NikkeiWest--Northern California Japanese American Newspaper

By J.K. Yamamoto

HAYWARD—Berkeley-based Japanese American Services of the East Bay (JASEB) has decided to end its ownership of two community homes — JASEB Home, also known as Cypress House, in Hayward and Channing Way House in Berkeley.

JASEB Home has 12 beds and 11 residents; Channing Way House has seven beds and four residents.

The board is considering different options, including sale of the properties. Family members of the residents have expressed concern that they won’t be allowed to stay, or if allowed, that they won’t be able to afford it. They are urging the board to keep the two homes within the Japanese American community as exempt-from-licensing residential care facilities.

The JASEB Home families were given six months’ notice; the decision takes effect March 31. The deadline for Channing Way House will be at a later date.

The result of a 1986 merger between East Bay Japanese for Action and East Bay Issei Housing, two organizations formed in the 1970s, JASEB provides case managers to assist seniors and their families, and operates a senior center at Berkeley Methodist United Church. JASEB also co-sponsors Eden Issei Terrace, an apartment complex in Hayward.

JASEB has the support of 22 community groups in Alameda and Contra Costa counties, including churches and JACL chapters, each of which is represented on the JASEB Advisory Board.

Cypress House has been in continuous operation since 1982. The original property was purchased in the 1980s by JASEB for around $200,000. In the early 1990s, the Japanese American community raised an additional $700,000 to build the second facility. JASEB is the landlord of the buildings and the organization from which the residents rent the facilities. As landlord, JASEB maintains the buildings and grounds and pays for the utilities.

The state granted Cypress House an exemption from licensing in 1994 and again in 2007.

Unlicensed Facility

In an interview, JASEB President Bruce Hironaka discussed how the homes operate and why the board unanimously voted to pull out.

“What we have are two homes ... that are exempt from licensing under California licensing statutes,” he explained. “Most residential care facilities are licensed by the State of California. Kimochi Home (in San Francisco) is a licensed facility.

“Our facility ... was started in the 1980s as essentially a family cooperative in which families were actively and intimately involved in the supervision and care of their loved ones ... Our role is to be the owner and the landlord, rent space to individuals, and to maintain the building. Under the exemption, we have no role in the care and supervision of the residents. That’s strictly within the domain of the families.”

Hironaka said he found it “frustrating” that the popular perception is completely different. “Even today, people still assume that JASEB operates the homes because we are the owners ... People expect JASEB to be responsible for whatever problems there may be in the homes ... It’s a difficult position to be in. Under state law, we have no responsibility for care and supervision, but are being held accountable by, essentially, the community.”

These concerns were heightened in 2004 when the family of 99-year-old Ayako Ozawa charged that unexplained injuries sustained while she was living at Cypress House contributed to her death. JASEB was not held liable, but the family called for changes in the way the facility is run.

For the past two years, the new 15-member board has been “trying to figure out how these homes made sense for JASEB as a non-profit senior organization ... We were trying to get families to address what we consider significant issues in the homes, trying to get changes made ... We did not see the results that we were interested in seeing,” Hironaka said.

In a licensed home, he continued, “you’re going to receive the protection of state-mandated controls and practices, with concern about consistency in the quality of care as families and workers turned over. (For example) under the law, all workers and volunteers should have TB tests before they’re allowed to work in the homes.”

He added, “Frankly, the character of the homes has changed. In the beginning, the families were Nisei taking care of their parents ... Things have changed in the world around us. The level of family involvement has not been at the level that it used to be. That’s not to say there are not families that are doing that, but it’s not uniformly at that level.”

Hironaka acknowledged the objections, saying, “If they like what’s going on in the homes, they’re not going to like what we’re doing,” but added, “We’ve clearly had our share of people approaching us, expressing support for the decision.”

“We gave the families a sufficient amount of time to effect a smooth transition for their loved ones,” he said. “We thought it would be better to give the families a date certain as opposed to leaving it totally open. We thought six months would be a reasonable amount of time. A letter was sent out Sept. 25.”

The letter offered the services of JASEB case managers “as a resource to assist in the transition of the residents to a new facility.” The letter, which also invited the families to an October meeting to discuss the board’s decision, was signed by Executive Director Mark Murano, who has since left the organization.

The board is considering three major options, Hironaka said. “One is to evaluate whether we can convert the home to a licensed assisted-living facility. That has advantages and disadvantages ...

“There’s the option of selling the home and taking the proceeds and putting them back into our senior programs. One of the clear trends occurring in the senior care world is that seniors are more and more interested in trying to stay in their own homes ... We’re looking for a way to provide programs to help individuals stay in their homes as long as possible ...

