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West Coast Nikkei Eldercare: Planning for New and More Diverse Systems of Care

Discover Nikkei, News Report, Nancy Matsumoto Posted: May 09, 2010

In 1971, a group of San Francisco Sansei began providing Issei seniors with rides and pedestrian escorts to and from their homes, as well as help with government health benefits applications. The non-profit multi-service care organization Kimochi Inc., located in San Franciscos Japantown, grew out of these early efforts. Around the same time, Japanese-American student activists from San Jose State University and UC Berkley began organizing support systems for elderly Issei, focusing on health fairs in San Jose and housing issues in Berkeley. Over the years, their efforts coalesced to form Yu-Ai Kai Japanese American Community Senior Service (YAK) in San Joses Japantown and the Japanese American Services of the East Bay, Inc. (JASEB). All three organizations were outgrowths of the Asian- American consciousness movement of the late 1960s, which later helped fuel the World War II redress and reparations movement.

My interest in these organizations and Nikkei eldercare in general grew out of my grandmothers stay at Keiro Senior Healthcare in Los Angeles and my mothers occasional work there, which gave me a glimpse into the unique cultural environment of the Japanese old folks home. Later, watching my mother and her friends approach decisions about retirement living and beyond, I realized that the all-Japanese environment once mandatory for non-English speaking Issei has become only one of several options for the Nisei and older Sansei generations. So I launched this exploration into the future of West Coast Nikkei eldercare.

After surveying the Los Angeles Nikkei eldercare scene, I moved my attentions north, to the Bay Area and Silicon Valley, to find out how Nikkei communities in those areas are facing the challenges of increased assimilation, the migration of Sansei and Yonsei away from the old Japantown hubs, and the economic challenges that face the entire healthcare industry now.

One difference is that unlike their Los Angeles counterpart, Keiro Senior Healthcare, Kimochi, YAK and JASEB were launched by Sansei, not Nisei. Another is that where Keiro developed residential, assisted-living, intermediate, skilled nursing and rehabilitative care, these organizationswith a smaller Nikkei population to serve and smaller budgetshave focused more narrowly on assisted-living facilities and social service programs. YAK is developing a wellness model that emphasizes health, exercise and preventive care. To varying degrees, these organizations have started reaching out to other Asian populations as a means of responding to changing demographics and to stay afloat financially.

Today in San Francisco, only a few Issei remain, says Sandy Mori, one of the co-founders of Kimochi and its recently retired development director, and the average age of its Nisei clients is 80. Now, its the older Sansei who are coming into the picture, adds Mori; they are the group for whom Kimochi (the word means feelings, and refers to the respect, gratitude and love the organizations founders felt toward their elders), is now developing services.

The center emphasizes an aging in place approach that allows seniors to stay in their homes as long as possible. Although Kimochi runs a small, 20-bed residential and respite care facility, its emphasis is on its social day care program for 40 clients, a nutrition program, transportation and home meal delivery services.

Kimochis federally funded nutrition program serves about 300 Japanese-style meals (a $2 donation is suggested) per day to seniors over 60 and their spouses, handicapped people who live with a senior, and those assessed to be nutritionally in need. A large segment of the people who congregate for these lunches is Nisei and shin-Issei. We were the first nutrition program in the state of California to do ethnic meals, Mori says. We wanted to show that meals that are culturally relevant are very important as people get older.

I know this is true from watching my grandmothers tastes narrow and revert to her earliest food preferences as she grew older. As a newcomer to the United States in the early 1920s, she quickly learned how to make meatloaf, tuna casserole, tacos and lemon meringue pie. After a certain age, however, she preferred sashimi, sushi, and for some reason, the occasional non-Japanese meal of Popeyes fried chicken.

Kimochi also delivers hot lunches to about 125 seniors, not all of them Japanese. The meals are for anyone who likes Japanese food, Mori says. Although only 40 percent of those who come in for hot meals at Kimochis Sutter Street location are Japanese, 90 percent of Kimochis home delivery clients are Japanese. It has to do with the culture, explains Mori; A lot of Japanese dont want to come get a meal where people will see them. Theres a lot of pride involved. Although the federally funded nutrition program, including home-delivered meals, is not based on need, some older Japanese seniors may view the luxury of a hot meal showing up on their doorstep as charitable handout.

Because Kimochis residential facility is non-medical, meaning nursing services are not included, it receives no government funding. Kimochis board decided not to provide medical services as Keiro Senior HealthCare in Los Angeles does, Mori says, because it felt the cost of health care was too high; the organization wanted to focus on social services instead. At one time, Kimochi benefitted more from local government and private foundation grants, but those sources have dried up along with the poor economy. There are more foundations that give to children and youth, observes Mori. There is still this attitude in our country that people who are older have had their day, you dont spend resources on them, you dont pay a lot of attention, you just dont deal with their issues. They dont see aging programs being about the future.

