Keiro Northwest closes its Seattle nursing facility


Keiro Northwest, Seattle’s largest and oldest Asian Pacific Islander senior care program, recently closed its main nursing facility and other programs for senior citizens after a decade of declining revenues and changes in the nation’s health care system.

Founded 41 years ago by Japanese Americans to care for their elderly in a culturally sensitive and linguistically competent way, the 150-bed Keiro Northwest nursing home originally served the first-generation immigrants who came to the United States beginning in the late 19th and early 20th century. They endured such hardships as blatant discrimination, the Great Depression, and the exile from their West Coast homes and incarceration in U.S. concentration camps that imprisoned 120,000 persons of Japanese ancestry during World War II.

Citing difficult financial challenges, the Keiro Northwest board of directors announced May 8 its intent to close the senior care facility at the end of October. The last resident moved out of the nursing home at 16th Avenue and East Yesler Way in mid-September.

Since the announcement to close the facility, seven residents have died due to “relocation stress syndrome,” according to Keiro Northwest CEO Bridgette Takeuchi in a Seattle Times story. She could not be reached for comments for this article.

Seattle Democratic Rep. Sharon Tomiko Santos said in a telephone interview that she’s “very sad” about the closure of Keiro NW’s nursing home. Her father, Kenneth Miyake, was one of the founding members of Keiro and had been a resident there at one time.

“I realize that for a lot of people in the Seattle area who have loved ones at Keiro, it was heartbreaking, it was a tragedy that they lost this facility,” stated the San Francisco-born Santos.

“Clearly, Keiro’s nursing home closing does have an impact on the Nikkei community, and the broader Asian Pacific American community, in terms of the availability of culturally competent skilled nursing facilities … not just in the Seattle Puget Sound region but in Washington state,” she declared. “There is quite an impact for those who are unable to afford skilled nursing facilities out of their own pocket.”

There is a nationwide effort to reduce costs for health care by focusing on having seniors age at home, Santos pointed out. “We know they live longer and they are more cognitive, physically healthy when they are able to age in place. At the same time, there is obviously still a need for highly skilled nurses for delivery of medical services.”

Changing Demographics
Keiro was “built for the Issei population,” the Nikkei state lawmaker said. “One of the things we find is that very few Nisei and Sansei are interested in living at Keiro. They have made other plans.”

Santos noted that in the demographics before Keiro’s nursing facility closed, even while there was still a large Nikkei population, there was a growing Chinese population, Korean population and Vietnamese population. “And to those linguistically isolated populations, the closure of this facility is a great loss.”

Keiro in 2016 changed its name from Nikkei Concerns to Keiro Northwest to reflect a shift from what it and its consultants judged as an unsustainable approach of serving only a dwindling Japanese American community.

Fiscal Challenge
When she saw a preview of the fiscal challenges that Keiro faced last year, Santos was hopeful that Keiro could get some funding through the state legislature. “But we were not successful in that and I don’t think that would have forestalled the closure of Keiro. It sounds like a much longer trajectory that caused the circumstances for Keiro nursing home to be closed.”

Public information revealed financial challenges at Keiro that were “very substantial,” she stated. “I think in terms of the difference between what Keiro brought in and Medicaid reimbursement … it was around $300,000 a month.”

One of the explanations the board gave at a public meeting was that back in 2008-10 the state of Washington cut back on Medicaid reimbursements, Santos related. “And Keiro was never able to fully recover, not only because we were consistently underfunding Medicaid, and Keiro has to pay more for their culturally competent and linguistically appropriate staff, has to pay more for their basics like food.”

Keiro Northwest is an umbrella organization that had the Keiro nursing home, the senior transportation program that was closed, and a food service program that was closed. What remains open today is the Kokoro Kai adult day program, and Nikkei Manor, the assisted living facility. “My understanding of the way the Keiro Northwest board of directors shared information to the public is, they wanted to save Kokoro Kai, and to save Nikkei Manor,” she related.

The 50-bed Nikkei Manor is just across Sixth Avenue South from Uwajimaya in the Chinatown International District. It typically operates at capacity with a waiting list of about 200, and is occupied almost solely by Japanese Americans, according to the Seattle Times. Like all other programs at Keiro Northwest, Nikkei Manor offers pricing well below cost.

Reasons for Closure
Santos said some factors contributing to the demise of Keiro’s nursing facility are: Medicaid reimbursement rates not keeping up with the actual cost of delivered service; a federal rule requiring a registered nurse to be on the premise 24 hours a day, seven days a week; the city of Seattle adopting a $15 minimum hourly rate. The cost of operating a nursing home in Seattle is much higher than in the rural part of the state where they don’t have the $15 an hour minimum wage requirement.

Another contributing factor in the demise of the nursing facility, Santos said, was the fact that many people — including Nisei and Sansei — who have private insurance, or long-term insurance, or who can afford to pay out of pocket, were not coming to Keiro.

Keiro could not afford to subsidize the low-income patients with the payments they would receive from patients who could afford to pay more, she explained. Typically, health care facilities would subsidize mainly low-income patients with the rates that they are getting from those who can pay out of pocket.

“I don’t know if this outcome could have been prevented,” Santos said. “In our Japanese culture, we have the tendency to not want to create alarm in the broader community, and to try to take care of things internally … It may have played a part in the closure because most in Keiro’s administration were people of Japanese background.”

Partnership, Not Closure
Amid the turmoil surrounding the closure, Board President Tomio Moriguchi was removed from his position in August, and some opponents of the closure saw this as an opportunity for a partnership between Keiro and Transforming Age, a Bellevue (Washington)-based national nonprofit organization that helps struggling senior-care institutions. (Moriguchi, a founding member of Keiro Northwest, declined to comment).

An online petition called for an affiliation with Transforming Age. That petition, “Help Us Save Keiro Northwest,” was signed by leaders of prominent Asian American organizations, Keiro employees and former board members, community members and business leaders. “We want our Keiro back,” the petition says. “It is bigger than all of us.”

However, in a close vote, the board chose not to affiliate.

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