“The third option is to use the home for a non-residential purpose, another purpose we have as an organization ...

“We’re trying to make the right decision. The three major options all have challenges. We’re exploring them, trying to find the best thing to do, trying to work with the families, not only with transition, but if they have ideas and can make them concrete, we’re very interested in talking to them.”

Sandy Mori, development director of Kimochi Inc., said in a statement, “Kimochi strongly believes that senior organizations should own licensed residential care facilities. I know this was a difficult decision for the JASEB board, but I believe it is absolutely the correct decision. Because of the increasing needs in the Japanese American and Japanese-speaking community for support services for seniors, JASEB more than ever needs to focus on services that allow seniors to age in place as long as possible.”

Kotobuki’s Concerns

Kotobuki Services Inc., a Hayward-based non-profit community support organization that has been providing assistance at Cypress House, was approached about the possibility of leasing and taking over operation of the home. The organization was founded in 1999 by former Cypress House families.

KSI ultimately declined because it had limited funds. According to the Cypress House Family Council, JASEB’s terms would result in a $1,800 monthly deficit for KSI.

In a letter to Cypress House families and supporters, the 12 KSI board members wrote, “JASEB has made this decision in spite of our efforts to make their board members aware of the quality of care that residents receive at Cypress House operating as an exempt facility. If JASEB converts to a licensed facility, an immediate consequence would be that almost all current residents would not be allowed to stay because of their physical or mental condition, and for many residents there would be no other facility that would accept them.

“The KSI board and all current Cypress House families are unanimously against JASEB’s action of closing Cypress House as an exempt, unlicensed facility as granted by the State of California in 1994 for both Cypress House and Channing Way House.

“We feel that as an exempt facility, Cypress House has had a long history of providing compassionate and quality care for elderly JAs. We are against JASEB converting to a licensed facility, and if JASEB decides to divest itself of Cypress House, we desire that the sale or transfer be kept within the JA community to a party that would continue to operate Cypress House as an exempt facility.

“The KSI board is aware that many, if not all, of you have had family members who were residents at Cypress House, and many of you have supported Cypress House financially. We trust that you feel grateful, as we do, for the Japanese meals, the social and cultural activities, the family involvement and participation, and the warm, efficient, loving Cypress staff that provide such a compassionate setting where our loved ones can spend their final days in comfort and dignity.”

Testimonials From Families

Janis Fujita, whose 96-year-old mother, Hisako Ikezoe, lived at Cypress House, shared those sentiments. In a letter to the KSI board, she recounted that her mother was living across the street at Eden Issei Terrace when she was found on the floor of her apartment last August.

“She was taken to the ER at Eden Hospital and had become too weak to stay living independently. I called Masa Fukuizumi at Cypress House, hoping that there might be a space for my mother so she could leave the ER,” she wrote. “Masa was extremely helpful to me and I was able to take my mother from the hospital to Cypress House.

“Once at Cypress House she seemed less anxious because she was in the surrounding of other Japanese people and an extremely caring and supportive staff.”

When her mother suffered a stroke a week later and was taken to the emergency room again, “the attending physician wanted to admit my mother to the hospital, but I knew that she wanted to spend her last remaining days at Cypress House and hospice was called in,” Fujita wrote. “During the following week, I saw the kind of care that was given to my mother, and it was outstanding. Even the hospice nurse commented how caring all the staff was.”

Emphasizing that it would have been difficult to find another facility that could provide that level of service, she said, “There is a real NEED to have a Japanese facility for the Japanese and Japanese American elderly. And I do agree that if JASEB decides to sell Cypress House that it needs to be kept within the Japanese American community.

“With all the difficulties surrounding my mother’s last weeks, I know that she was very happy at Cypress House. That was one of the great comforts to me. To think about displacing the elderly people I saw living there seems very cruel to me. Where are they to go and what is to become of them?”

Sherian Hamamoto, a member of the Cypress House Family Council whose father currently lives at JASEB Home, is involved in an e-mail campaign to keep the facility as is. “This move by JASEB leaves the future of my father’s residence and care in limbo as well as it does for the others who live at Cypress House,” she said.

Since her mother passed away in 1999, her father lived alone. But by 2007, when he was 96, he needed help with everyday activities. The family’s experience with caregivers was problematic. For example, Hamamoto wrote, “We began with agencies that would send workers into the home two to four hours, twice a week ... The agency would change the workers without notice and they sometimes stayed longer than Dad liked ... We tried to locate Japanese-speaking caregivers without success.”

