and the most valuable assets of the Nikkei community in Southern California.

If it is true that the reimbursement for the Medi-Medi residents under Ocamacare would be drastically curtailed, the Keiro Board could have requested the Nikkei community to support them in protesting such curtailment. Such a protest would most likely be understood and recognized by other ethnic communities trying to provide culturally sensitive and language-specific care to their elderly members.

Residents from the neighboring locations to the Keiro facilities should be welcomed as long as they accept Keiro’s bicultural services.

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In 1985, the Nikkei City View Hospital closed. I worked together with other doctors and community members to stop the closure. However, we were not able to prevent this because many Nisei who had political and financial power in those days were not involved.

In the current Nikkei community, Sansei possess such powers. I believe they will also need the true “Keiro care” soon or later. Before being too late, it is essential that they assume an active role in Keiro’s survival.

The entire Keiro system actually has not experienced any financial difficulty yet. This is only speculation by the Keiro Board. Obamacare has just begun and its reimbursement for Medi-Medi residents would substantially change depending on the political climate of the times to come.

I am talking to my Sansei friends and colleagues about cuts in reimbursements for Medi-Medi residents of nursing homes. If there is no such reduction, there would be no need for the sale.

Sanseis’ participation is most urgent in the survival of Keiro as well as my personal future security and that of others.

Kenji Irie is a Little Tokyo-based physician. Vox Populi is a forum for the community. Contributions to Vox Populi may be sent 701 E. Third St., Suite 130., Los Angeles CA 90013 Attn: Editor, or emailed to [email protected] Opinions expressed are not necessarily those of The Rafu Shimpo.

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