By Mahlon Meyer
Northwest Asian Weekly
As he walked up the stairs to his small office, his whole body bent forward as if in pain.
“I’ve been crying about this goddamned closure,” said Tomio Moriguchi, who founded Keiro Northwest, a nursing home for the Japanese community in Seattle, over 40 years ago, along with a group of half a dozen coevals.
It was meant to sustain the aging Japanese Americans that had been interned in concentration camps—like his own family—and those that had fought for their new country and eventually become a home for future generations.
Now that vision may be coming to a close.
Keiro announced on May 8 that it was operating with a loss of $300,000 per month, citing mostly Medicaid shortfalls, and that it had no other option but to shut down its skilled nursing facility and other programs.
In the news release, the board announced the decision to “wind down” the nursing home “in order to assure the continuation of select programs,” particularly the assisted living center, known as Nikkei Manor.
But at a town hall meeting on May 14, just a week later, Moriguchi and other members of the board appeared to change course. They announced a “60-day due diligence” period, during which they would explore options to keep Nikkei Manor and an adult day care service open in some form, whether through raising millions of dollars through the community, or by joining in some form with a partner.
In other words, Nikkei Manor’s future was not secure, after all.
“Any efforts currently under way to ‘Save Keiro’ are to ensure continuation of ‘Keiro Northwest’ specifically the remaining programs Nikkei Manor (Assisted Living) and Kokoro Kai (Adult Day Care),” stated a new information sheet handed out at the town hall.
Yet the signs were not immediately promising.
When asked what it would take monetarily to keep the institution open, Moriguchi stumbled for an answer, saying it was an “unknown.”
But, he added, “My personal gut feeling is that whatever we do, it will take $5 million.”
Still, he noted that 7,000 people had donated money to Keiro over the years. He also reminded the near capacity crowd at the Stroum Jewish Community Center auditorium that he had founded Keiro when the community asked him and others to build a nursing home.
“They wanted it,” he said.
The crowd met the statements of the board with anger, sadness, and desperation.
After board members delivered preliminary remarks, moderator and state Rep. Sharon Tomiko Santos gave audience members the option to deliver questions anonymously by writing them on cards, which she then read or summarized.
She also invited others to share questions by standing. Of those few who stood up and shared questions directly, it was not immediately possible to verify their names.
One man in a blazer, who appeared to be in his 40s, holding the microphone for at least a minute before he could muster his voice to speak, lambasted the board.
Saying that his mother is a current resident and that he had contacted 33 other facilities in the past week to see if they could take her, and finding they could not, he vented his frustration that Keiro knew it was in financial trouble over a decade ago and apparently failed to take action.
“What have you done? What has the past board done?” he yelled.
Another family member mentioned safety issues and a declining rating with DSHS.
Later, she said she had been served with numerous legal documents to silence her.
Another middle-aged woman stood up and began crying, wrestling her emotions into shape before she could speak.
“I’m incredibly sad that this is happening, but also grateful to the Japanese American community,” she said, weeping openly again. “My mother wouldn’t be alive if this didn’t exist so I want to take this opportunity to thank the staff and the community.”
Then, looking at the stage, where the board members sat, she asked them, in a calmer voice, to consider “leasing the building for a time and then, when you get your finances in shape, take it back.”
Yet it was not clear if the board would be able to do that, and not so much because of an unwillingness on the part of the community to help out.
In fact, the crowd was so large that cars jammed the parking lot and attendees had to park far distances and walk to the meeting.
“They didn’t expect so many people,” said a Japanese American man that identified himself as an investor in Keiro, but was reluctant to give his name. “The whole community turned out.”
Rather, the board appeared fractured, with some members even willing to publicly undermine other members.
At issue was a board retreat last year, when board members considered whether or not to become affiliated with a national nonprofit organization, Transforming Age. Such an affiliation might have kept Keiro afloat, said those members that voted for it.
Tomiguchi and some other board members that represented an earlier generation were against the affiliation. They said they worried it would have meant at best a loss of identity. They explained that allowing Transforming Age, which runs multiple facilities nationwide, to take over might have dissolved Keiro’s mission to serve the Asian Pacific Islander community in a culturally and ethnically meaningful way.
Moriguchi said he worried that “some kind of drastic change would come” or that it would simply be shut down.
“So why shouldn’t we be the ones to do it?” he said.
In response to ongoing questions from the audience, other board members began to state how they had voted on the issue of affiliation and why.
Perhaps the most fractious moment came when Treasurer J-F Mannina, the only white member of the board, appeared to flatly contradict a statement made by fellow board member Fred Kiga.
Kiga had said that the board had been faced with two options — affiliation or closing Keiro.
Mannina jumped in and said, “We didn’t have two options. The board came to the decision to decide on two options.”
Mannina also appeared to suggest that an alliance with Transforming Age had not been seriously considered at the time. And, he added, that the decision to consider it now was, if not hypocritical, then “ironic.”
“The strategic alliance was not explored,” he said.
Now that the board has announced it will consider this option during its 60-day due diligence period, Mannina appeared to express frustration.
The devastating consequences
If Keiro does close, it will mean the end of a community that has served as a beacon of hope for many generations of Japanese Americans and more recently APIs (the community is now only 30 percent Japanese).