By March of this year, the family was hiring live-in help and her father was having more difficulty walking due to arthritis in his back, the result of many years of work as a gardener. His neurologist warned that he would fall more often and eventually lose the ability to walk.

“When Dad mentioned moving to a nursing home in a nearby town after visiting a friend there, we started looking for what we felt would be a more appropriate place for him — a culturally Japanese home with Japanese-speaking caregivers,” Hamamoto said. On the recommendation of a friend whose mother had lived at Cypress House, “we visited and convinced Dad to try it out in April 2009. And we have been very pleased with the quality of compassionate care and Dad’s response to it.”

Noting that her father is Issei, she wrote, “I think all the families share the common experience of seeing our loved one lose their ability to speak English and revert more and more to Japanese. It has been so wonderful for Dad to be able to understand and be understood by those around him (while) having a knowledgeable and caring staff who help him through the day and night.”

Emphasizing that the exempt-from-licensure status enables residents to stay until the end of life, Hamamoto said, “There are very few facilities in California who are able to operate in this manner. I believe it would be very difficult to replace the current staff with certified or licensed nurses who speak Japanese and are as culturally aware. I worry that most of those living comfortably at Cypress House would not be allowed to peacefully live out their lives there due to their physical and mental conditions, should Cypress become licensed.”

The letter included the contact information for the JASEB Board of Directors, Housing Committee and Advisory Board and asked concerned individuals to ask the agency to “work in good faith to keep Cypress House in the Japanese community as an exempt-from-licensure program.”

At a meeting between the families and JASEB representatives in November, the agency stood by its decision.

Hironaka, who was not present, summed up the meeting based on discussions with his colleagues: “We appreciated very much the opportunity to interact with the families. The families shared their personal stories and asked that the unlicensed home be left as is. We were disappointed that some of the families resorted to personal attacks when the JASEB representatives were unwilling to agree with their request to keep the home open. JASEB reiterated its offer to support the families through the transition and make its case managers available ... We have tried to keep the discourse civil and focused on the issues and what the families need to accomplish for a safe and smooth transition of their elderly loved ones.”

He added, “One community member who is not affiliated with JASEB compared the exempt-from-licensing home to an unlicensed day care for children.”

Responding to criticism that the board does not represent the community, Hironaka said that the members are “very committed Nisei, Sansei, and Shin-Issei ... who reflect a broad spectrum of East Bay Nikkei. Many directors grew up in the East Bay and a number of us belong to local churches and temples and JACL chapters. All of us support JASEB financially and contribute countless hours volunteering, not just on board responsibilities, but also on the events and services that make JASEB what it is.

“However, maybe more importantly, my colleagues and I have had to deal first-hand with aging parents and/or other loved ones and have faced many challenges, including those relating to housing for our elderly loved ones. I believe that all of us have the right experience, commitment and concern to make knowledgeable, caring and compassionate decisions as to how JASEB is best able to serve the elderly in our community.”

Following JASEB’s December board meeting, Hironaka announced, “The board approved a plan to provide some transitional financial assistance to the most financial needy residents of JASEB Home. This assistance is designed to help the most needy residents in their transition to a new facility. We have been told by individuals familiar with elderly care facilities that such a plan is unprecedented. I do not know how unprecedented it is, but we do want to provide some financial assistance to those who need it most.”

Council’s Position Statement

The governing body of Cypress House is the Cypress House Family Council, which is made up of members of the families whose loved ones are current residents. The council said in a statement, “Past and current Cypress House families are overwhelmingly opposed to JASEB’s action because it will destroy an institution that has had a long history of providing compassionate and quality care for elderly Japanese. Moreover, closing Cypress House will create undue hardship for the elderly who currently reside at Cypress House. The current families are hopeful that JASEB will transfer title of the Cypress House property to an organization within the Japanese community that will allow the operations at Cypress to continue.”

The council explained that the exempt status “allows the families of the residents to work together cooperatively to provide care for their loved ones. Each resident rents a single room or shared room at Cypress House from JASEB. Family members contract with individual care workers at Cypress House to help provide care for their loved ones as if the family were doing so in their own home.

“The families work together to supervise and coordinate the care given to their loved ones, but each family is responsible for the specific medical care required for their loved one. Very few facilities in California are lucky enough to be granted such an exemption …

“As part of the exempt-from-licensing status … the State of California requires that JASEB act only as a landlord of the property. Under the exemption, JASEB is not allowed to recommend or mandate any changes to how family members at Cypress House provide care for their loved ones.

