By Judd Matsunaga, Esq.
National Caregivers Day is observed on the third Friday in February, Feb. 20 this year. The day honors individuals who selflessly provide personal care and emotional support to those who need it most. Many are not paid, which is why it is essential to appreciate and thank them for their long-term commitment. They don’t wear capes, but caregivers are real-life heroes.
Caregivers play an indispensable role in ensuring the health, dignity, and quality of life of the people they serve. They live almost two (or more) lives and juggle their personal tasks while providing care to the best of their abilities. They:
- Reduce the burden on healthcare systems by enabling individuals to remain at home.
- Provide emotional stability to families during times of illness or crisis.
- Ensure continuity of care, which is critical for managing chronic conditions or recovery.
Caregiving involves a lot, and it can be extremely stressful to look after someone with diligence. Personally, I couldn’t do it. Imagine waking up in the middle of the night to this: Dear old Dad is standing in the living room crying. He can’t remember where the bathroom is and has soiled his pajamas. His wife is on her knees in front of him, scolding him as she tries to clean up the mess. As Ricky Ricardo (“I Love Lucy”) used to say, “Ay yi yi.”
It’s no wonder that many family caregivers often feel overwhelmed, frustrated, or hopeless and experience guilt or shame for having these feelings. According to an article from Yale New Haven Health (Sept. 18, 2025), being a caregiver who is experiencing mental or emotional strain is an independent risk factor for mortality. In one study, participants who were providing care and experiencing caregiver strain had mortality risks that were 63% higher than non-caregiving participants.
Some families in the Rafu Shimpo community have at least one daughter (or daughter-in-law) who refuses to put Mom or Dad in a nursing home. Some may have even promised never to put an aging parent in a home. I can respect that. But the stories I hear from families right here in the Rafu Shimpo community … If a couple comes in where the wife’s mother has moved in, I’ll look at the husband and say, “I bet you feel neglected.” There’s no argument, never.
One beautiful, sweet Sansei woman who had agreed to take her mother-in-law into her home, came into my office in tears. Apparently, as the mother-in-law’s dementia got worse, she started accusing her of stealing. She had given and sacrificed a lot, a real-life angel, but she was at the end of her rope. She came to me to see if I could help get her mother-in-law into a nursing home and get the state to pay for it through the Medi-Cal program. I did.
For years now, people have come to my office from all over the country (and occasionally from other countries) because they have a parent, sibling, or cousin who is up in years and lives in California. They hire me to explain what government benefit programs are available and how to qualify for them. So, when someone who does this for a living wants to tell you something for free, my advice is to listen.
I’m going to use this Rafu Shimpo article to explain the top three most common questions that I think are most beneficial to family caregivers. First, we’ll talk about how to shop around for the best, most suitable skilled nursing facility (SNF). Next, we’ll discuss how to get your aging parent into the SNF that you picked. And finally, we’ll cover how to get the government to pay for nursing home care. I’m often told, “I feel so much better after talking with you.” So hopefully, if you’re a caregiver, this information will be very helpful.
First things first. Let’s say you’ve been caring for dear old Mom or Dad at home. But as he or she gets weaker, the level of care they require can’t be provided at home. The doctor says they need to be in a 24/7 skilled nursing home. Or the police bring your mom or dad home after they are found wandering the neighborhood, lost. They might say, “This is the last time. You can’t allow your parent to roam around lost anymore. You have to place your mom or dad into a nursing home.”
So, being the dutiful daughter (or son) that you are, you start shopping around. You might think, “Mom is more comfortable with Japanese people. What about Keiro Nursing Home?” Not so fast. In 2016, non-Japanese San Diego-based Pacifica Companies bought four Keiro Senior HealthCare facilities in Los Angeles for $41 million. The deal, approved by then-Attorney General Kamala Harris, transferred ownership of the Japanese American nursing homes to the for-profit company. The facilities were subsequently renamed Kei-Ai.
Pacifica saw huge upside potential for their shareholders in the “nonprofit” Keiro nursing homes. Keiro was a nonprofit. That means they made a commitment to the Japanese American community to care for members of the aging Japanese American community, regardless of the form of payment i.e., Medicare, private pay, long-term care insurance, or Medi-Cal.
“What’s the difference?” you might ask. Short-term Medicare beds will reimburse the nursing home at rates up to 10 times more than a long-term Medi-Cal bed will pay. Profits increase if a facility increases the percentage of short-term Medicare beds and reduces the percentage of long-term Medi-Cal beds.
At the time of the sale, approximately 70% of Keiro beds were occupied by long-term Medi-Cal residents. All Pacifica had to do was wait for those 90+ year-old residents to die and replace them with short-term Medicare patients, and they profit.
Then came the COVID pandemic. AsAm News featured the inordinate amount of sickness and death at the Kei-Ai Los Angeles nursing home during the COVID pandemic. A total of 115 residents died from COVID from May 2020 through December 2022, the most of any nursing home in the state.