Fees for residential care range from $2,870 to $4,550 per month, based on the level of care required; respite care is $165 per day. Four Supplemental Security Income beds are available (for the blind or otherwise disabled aged), but they are subsidized at only $800 a month; the balance comes from private fundraising.

Its a struggle, says Mori of keeping the non-profit afloat, and something that would not be possible without the centers 200 volunteers. Even with this strong support system, however, Mori says, Its continual fundraising. My thinking now is that our donor base has to be more extensive, weve got to go beyond the Japanese community in order to maintain what were doing. The organization serves a large population of Korean seniors, and has hired a part-time Korean social worker. Adds Mori, Now we have to go and raise money from the Korean community.

Scott Ito, Kimochis planned giving manager, is working to engage younger Sansei and Yonsei in fundraising. Kimochi holds a Sansei Live musical variety show every year featuring performances and food demonstrations, and experimented with a hip hop fundraising event last year. This year, Kimochi organized a telethon featuring a film by local public defender Jeff Adachi on Asian American stereotypes. The show was broadcast live on the local Asian-language station KPFS, and raised more than $15,000 for Kimochi.

Ito, who worked at Keiro Senior HealthCare in Los Angeles before returning his native Bay Area to work for Kimochi, is optimistic about the prospects of Yonsei taking over the Sansei fundraising and leadership roles at Kimochi. He points out that although Keiro L.A. was founded by Nisei, and Kimochi by Sansei, both organizations attacked the same problems and ended up pretty much in the same place. Ito adds, It makes me very optimistic about the role of the Yonsei generation. This deep Japanese sensibility of taking care of our elders in a respectful way, its pervasive beyond any assimilation. We all want our parents and grandparents to be in the most comfortable place possible.

For those in need of a more intensive level of care than what Kimochi provides, Bay Area seniors can go to Kokoro, a nearby non-profit assisted-living complex that opened in 2003. The facility grew out of a 13-year-long effort by a consortium of church groups, and is headed by a volunteer board of directors, a staff of 27 full-time and 20 part-time employees, and a corps of 25 volunteers, some of whom are old enough to be residents.

Kokoro (the Japanese word for heart that combines notions of heart, mind and inner spirit) is located at 1881 Bush Street, in close proximity to Japanese Buddhist, Shinto and Presbyterian churches and a block from the Japantown mall. Residents can walk to the yearly obon festival, eat rice and Japanese foods daily, and participate in the annual cherry blossom festival and other cultural events in the neighborhood.

Kokoro offers 37 of its 54 apartments at below-market rates, using a sliding-scale fee system based on a review of prospective residents income and assets. Depending on the level of care needed, income level and availability of discounted rates, the cost of a private studio apartment can range from $1,950 to $5,100 dollars per month, says Kokoro Executive Director Kirk Miyake. Since the facility does not offer skilled nursing or rehabilitative care, Kokoro, like Kimochi, does not receive Medi-Cal or Medicare funding. The facility does, however, attract new residents by providing short-term care to seniors recovering from surgery or other hospitalization. In some cases, Miyake says, respite stays have turned into long-term occupancy when the senior sees how much Kokoro offers.

Over the past year, Kokoro has faced a recession-driven fall in occupancy rates. Meeting its annual budget requires a 90 percent occupancy rate, but Miyake says that the organization is now running at 87 percent occupancy and has 7 vacant apartments. Some potential clients are going straight to assisted- living communities that offer support for residents suffering from advanced dementia (Kokoro can only accommodate residents evaluated to have initial stage dementia) and some seniors are opting for facilities that do not cater primarily to Nikkei but are closer to family members.

Now Kokoro is refocusing its marketing efforts to help reverse the effects of an industry-wide occupancy slump. I joke with board members that Im going to have to convert the rooftop into a spa for residents, says Miyake, but he knows that he may also have to start marketing beyond the Japanese community. Right now what brings people into Kokoro is being able to speak to someone in Japanese and the Japanese food, says Miyake, but that is slowly changing. Today, 83-percent of Kokoros residents are Nikkei; the remaining population is a mix of different ethnicities, including Chinese, Korean, Jewish and African Americans. Miyake sometimes fields requests from prospective Chinese residents for Cantonese speaking caregivers, but he says, Its hard to guarantee staff who can speak a specific language other than English. Even providing a round-the-clock Japanese-speaking staff person has not been possible.