“However, despite this fact, the existence of the Cypress House and the care provided there have reflected very positively on JASEB as an organization that provides an excellent facility for the care of elderly Japanese Americans. This (mis)understanding in the Japanese American community undoubtedly prompts many of the donations that JASEB continues to receive …

“Because the whole premise of the exemption is that family members are taking care of loved ones … it allows these family members and care workers at Cypress House to care for residents who are wheelchair-bound, bedridden, and/or experiencing levels of dementia … Because the state has deemed Cypress House an exempt facility, our loved ones do not have to find another place to live as their physical conditions degrade.

“On the other hand, a licensed facility is only licensed to provide up to certain levels of care. Often, when residents are no longer ambulatory, they may be asked to leave a licensed facility, or go to a skilled nursing facility. Or, if the resident has a condition such as dementia, he or she may be required to stay in a locked facility.

“In fact, some of Cypress House’s residents who are currently in wheelchairs came from other facilities that were licensed only for the ambulatory. Some came from facilities which felt the resident needed to be in a locked building to decrease the risk of wandering, or because the resident was disruptive. Cypress House’s small size has permitted the caregivers to work with individual residents in easing them all into the comforting and peaceful surroundings.

“That the language, culture and meals are familiar to the resident community is immensely helpful in aiding this process. Cypress House further enhances the residents’ quality of life through art projects, musical performances and other events presented by outside community groups, staff, family members and other volunteers. These activities bring sparkle and enjoyment to the residents.

“For those elderly whose constitutions are already frail, the changes inherent in moving from one facility to another are very traumatic. The move can result in a downward spiral of health and mental conditions that may result in serious illness and even death.“

Referring to the recent death of a resident, the council said, “During the course of almost 30 years that Cypress House has been in operation, there has only been one incident involving a threat of suit (never carried out) against Cypress House or JASEB over the care any resident received. There have been no other comparable problems with care since that unfortunate incident occurred in 2004. However, this one incident has set in motion a series of events which has ultimately led to JASEB’s decision to close Cypress House.”

However, the council stressed, “Under the State of California exemption from licensing … JASEB is actually not responsible for the level of care at Cypress House — the family members themselves are responsible for the care.”

As a result of a study commissioned by JASEB in 2007 to help determine its next steps, a social worker recommended that the choices were to continue operation of the home as is but with key changes, to license the facility, or to sell it.

In 2008, family members and JASEB discussed the possibility of retaining exempt status, but according to the council, the requirements were unreasonable: “JASEB’s Housing Committee outlined five key areas with which it mandated Cypress House families must comply in order to be ‘allowed’ to maintain its exempt status, and avoid having the home licensed or sold.

The Housing Committee gave family members between 30 and 120 days to comply with all requirements. The family members lacked the expertise to navigate through the legal and regulatory frameworks necessary to meet the requirements. They asked whether they could seek help from JASEB, but JASEB declined to help, stating that providing help would be ‘a conflict of interest.’

“JASEB wanted the family members to create, in four short months, a facility at Cypress House that operated very much the same as a licensed one … Despite claims made by JASEB in its recent newsletter to its supporters, the Cypress House families made a great cooperative effort to meet all requirements, and submitted all requested documentation and plans to JASEB by August 2008.”

In a subsequent discussion of the submissions, which JASEB said fell short of expectations, the families suggested the possibility of JASEB subleasing Cypress House to another non-profit, giving JASEB distance from Cypress House’s operations while allowing the facility to remain exempt. However, talks between JASEB and Kotobuki Services Inc. did not result in an agreement.

“In September 2009 … JASEB informed the Cypress House residents and their families that it no longer wanted to be its landlord,” the council said. “It planned to transfer that responsibility to any organization with appropriate experience and ability to purchase the facility. If such an arrangement could not be reached, JASEB had also indicated that it would shut down Cypress House …

“This was, of course, upsetting to the families. One resident is currently on hospice care. Two of the residents are 98 years old and two have been living at Cypress House for six years. The majority of the current residents experienced alternate living situations before coming to Cypress House, from residing at licensed facilities to using in-home care. Cypress House families fear relocating their loved ones again will be traumatic, even fatal.

“Cypress House families asked that the March 31, 2010 move-out date be postponed, especially if there are negotiations under way for the transfer of title to the property. As yet JASEB has refused to grant this request.

“The families are resolved to engage JASEB in negotiations to bring about an outcome whereby Cypress House will continue operating as an exempt-from-licensure facility ... We encourage community support at this critical juncture to persuade JASEB to negotiate in good faith, and to sustain Cypress House as a home where elderly Japanese Americans can enjoy their last years in peace and serenity.”