By Zachariah Bryan
NORTHWEST ASIAN WEEKLY
Every day, Carmen Tsuboi Chan visits her father at Keiro Northwest’s Rehabilitation and Care Center in the Central District of Seattle. She goes to do his laundry, she said, but mostly it’s an excuse to see him.
Her father, Frank Tsuboi, is 95 years old and he’s been here for seven years. Above him hangs pictures of his wife and family. A small stereo sits across from him — he likes to listen to Johnny Cash and Kris Kristofferson mostly, but sometimes Japanese music, too.
Before he came here, he was a flight engineer and then an involved member of the Nisei Veterans’ Committee.
He also played ukulele. Among the CDs in his collection is a compilation of ukulele players and under track six, you can find his name, playing the song “Crazy G.”
The Tsuboi family has roots at Keiro Northwest. Tsuboi Chan’s aunt stayed here. Her grandma stayed here.
Even a neighbor of hers stayed here. She said it’s a unique place. It feels like home. The facility hosts cultural events and residents can eat rice here.
But Keiro Northwest is at a turning point. First founded as Nikkei Concerns in the 1970s for elderly Japanese Americans, the 150-bed facility is looking at a future with new leadership, a more diverse demographic, and substantial budget and recruiting challenges.
Tsuboi Chan said she’s concerned about changes in the facility, since the previous CEO, Jeffrey Hattori, stepped down at the beginning of this year and Bridgette Takeuchi took the reins.
Over the past year, Tsuboi Chan said the environment, culture, and “kimochi feeling” have changed. The leadership has been less transparent and more “my way or the highway,” she said, and patient safety has suffered due to staffing issues.
Tsuboi Chan isn’t alone in her thinking. In August, she crafted a letter with about five other stakeholders, listing point by point their concerns. Based on conversations she’s had with others, the letter represents the feelings of over 30 people, she said.
One concern was Keiro’s registration with the Washington Secretary of State from “nonprofit” to “WA Public Benefit Corporation.” “WA Public Benefit Corporation” is the technical name for nonprofits and not for profits.
On one level, CEO Takeuchi said in a phone conversation that these feelings can be attributed to transitional pains.
“One of the things that has been a challenge is we had a very loving person who was my successor here,” she said. “When there’s a change, sometimes folks, they’re fighting with their hearts. … It just feels different and it looks different.”
At a public meeting held by Keiro Northwest on Sept. 4, 27 community members, board members, and staff members sat down to talk about the challenges of the organization.
During the meeting, family members of residents said they were seeing less attention to patient care. They cited instances where residents were neglected, not getting scheduled showers, and would fall without a staff person around to help.
Tsuboi Chan said her father was dehydrated and was hooked up to an IV bag, but the staffer failed to tighten it. He was soaked in 1,000 milliliters of IV fluid and his own blood when a nurse caught it an hour and a half later.
On another occasion, she and others saw a Chinese man sitting in a wheelchair holding up an arbitrary number of fingers, shouting, “13 days! 13 days! No shower!”
Standing up, Virginia Hiramatsu talked about how her husband was left in his wheelchair during mealtime with an uncomfortable sore on his bottom, even though he asked staff to put him back in bed. It wasn’t until after mealtime was finished that he was put back into bed.
When Hiramatsu brought up the issue with the administrator, who has since left his position, she was told that she could take her husband to another facility. Confused, she asked again, she said, and he repeated the statement.
“It makes me mad. It makes me furious,” she said, fighting through tears. “I can’t be quiet any longer. I sit here and I can’t.”
Takeuchi said she couldn’t address specific cases due to privacy concerns. According to company data, the facility has historically seen an average of 20-23 falls per month. At the moment, 23 falls are taking place per month.
Tsuboi Chan wasn’t convinced.
“I challenge you to go up there during mealtime,” she said. “You will see the challenges.”
Staffing ratios have also remained largely the same, she said. Keiro Northwest previously staffed one nursing assistant for every seven-to-nine residents and currently are staffing one per eight-to-nine residents — higher than state requirements.
However, those ratios have been sustained by paying nurses overtime, totaling $800,000 last year. Takeuchi said paying overtime isn’t sustainable and is looking to hire a nursing manager, four registered nurses, one certified nursing assistant, and a few part-time roles. Because recruiting is challenging in this field, Keiro Northwest has given nurses a raise to stay competitive and is offering a $10,000 bonus to hire on new registered nurses.
Furthermore, Takeuchi said she is looking to take immediate action to permanently fill the certified administrator role, which is currently filled by interim administrator Denney Austin.
Throughout the meeting, Takeuchi was honest about the organization’s financial challenges.
Keiro Northwest lost $2.5 million last year. This is part of an ongoing trend. For years, the gap between rising costs and falling revenue has widened. Keiro lost $1.1 million in 2015 and $1.8 million in 2016.
There are a number of reasons for this trend, wrote Brandon Nelson, director of strategic operations, in an email. 2015 was the first year the Seattle minimum wage increase took effect, it was the first year the facility was required to have a registered nurse on staff 24-hours per day, seven days a week, and it was the year that Keiro Northwest launched its home care initiative, increasing expenses in its beginning months.
Add on top of that the strains of Medicaid, which pays $230 per day for a resident who lives on-site, well short of the $390 it costs to take care of that patient. The number of Medicaid patients has gradually increased throughout recent years, from 67 percent in 2015, to 75 percent at the end of July.
The goal is to raise $2 million in three to four months, Takeuchi said, coming from the community, corporations, and the government. The idea is to stabilize operations temporarily, so the leadership can implement ways to save money in the future.
“Really what we’re doing is buying time,” she said. “Don’t think it’s a one-time shot and that we’re going to ask for more money in a couple of years.”
Another goal of the campaign is to expand the donor base, beyond the traditional base of Japanese Americans, to reflect the current demographics, she said.
At the meeting, board chair Frank Fukui pondered what the changing demographics mean for what Keiro Northwest calls community. Activities have been largely dedicated to the Japanese American culture, but currently, 32 percent of residents are Chinese, 30 percent Japanese, 12 percent Vietnamese, and 12 percent other API.
“[We need to think about] the makeup of what we call community,” Fukui said.
How Keiro defines itself is important if it’s going to remain competitive with other facilities. Earlier this year, Aegis Living opened up a facility for elderly Chinese Americans on the Eastside of King County.
Takeuchi stressed that they wanted to avoid the fate of Keiro Senior HealthCare in Los Angeles, which sold off facilities to a for-profit real estate community in 2015. The CEO of the LA outfit said demographic changes and increasing diversity were largely to blame for the losses, according to Nichi Bei, a Japanese American newspaper based in California.
In a way, Takeuchi represents the future of the organization. She’s 38 and a fourth-generation half Japanese, half Caucasian American. She said people have judged her for being half white. One person even called her stupid because of her mixed race, she said. But she shrugged it off. Change can be uncomfortable for people, she said.
Though Tsuboi Chan’s letter has stirred up a miniature political storm, and even though she feels there’s a communication gap between leadership and the community, she said she wants to see Keiro Northwest succeed, and she wants her dad to live out his last years here.
“I think they care. I have to think they care,” she said.
But for some reason, she said, Keiro’s new leadership team and some members of its community are just not seeing eye to eye.
“Somehow, there’s a gap,” she said.
Zachariah can be reached at email@example.com.