During that time, state inspectors found myriad violations of infection-control standards that led to multiple citations. You may recall hospitals were flooded with patients left in hallways. Kei-Ai was one of only three nursing homes in the state that accepted COVID patients from hospital overflow. (Source: https://asamnews.com/, July 3, 2024)
Since 2021, the Kei-Ai facility has been the subject of 474 complaints, 20 state enforcement actions, and $764,000 in fines. Please don’t misunderstand me. You might be extremely happy with the care Mom or Dad is getting at Kei-Ai. If that’s where your mom or dad is, I hope that’s the case for your loved one. All I’m saying is that Kei-Ai has a poor record of care, and “if the shoe fits …”
Some of you would only want your aging parent to be in the best nursing home available. Top-rated facilities excel in preventing long-term care residents from losing self-care abilities and in reducing the use of antipsychotic medications. Ratings heavily weigh nursing hours per resident, turnover rates, and as of early 2025, staffing stability. For detailed, up-to-date, and searchable ratings, refer to Medicare.gov Care Compare, U.S. News & World Report Best Nursing Homes, and Newsweek’s Best Nursing Homes.
But, in my opinion, you don’t want the highest-rated nursing home that might be located across town. You want the best available facility that’s convenient for you and other family members to visit. California nursing homes are infamous for nursing home abuse and neglect. No, I’m not talking about physical abuse or sexual abuse (although that does occasionally happen). I’m talking about giving residents antipsychotic medications without their consent.
Let’s say a for-profit nursing home wanted to increase its bottom line. Any business school would teach a basic, simple formula: increase revenue and cut costs. We already talked about increasing revenue by increasing the number of short-term Medicare beds. Now let’s talk about cutting costs, more often than not, by cutting staff. So how does one caregiving staff member take care of an entire floor that used to take two caregivers? According to the various violations and citations I read about, nursing homes will often put residents to sleep, without consent.
That’s why you hear family members say, “Every time I go visit Mom or Dad, they’re really groggy or asleep.” Many times, they’ve been drugged. And the way I understand it, they use the same antipsychotic drugs given to dangerous criminals in prison. You say, “Don’t they need consent?” Absolutely. But they do it anyway. If caught, they get a fine. But there’s no quality of life for your loved one.
The solution is to visit as much as possible. They won’t drug a resident who gets visited regularly. You, the family member, are the best way to make sure your loved one is getting quality care, so hopefully they can return home.
And don’t be the typical Japanese person who doesn’t want attention. Don’t slip in and out unnoticed by staff. When it comes to quality care, “it’s the squeaky wheel that gets the oil.” Every time you visit, drop by the nurses’ station: “How’s Mom doing today?”
Next, getting your parent into the SNF isn’t going to be easy. In fact, experts say that getting in is half the battle. If your parent is in the hospital and they want to discharge to a rehab facility, tell the discharge planner at the hospital where you want Mom or Dad discharged. That’s why shopping around first is good advice. More often than not, that facility will find a bed. Why? Because they’ll get the highest reimbursement rate from Medicare. Medicare will pay up to 100 days — actually 20 full days and 80 partial days.
After the first 20 days, many families are told they are out of Medicare’s 20 days and they have to take Mom or Dad home. DON’T DO IT. If you take Mom or Dad home, you’ll have a nightmare of a time getting them back in.
Here’s the key: if the facility says they are a short-term care facility only, don’t believe them. There is no such thing as a short-term care facility only. If they accept federal funds from Medicare, they must accept federal funds from Medi-Cal. But that won’t stop them from trying. They don’t want you qualifying for Medi-Cal.
If Mom or Dad is still at home, and you start visiting nursing homes to find one you like, the admissions officer taking you on the tour will ask, “How is Mom or Dad going to pay?” If you say “Medi-Cal,” you’ll be told there’s a waiting list for a Medi-Cal bed, possibly as long as one to two years. The trick is: Don’t say Medi-Cal; say “private pay.” It will cost you one month of private pay, but after 30 days you can convert to Medi-Cal, and they can’t do anything about it.
Finally, how to pay for the nursing home. They will tell you that the private pay rate is $12,000 per month. You say, “Mom can’t afford that.” That’s where Medi-Cal comes in. You further say, “They told me Mom won’t qualify for Medi-Cal because she has too much money.” I beg to differ.
There are legal ways to spend down, or turn excess non-exempt assets into exempt assets, and qualify for Medi-Cal benefits without triggering a three-year waiting period. This is where a qualified, experienced Medi-Cal planning attorney comes in.
For questions regarding nursing home placement or Medi-Cal planning, contact Elder Law Services of California, APLC, 1609 Cravens Ave., Torrance, CA 90501. Phone: (310) 348-2995. Website: www.elderlawcalifornia.com
Judd Matsunaga, Esq., is the founding partner of the Law Offices of Matsunaga & Associates, specializing in estate/Medi-Cal planning, probate, personal injury and real estate law. With offices in Torrance, Hollywood, Sherman Oaks, Pasadena and Fountain Valley, he can be reached at (800) 411-0546. Opinions expressed in this column are not necessarily those of The Rafu Shimpo.