By Keiko Ikeda, Ph.D., Tazuko Shibusawa, MSW, Ph.D.
In September 2019, outcome of the survey and feasibility study on Nikkei senior facilities was presented at Maryknoll Japanese Catholic Center in Los Angeles. The auditorium was filled with concerned individuals, since the sale of Keiro in 2016 left a paucity of affordable, Nikkei senior care facilities in the nation. 1,478 Japanese Americans of various generations, living in U.S. cities with significant concentration of Nikkei population participated in the study. They included Shin-Isseis to Goseis, and mixed heritage JA populations, consisting of Japanese & other Asian and Japanese & non-Asian individuals.
This research was funded by UCLA Asian American Studies/Aratani Community Advancement Grant and by Koreisha Senior Care & Advocacy. Researchers were Christina
Miyawaki, Ph.D. of University of Houston, Tazuko Shibusawa, Ph.D. of New York Univ., Ray
Hamaguchi of Los Angeles and Keiko Ikeda, Ph.D. of Los Angeles.
According to Pew Research (2017), there has been a steady increase of Japanese population in the U.S. In 2015, there were 1.4 million Japanese living in the nation and Japanese immigrants were staying longer in the U.S. than ever before. However, only half of the Shin Isseis were proficient in the English language. And while the U.S.- born JA’s outnumber the foreign-born Japanese at younger age groups, this number reverses with the older age groups, such that at age 65 and older, there were more Shin Isseis than native-born Japanese Americans living in the U.S. This study set out to find out how the different generations, age groups, people with varying educational backgrounds, and marital status felt about entering a Nikkei senior facility.
Majority of the participants preferred to live in the three types of residences: Nikkei
retirement home, Nikkei assisted living facility, and Nikkei nursing home. It is to be noted
that nearly half of those who preferred to live in the retirement home stated that they could
pay up to $2,000 per month as rent. With assisted living, which typically does not accept government insurances, majority responded that they would use Medicare, or both
Medicare and MediCal, and only 14% would pay out-of pocket. Of the three long-term care
facilities, the respondents showed the highest interest in Nikkei nursing home. These
findings indicate a lack of awareness of many Japanese Americans on the current cost of
facility-based care ($4,000-$5,000 for retirement homes) and which insurance can be used
for what type of care.
The vast majority of respondents believed that the Japanese culturally sensitive services were an important factor when deciding their long-term care residence; however, as far as
services were concerned, their preferences differed depending on the generation. For instance, Shin-Isseis required Japanese language and bilingual staff, but a large percentage
of English-speaking younger generation individuals felt the need for Japanese food, activities, and programs.
Dementia care was very much in demand with Nikkeis expressing the need for immediate
care of their family members living with dementia. Many respondents were willing to make donations and volunteer their time at a Nikkei facility.
Feasibility study conducted independent of the Needs Assessment study showed sustainable demand and shortage of nursing and assisted living beds in the Japanese community. Of the beds available in the Nikkei senior facilities, Japanese seniors currently
occupied over 90% of the beds. The high percentage occupancy was a clear indication of a
need to develop more beds. With demand levels rising and no new supply being planned,
there was need for new development.
Survey outcome indicated strong need for facility-based care of our elders. There was need
by the Japanese American community for all four types of care: retirement, assisted living,
nursing home and dementia care, with greatest demand being a nursing home. These findings were consistent with other research studies that indicated that family and community care alone were not enough for elders with physical and cognitive disabilities
(American Geriatric Society, Ethnogeriatrics Committee 2016). Long-term care facilities
were needed for a portion of elders. Furthermore, studies indicated that providing culturally specific services in both community settings and long-term care facilities were associated with enhanced quality of life, improved health outcomes, depression prevention and better communication among elders and their families.
As an initial step towards developing a non-profit senior facility, we recommended that an Independent Task Force of experts in property development and in finances be formed.
Furthermore, we recommended the development of a Nikkei nursing home, which accepts
government insurances (Medicare and MediCal) as well as private pay to accommodate
individuals of different levels of financial standing.
Keiko Ikeda, Ph.D. is a psychologist in private practice for the past 38 year in Los Angeles. She is also the President of Koreisha Senior Care & Advocacy.
Tazuko Shibusawa, MSW, Ph.D. is Associate Professor at New York University Silver School of
Social Work. She has done extensive research and teaching on cross-cultural geriatric issues.