By Zachariah Bryan & Ruth Bayang
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 (KNW). 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 KNW 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. Over the past year, she said the environment, culture, and “kimochi feeling” have changed.
On one level, CEO Bridgette Takeuchi said in a phone conversation that these feelings can be attributed to transitional pains.
“[Former CEO] Jeffrey (Hattori) was loved by many. Whenever you have someone that is well liked and there is change, that is hard.”
In August, Tsuboi Chan 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 highlighted in the letter was Keiro’s change in 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. Takeuchi affirms that KNW is still a nonprofit corporation.
At a public meeting hosted by Keiro on Sept. 4, 27 community members, board members, and staff members sat down to ask questions of the staff and Board members about the state of KNW and its future.
During the meeting, family members of residents voiced their concerns.
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 man holding up an arbitrary number of fingers, shouting, “13 days! 13 days! No shower!” KNW said its records show that no resident has gone without a shower for 13 days — even those who have refused showers, which is their right.
Felicia Seubert refutes Tsuboi Chan’s statements. In an email to the Northwest Asian Weekly, Seubert said that Tsuboi Chan violated her mother’s HIPAA privacy in that letter.
“I can assure you there is no neglect of any sort by any of the staff,” Seubert said. “Mistakes do happen but not neglect and I am extremely unhappy that my mother is being used by Mrs. Chan for what purposes I do not know.”
Virginia Hiramatsu stood up at the meeting and shared that 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.
“It makes me mad. It makes me furious,” she said, fighting through tears.
KNW claims that Hiramatsu’s comments were taken out of context. According to KNW, the former administrator conveyed that he wanted Hiramatsu to be happy with her husband’s care “but if there was simply nothing we could do, we could help her find a solution that would better meet her needs.”
According to company data, the facility has historically seen an average of 20-23 falls per month. Citing the Centers for Disease Control, KNW said the number of falls at their facility is lower than the national average.
“I challenge you to go up there during mealtime,” Tsuboi Chan said. “You will see the challenges.”
KNW acknowledges mealtimes are one of the most challenging times at any facility. “We are currently looking at creative ways to offset this challenge, including launching the Feeding Program (where volunteers can be trained to help feed residents) to alleviate the burden on our staff,” said Takeuchi.
Staffing ratios have also remained largely the same, Takeuchi 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 $480,000 last year.
In addition, KNW has had to pay $300,000 for agency fees for third party temporary clinical staff.
Takeuchi said paying overtime and agency fees 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 had an operating loss of $2.5 million last year. This is part of an ongoing trend, and there are a number of reasons why, according to Brandon Nelson, director of strategic operations. 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.
“In the next few months we will be running a campaign to raise funds where a portion of the proceeds will go towards operating expenses,” said Takeuchi. “This is an investment to grow our current programming (particularly for Assisted Living, Horizons, and Home care) for the future. We want to allow for time to have meaningful conversations with the community about what their needs will be in the future and grow and develop these programs to be sustainable. In addition, a portion of these proceeds will go to our endowment… to ensure that future generations will be able to continue and evolve these programs for years to come.”
At the meeting, board chair Frank Fukui pondered what the changing demographics mean for what Keiro Northwest calls community. What started out as a facility for Japanese Americans now serves Chinese (32 percent), Japanese (30 percent), Vietnamese (12 percent), and other API (12 percent).
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.
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.
This story was updated on Sept. 26 after a meeting between the Keiro Northwest board and editorial staff of the Northwest Asian Weekly.
Zachariah can be reached at firstname.lastname@example.org.
Ruth can be reached at email@example.com.