Currently, there are 108 residents. All of them will need to find new places to be cared for. The roughly 300 staff members also will need to find new jobs.
Perhaps the greatest blow to the community, however, is the dashing of the hopes of all those who had seen Keiro as a potential final home in case they had no other alternative.
One man, who gave his age as 66, but preferred to remain anonymous, said that he had counted on Keiro to take care of him in his old age if all else failed.
“You want to avoid going there at all costs,” he said.
“But if I get dementia or my health gets really bad, I might not have a choice,” he said.
“All my friends think the same way,” he added.
Perceptions of mismanagement
Some community members shared concerns over alleged mismanagement of funds.
One family member, who preferred to remain anonymous since her grandmother has dementia and is still at Keiro, vented frustration about alleged poor judgment in financial decisions and a lack of transparency.
“To be fair, I’m not sure how many of the current board members were around when most of the money was misused or not raised,” she said in an email before the town hall meeting.
“I believe the previous director of Keiro is the one who decided to build a multi-million dollar rock garden in the front of the building. It was common knowledge that he spent millions to build it,” she wrote.
She also accused the former management of failing to fully disclose financial problems out of fear that residents would move out and potential residents seek accommodation elsewhere.
“What I really think it boils down to, is that the last director mismanaged funds and was too ashamed to ask for help.” Current board members disputed this narrative. They said that the past board, composed mostly of different members, did try various measures to bolster Keiro’s financial situation. They created a program to provide in-home health care, for instance, besides pursuing increased fund raising.
“Many of those projects, though promising, did not yield the results the board at the time was expecting,” said Kiga.
He and others attributed much of the current financial shortfall to insufficient reimbursement from Medicaid.
He said that Keiro was losing $100 a day per Medicaid patient and that this was “clearly one of the factors” in the financial collapse.
He and other board members said that Medicaid reimbursement depends on the acuity level, or the extent of the care needs, of the resident.
Keiro, unlike other similar skilled nursing facilities, had taken in residents with lower levels of need, thus garnering less support from the government while still having to meet a high overhead, they said.
A generational shift
An inconsistency in style of management and governance among different generations of Japanese Americans may ultimately account for the breakdown in Keiro’s operations.
Scholars of Japanese American history insist that the first generation was successful in passing down values of reverence and respect.
“An important cultural value in Japan venerates the elderly, and perhaps especially because in the United States, the Issei generation faced tremendous issues of discrimination and suffering, yet preserved their dignity and community social cohesion,” said Tetsuden (Tetsu) Kashima, Emeritus Professor of Ethnic Studies at the University of Washington (UW). “I think the younger Nisei first learned and then later reflected the basic Issei cultural values—among which are compassion and gratitude.” But some board members suggested that administrators representing later generations may have simply approached financial and operational challenges with different sensibilities and a different manner of problem solving.
“We have a generational shift that we have to acknowledge. I see a different energy, I see a different way of operating,” said Julie Ann Oiye, vice president of Keiro Northwest.
Intergenerational trauma from the experience of internment in concentration camps during World War II may also have complicated communication and cooperation between the founding generation of Keiro and leaders from later on.
“The camp experience is known to have affected the family dynamic, undermining the authority of the older generation,” said one survivor of internment who has studied the long-term effects of the internment and displacement. She asked that her name be withheld.
She also suggested that later generations would more likely have pursued greater assimilation into mainstream society, perhaps changing the way they approached fund raising or other revenue-gathering activities.
“It also probably contributed to the integration of third and fourth generation Japanese Americans into the greater society—a survivor of the camps,” she said.
A harbinger of a shift in care
Board members also alluded to policy changes that slowed the processing of Medicaid payments. They said that this represents a shift away from support for nursing homes on the state and national level.
“The Division of Aging of DSHS has stated on their website it is their intent to focus on in-home care,” said Kiga. “People are doing hospice at home.”
Keiro’s closure may be a harbinger of the closure of more skilled nursing facilities across the country, if not the end of nursing homes as an industry.
“In my opinion, unless states and the federal government commit to increasing Medicaid reimbursement rates, you will continue to see an increasing number of Medicaid reliant nursing home facilities become financially insolvent and closing,” said Jerome A. Dugan, a professor in the Department of Health Services in the UW School of Public Health.
“There is a clear need for policymakers to explore the actions that can be taken to increase Medicaid reimbursement and encourage the expansion of long-term care insurance in the overall population,” he added.
The end of a vision
For Moriguchi, the only remaining founder, the issues are more immediate and personal.
He said, during the interview, his chief concern was with the residents.
“The staff says that if they move them, they’ll die faster,” he said.
The end of the nursing home also somehow seemed associated with endings in general. He mentioned his own “funeral” several times during the interview.
When asked about his religious beliefs, he said he was a member of a local Buddhist organization.
“My son tells me I should stay a member so I have a place to have my funeral,” he said.
Still, he expressed some hope for other trajectories, however remote.
When asked what was next for him, he stood up, rummaged through papers, and eventually pulled open a drawer of a file cabinet.
He held up a blueprint for what he described as a multi-use high-rise development that could be built in the International District, with some units for low-income occupancy.
The blueprint showed a tower surrounded by a lower level block.
“It’s just a dream,” he said.
Mahlon can be reached at firstname.lastname@example.org.