Miyake predicts that Sansei will still feel comfortable in an all-Japanese environment for another 20 years or so, but adds, Im part of that group, and I dont think I will have a problem fitting into another kind of assisted-living facility when my time comes. I grew up eating Japanese food, [A Nikkei facility] would be nice, but I could go to a place that offers a more western style of food; its not a requirement. On a small scale, Kokoros dining room is already home to a blend of races, ethnic foods and preferences. One of Kokoros residents is a Caucasian man who will sometimes decline the Japanese option at mealtimes, order from the alternate menu that is always offered, and is satisfied with a hot dog or tuna sandwich. Miyake recalls one Nisei resident who preferred potatoes to rice and complained that spud dishes were not served often enough.

As with many of the Nikkei eldercare organizations I spoke to, at Kokoro, says Miyake, Fundraising events and unsolicited donations have helped us a great deal, allowing us to maintain a robust activity program.

Inland and to the south of these Nikkei centers, San Joses Yu-Ai Kai Japanese American Community Senior Service serves about 3,000 seniors a year, offering senior day services, on-site hot lunches and meals on wheels, transportation, case management social services and caregiver support groups.

Aided by a long list of community supporters and its close ties to the Japantown business community, Yu-Ai Kai has been serving the community for 35 years. Anticipating the needs of its growing number of seniors, the center adopted what it calls its Healthy Aging Initiative last fall, aimed at helping members from 55 to over 100 stay active, sharp-minded and fit. Especially designed to appeal to the boomer generation, activities such as healthy cooking and nutrition classes, health education programs that focus on chronic illnesses and injury prevention, and exercise classes for all members from the more active to frail seniors are planned. These activities will take place in YAKs new Akiyama Wellness Center, scheduled to open later this month.

Yu-Ai Kai (the name means gathering of friendship and love in Japanese) has an annual budget of a little over $1 million, says Executive Director Sophie Horiuchi-Forrester,. It receives a mix of government and foundation grants to help fund its nutrition and senior daycare programs, and actively competes for government, corporate and foundation money, donations and sponsorship. Although the recession has taken a toll, strong community backing has so far helped YAK stay in the black.

Commenting on the increasing diversity of its community, Horiuchi-Forrester says, Opening the doors to other ethnicities is a natural progressionwe want to honor and keep our traditions, and yet recognize that our population is increasingly diverse. A recent Nikkei cancer forum, which featured simultaneous English-Japanese translation via headsets, drew surprisingly large numbers of both JA and shin-Issei, and showed YAK that there is a hunger for health and wellness programming. YAK plans to add a support group for cancer patients, survivors and caregivers, and is contemplating an inter-generational and inter-cultural program called Chibi and Me to recognize the growing number of members who are helping care for their grandchildren.

The Japanese American Services of the East Bay, Inc. provides Nikkei seniors of Alameda and Contra Costa Counties with a senior center, nutrition and educational programs, case management by social workers and transportation services.

In addition to facing the same fundraising challenges as other Nikkei eldercare organizations, JASEBwhich operates on a budget of less than $1 million annuallyis challenged by the geographic dispersion of its members and the lack of a unifying Japantown in the area it serves, says JASEB board president Bruce Hironaka.

The organization has been involved in a multi-year process of deciding whether or not to divest two community homesunlicensed family cooperatives allowed to operate as low-cost, culturally sensitive senior housingin Hayward and Berkeley. Hironaka says the organization made the difficult decision last September to gradually phase out its affiliation with the homes; it will continue to serve as a co-sponsor of a 99-bed federally subsidized affordable-housing complex in Hayward, however.

JASEB has just completed the first strategic plan in its 39-year history, and the organization is planning a fundamental change in direction. Our current fundraising model, where were heavily dependent on the Nisei generation, says Hironaka bluntly, is not sustainable. Like YAK, JASEB hopes to broaden its reach by becoming a multi-generational service center focused on families. Although JASEBs services are open to everyone, most of its participants are Nikkei. Ultimately Hironaka believes the organization will broaden its scope to serve a broader Asian Pacific Islander population, but he says, What we heard from the community was that they were not looking for a rapid transition in this area.

That may be so, but given the high rate of intermarriage among the Sansei and Yonsei generations, Hironaka points out, just by focusing on the different generations of the Nikkei community well in fact come to serve different ethnic backgrounds.

The bottom line, says Sandy Mori of Kimochi, is that until the federal government provides financial support for community-based long-term care, and as long as ninety percent of seniors want to live at home or age in place, our society and families will need to continue to help care for their elderly. Because our Japanese culture promotes and embraces this value, our JA systems of care work.

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