JASEB to Stop Operating Homes for Japanese American Seniors

In the early 1970s, the aging Issei presented a unique challenge for the Japanese American community. While there were plenty of resources and care facilities for elderly people, they were not well-suited for a first-generation Japanese immigrant population.

Around this time, two organizations dedicated to caring for the Issei — the East Bay Japanese for Action and East Bay Issei Housing — formed in the San Francisco Bay Area. By the mid-1980s, they merged to become Japanese American Services of the East Bay (JASEB) Today, they provide bilingual and bicultural programs and services that include a senior center in Berkeley with activities and classes, a meal delivery service, a case manager program to help families with various aspects of aging and two assisted-living homes — Cypress House in Hayward, Calif., and Channing Way House in Berkeley.

The JASEB board voted unanimously in September 2009 to end its ownership of the two homes, in a move they say will accommodate changes in the Nikkei community and allow for more accountability in the care of the seniors.

The decision is the result of several years of debate as to whether the facility should retain its current status as a rare senior care facility exempt from state license.

Many residents of the homes and their families are dismayed by the uncertain future of the facilities.

A Home for Nikkei Seniors

The Cypress House was founded in 1982, at a building purchased by JASEB. The facility provides a place for Nikkei seniors to live in the company of other Nikkei and receive culturally-sensitive care. The facility, as well as its sister house in Berkeley, serve Japanese meals and have a Japanese-speaking staff.

Designed essentially as a small family cooperative — Channing has a capacity of seven residents, Cypress has a capacity of 12 — the facilities obtained exemption from state regulation under the premise that residents would be cared for by their families as if they were in their own home.

Under this agreement, families are responsible for contracting the home’s staff, allowing them greater autonomy in deciding the type of care they receive. For instance, it allows seniors who are wheelchair-bound, bedridden or experiencing dementia to remain in the home, whereas many state-licensed facilities are only allowed to provide certain levels of care and could not legally house them. As seniors age and their conditions deteriorate, they often move out of their state-licensed homes at the end of their lives; under the exemption, seniors are allowed to remain.

Of the approximately “130 Japanese elderly who have stayed at (Cypress House), most have stayed until the end of their life,” Masa Fukuizumi, who has been with Cypress House since it opened in 1984 — initially as a caregiver and currently as a resource specialist — said in a statement. “It is commonly said that the older one gets, the less flexible a person is and the more fragile one becomes when adjusting to his or her surroundings… to the families of the residents, and most importantly the residents themselves, passing away in one’s familiar surroundings is, I believe, everyone’s wish.”

Problems with the Exemption

In 2003 the limitations of the current arrangement became apparent when 99-year-old Ayako Ozawa passed away due to what her family alleged were unexplained injuries she suffered at Cypress House.

Under the exemption, JASEB is only authorized to act as landlord of the facilities — they are not liable for the way care is delivered, but at the same time, they are not able to impose regulations to protect the residents.

“We are not supposed to be responsible for the provision of care, and I think the unfortunate circumstance is that it is not well understood by the community and even by some former residents,” Bruce Hironaka, board president of JASEB explained to the Nichi Bei Weekly. “When there are problems in (the facilities), people come to JASEB and ask them to fix the problem.”

While the organization was not sued in this instance, JASEB was left feeling vulnerable.

“Liability is ultimately determined by a court of law,” Hironaka explained. “Anybody can decide that they want to sue and that means we would have to defend ourselves.

“JASEB has a strong reputation in the community,” he continued, “and a suit being brought against us (regardless of its merits) could damage it… It would drain resources and effect our overall (operations) and ability to serve the community.”

JASEB began considered licensing the homes so they could institute state regulations that could protect both the organization and its residents.

“Licensing maintains quality of care,” Sandy Mori, the former development director of Kimochi, Inc,, said. “State licensed facilities are subject to two inspections yearly that assess facility cleanliness, record keeping and hiring practices, among many other important regulations.

“Kimochi advocates for facilities to be licensed, and I completely support the JASEB board of director’s position,” Mori said. She also, however, emphasized the importance of family members having “access to information on options for their seniors.”

A Different Generation of Nikkei

In 2007, JASEB commissioned a Nikkei social worker to help determine their course of action. The social worker conducted interviews with Cypress House residents and recommended that JASEB license the facility, sell it or continue to operate it as an exempt facility but require a degree of self-regulation.

“The old way wasn’t working,” Hironaka explained. “It worked when the Issei were in the home, because the Nisei would check on the quality of care the staff they hired provided… you could argue that we didn’t need state regulations.”

The JASEB board president explained that Nisei were both less likely to be litigious and more active in the care of their parents, compared with Sansei.

“Today, we clearly don’t have state regulation and clearly not all the families are actively involved… and the level of involvement of all the families in totality has declined,” Hironaka continued. “That’s not to say people don’t love their mom and dad, but our lives are different and the world is different.”

The Residents and Families

For many of the residents, the primary appeal of the homes was their unique ability to house seniors who could not stay in state-licensed facilities.

The Cypress House Family Council, the governing body of Cypress House (responsible for setting policies and ensuring proper care) wants to keep the facility exempt. The council, comprised of residents’ family members, has maintained that position for the past several years.

From November 2008 to August 2009 they negotiated to have the facilities subleased by Kotobuki Services Inc., (KSI), a nonprofit organization founded in 1999 by former Cypress House family members.

JASEB is currently offering KSI first rights of refusal to buy the property now that JASEB has decided to end ownership.

The negotiations are confidential and the family council is not involved in them, however, if the facility were handed over to KSI, current residents would be allowed to remain there.

“As long as they have a strong protocol in place, unlicensed facilities can operate properly if the owner is willing to take on that personal liability,” Kirk Miyake, executive director of Kokoro Assisted Living, explained. “I refer residents to ‘Ume no Ki’ (an exempt Nikkei facility in the East Bay), and it seems to be a great, nicely run place.”

“I think we all would like to see Kotobuki take over the facility,” Rich Kakigi of the family council told the Nichi Bei, adding that the council does not have an official spokesperson, so he cannot truly speak on their behalf. “I think that would be a win-win situation.

Currently, Cypress House residents have been given a March 31 move-out date, which is longer than the 30-day notice legally required. However, the uncertainty about their future, families have said in a statement, is causing stress for the elderly residents who may be facing eviction.

As of press time, the Nichi Bei Weekly was unable to reach any family members who would comment publicly about having to move their parents from their homes in JASEB facilities.

“This is a difficult decision and we know that is impacting the families in a way they don’t want,” Hironaka said. “We all have or have had family (in assisted-living care facilities) and we’re trying to do what we think is the right thing for the Nikkei senior community.”

JASEB has offered assistance to the families by providing individual case management services to assist interested families, including helping families evaluate alternative facilities. The JASEB board has also created a fund to provide some need-based transitional financial assistance to residents. If JASEB were to sell the facility, it would use the proceeds from the sale to further its mission.

“Whether they get it from JASEB or not, those families need advice from professionals in the field of aging,” Mori added. “Family members need to know how to get access to information about the options for their parents given their various conditions.

“This is a very complex issue that touches on larger ones,” she continued. “The creation of more services to help keep seniors in their own homes, in the neighborhood in their community as long as possible is needed, as is additional sensitivity to the needs of caregivers.

“This shouldn’t be a divisive issue… Because of the increasing needs for (senior care) in the Japanese American and Japanese speaking community, we will need new solutions.”