VOX POPULI: Closure of Sakura ICF: Start of the End to Culturally Sensitive Elder Care for Japanese Americans?

By KENSAKU NAKAYAMA

My 93-year-old mother, Tomiko, who struggles with cognitive impairment, does not understand what is happening to Sakura Intermediate Care Facility in Boyle Heights, her home for the last eight years.

The ICF’s administrator, Beverly Ito, has indicated that she hopes to transfer out all residents by late August. We know of no other place that can provide my mother the Japanese-language care she needs. Sakura ICF is the only ICF facility in California that offers culturally sensitive living and health care services to Japanese and Japanese American seniors.

The closure of the ICF will mean more than her transfer to another facility: it will be the loss of the relationships she’s developed with the residents and staff. She will no longer be dining and singing old-time Japanese melodies with these friends and residents, some whom she’s known for decades prior to her life at the ICF.

Also, familiar caregivers will no longer be there to assist her with fundamental life needs. It will mean an end to the Japanese language-centered community that has been one of her few comforts in her old age.

Pacifica Co., a multinational real estate development company that in 2015 purchased the four Keiro facilities comprising Keiro Retirement Home (now Sakura Gardens), Keiro South Bay Nursing Home (now Kei-Ai South Bay), Keiro L.A. Nursing Home (now Kei-Ai L.A.), and Keiro ICF (now Sakura ICF), has plans to convert Sakura ICF into market-rate apartments.

The sale of the four facilities to Pacifica by the nonprofit Keiro Healthcare board was strongly opposed by the Japanese American community. However, the board proceeded with the sale partly due to decline in revenue resulting from a Medi-Cal change that lowered the reimbursement payment for each ICF resident. 

The Keiro board did not explain to the Japanese American community any options they considered before they decided to sell, nor give details of Keiro’s financial status. In 2016, a year after the sale, the CEO for Keiro received compensation that was more than three times the average compensation for the previous five years (2010-2014; figure for 2015 is not available through open990.org).

The then-attorney general of California, Kamala Harris, allowed the sale under the requirement that Pacifica abide by 13 conditions of sale for five years. One central feature was Condition XIII, which stipulated that the four facilities operate in a “culturally sensitive manner,” where “the environment foster an awareness and acceptance of the cultural characteristics, history, values, beliefs, and behaviors of the Japanese American residents and families and community.”

Now that the five-year period for the sale conditions has passed, there is growing concern that the culturally sensitive care will slowly disappear from the remaining facilities.

The four Keiro facilities, through acquisitions beginning in the 1960s, were a comprehensive retirement home to nursing care network called Keiro Healthcare and a result of the vision of Japanese American community leaders such as George Aratani (founder of Mikasa and Kenwood Electronics), Fred Wada (wholesale produce businessman), Edwin Hiroto, Frank Omatsu (VP, Sumitomo Bank),and others. These original Keiro founders envisioned facilities that assured Japanese American seniors a place to spend their twilight years in an environment that “fosters and accepts their cultural history and values.” This vision was betrayed, however, by the sale to Pacifica Co.

There are very few facilities in California that offer the culturally sensitive care towards Japanese Americans that have been provided by these facilities. So, the residents have very few choices in relocation alternatives. The seemingly obvious choices are the two Kei-Ai skilled nursing facilities, but many residents are too high-functioning to transition from an ICF into a skilled nursing facility. SNFs tend to be much more restrictive in allowing residents freedom of movement due to fear of falls compared to ICFs, forcing the more active ICF seniors into less active lifestyles.  

Also, Kei-Ai L.A. suffered extremely high COVID-19 deaths during the pandemic. (**L.A. Times,** March 1, 2021) As of May 30, out of an average daily census of 230 residents, there have been a staggering 105 deaths among the Kei-Ai L.A. residents, mostly Japanese American seniors.

It must be also mentioned that Pacifica was granted approval for Kei-Ai L.A. to be a COVID-19 designated facility, allowing over-stretched hospitals to transfer COVID-19 patients there, the program being of financial benefit to the receiving facility. Kei-Ai SB, a non-COVID-19 designated facility, reported only five total COVID-related deaths out of 83 occupied beds as of May 30.

Clearly, serious problems existed in staff training at Kei-Ai L.A. The facility has not provided any explanation on what caused such a horrific outcome. In contrast and to the credit of current Sakura ICF administrator Ito and her staff, residents there have experienced no COVID-19 cases nor deaths during the same period.

Another possible transfer site is Sakura Gardens, an assisted living facility that does not accept Medi-Cal residents. However, though several assurances were announced that SG has applied for a Medi-Cal waiver (assisted living waiver) that will allow Medi-Cal residents into SG, the complete application is yet to be received by the California Department of Health Care Services. These developments strongly suggest that Pacifica has not been enthusiastic about transferring ICF Medi-Cal residents to SG, rather preferring the admission of higher-paying private payees.

Pacifica has also not been kind to the staff at Sakura ICF in that more than 20% of the care-givers were laid off in May after receiving their notices on the day of their termination, without severance pay. One staffer had been employed at the facility for over 20 years. Beverly Ito reported that her offer to find ways to cut back on expenses to save staff positions was denied by Pacifica.

Collateral to all of this is that efforts made by various activist groups to delay the closure such as filing complaints and appeals to the CDPH. This adds to the stress and workload of the ICF staff, who must respond to each inspection, but does not affect the parent Pacifica Co.

Assembly Bill AB 279, sponsored by Al Muratsuchi and Miguel Santiago, is moving through the California Legislature. If passed, it will “prohibit the transferring of ICF or SNF residents during any state of emergency relating to the coronavirus disease 2019 (COVID-19).” It passed the California Assembly on May 13, 2021 and is now awaiting deliberation in the State Senate.

Those of us who are against the closure of Sakura ICF hope for its passage in the Senate and signature into law before the August closure of Sakura ICF. Support for not only AB 279, but halting the closure of Sakura ICF has been voiced by many local politicians, the attending physicians of the ICF residents, and community organizations such as Save Our Seniors (SOS) Network, Sakura ICF Family Council and Koreisha Senior Care and Advocacy (KSCA).

I, along with my mother and the remaining ICF residents and their families, ask for your support on this issue and to contact your state senators expressing your support for AB 279. The closure of Sakura ICF may just be the beginning of the gradual disappearance of the remaining culturally sensitive ex-Keiro retirement and nursing facilities for Japanese and Japanese Americans.

As a community, we must all become more alert to future developments at these facilities and voice concerns loudly and clearly.

Kensaku Nakayama is professor emeritus at CSU Long Beach.