Japanese American Eldercare Foreshadows Nation’s Aging Future

June 30, 2011

Pictured above are Maggi Yaguchi (seated, left) with her mother, Kikuyo Utsumi (seated, right) and sister Aiko Backhus (standing). Photo: Ken Matsui Images Photography

Originally posted at New America Media.

by Ellen Endo

Retiree Maggi Yaguchi of Long Beach knows well what it means to care for an aging parent. Seven and a half years ago, she helped her mother, Kikuyo Utsumi, transition to the Keiro SeniorCare facility.

Utsumi, a Kibei-Nisei, or an elder born in Japan, is still spry at 99-years old. Yaguchi, a member of the younger sansei generation, is 77, and has been widowed for 28 years. Her husband, John, was killed in 1983 by a drunk driver. 

Although Yaguchi is healthy and active today, she can’t help wondering what would happen if she could no longer take care of her mother or herself. Would they one day live at a Keiro Senior HealthCare facility at the same time?

One in Five Are 65-Plus

Japanese Americans, with an average life expectance from birth of almost 85, are only second to Chinese Americans in US longevity.

Some 21.5 percent of the 1.3 million Japanese American (JA) population is 65 or older, making it this country’s oldest ethnic group. The overall number of 65-plus residents in the United States, now 12 percent, will reach 20 percent about 2050. So the challenges of housing and caregiving for JA seniors foreshadow what the future will bring for the rest of the country.

As a breast cancer survivor, Yaguchi knows that life can occasionally throw a curve ball. Her “pink journey,” as she calls it, helps her view life’s uncertainties with new resolve.

“I don’t think about age a lot, but (the fact is) I’m old,” Yaguchi said. 

Even so, Yaguchi explained, she follows a personal fitness regimen that includes eating healthy foods and exercising both her body and her brain by golfing, getting involved at church and volunteering at Keiro.

Still, like many Sansei, she is asking, “Who will take care of me?”

Those in the much younger Yonsei generation are the logical designees, but most of them are still in school or working. Many are raising young families. Others are already in their 50s or older.

One Yonsei, 25-year-old Kimberly Nakashima, understands what it means to be a caregiver. Nakashima had just finished college last year when she learned that her 87-year-old grandmother needed help getting around. Nakashima provided transportation and assisted wherever she could. “I was surprised at what a big responsibility it was,” she said.

Eventually, as her grandmother’s condition required more frequent professional attention, Keiro became the best option. Nakashima had developed a strong bond with her grandmother and harbored preconceived notions about nursing homes. To continue her connection with her grandmother, she volunteered at Keiro’s Intermediate Care Facility for seniors not yet frail enough for constant nursing home care. 

“Immediately, everyone knows her name and my name, too. Some of the residents hug me every time I go,” stated Nakashima.

50 Years of Japanese Senior Homes

Nisei (second-generation) community leaders, who founded Keiro in L.A.’s Boyle Heights area 50 years ago, saw a need for a senior care facility. Today, Keiro Senior HealthCare has two nursing homes, an intermediate care facility, the Institute for Healthy Aging and a retirement home. 

Soon, organizers in Seattle, Chicago, Northern California and Hawaii were creating their solutions to the aging Japanese American (JA) communities.

Nisei in the Washington State formed Nikkei Concerns to address issues facing the older generation. In 1976, the group purchased a 63-bed nursing home in Seattle’s Mount Baker neighborhood, and in 1987 built a 150-bed facility. To serve residents with dementia, who required special care, Seattle Keiro Garden Terrace was opened in 1997, followed by construction of Nikkei Manor, a 50-unit assisted-living facility, in 1998. (Nikkei is a broad term for Japanese people.)

Chicago’s Nikkei community developed subsidized housing for seniors and people with disabilities and in 1980 built Heiwa Terrace, operated by the Japanese American Service Committee Housing Corporation. 

The latest California complex is Nikkei Senior Gardens, an assisted-living facility providing professional services, such as wellness monitoring, medication assistance and assistance with everyday activities, for example, bathing and dressing. Located in Arleta, a San Fernando Valley residential community, the apartments are near the 40-year-old Japanese American Community Center, Buddhist church and Nikkei Pioneer Center.

Remarkably, people in Japan have begun to look at how the U.S. is addressing the needs of an aging population. One team of real estate developers has formed the American Japanese Agriculture of Los Lunas, a limited liability corporation seeking to build a retirement community for retirees from Japan

According to a report in the New Mexico Business Weekly, developers Max Kiehne of New Mexico and Hitoshi Hoshi of Japan hope to build the retirement community on a 500-acre section of Mesa del Sol, a master-planned site near Albuquerque International Sunport.

With the high cost of homes and rental property in Japan, New Mexico presents an affordable alternative to retirees. Kiehne said, for example, that a family living in Japan can expect to pay $3,000 to $5,000 a month in mortgage or rental payments compared to $1,000 a month for the same size house in New Mexico.

Complex Needs and Waiting Lists

Despite the seeming proliferation of sophisticated and culturally-sensitive housing and health care services created by and for Nikkei, the ultimate solution lies in looking at the complexity of issues and the community as a whole, said Shawn Miyake, president and chief executive officer of Keiro Senior Healthcare.

There is a minimum two-year waiting list at Keiro, where residents include older Nisei, Sansei and Shin Issei (elders who emigrated to the U.S. after World War II). There are also mixed-race couples and transplanted seniors from Japan.

Dietary preferences have changed, and volunteers have become an essential part of the day-to-day activities. In Los Angeles, Keiro volunteers number 1,200.

When Miyake first arrived to lead Keiro Senior HealthCare, Issei (first generation immigrants) comprised a large segment of the retiree population. Food preferences and language were the number one and number two priorities. “Now it’s security and transportation,” he said.

Elderly Issei enjoyed ikebana (flower arranging) and shigin (song-poems), but the newer Nisei retirees are asking for games like poker and mah jong. Also, they want to watch Korean soap operas on television. “In the past, there was no way the residents would want to watch Korean TV,” Miyake recalls.

Nisei are vocal yet tend to retain traditional Japanese values. Décor in the living quarters at Keiro reflects this. The Nisei enjoy decorating with Japanese-style wall hangings, dolls and trinkets. On the other hand, Shin-Issei and those more recently arrived from Japan prefer a more westernized ambiance.

Miyake expressed concern that the Nikkei in America may be lulled into “thinking our community has no issues.” Aging, he asserted, has been a key concern for many years.

With one in five Japanese Americans now 65 or older -- a proportion the general U.S. population won’t reach until 2050 -- Miyake added, “We can try fixing the health-care system, but the underlying problem is health.”

Maggi Yaguchi has endured her share of ups and downs. She lost a daughter, Sharon, 47, to cancer and waged a long battle with her own illness and won. She credits her faith with guiding her through the tough times and is now committed to life balance. She has acquired long-term care insurance, determined not to be a burden to her two surviving children, Steve, 53, and David, 48.

Yaguchi agrees with Miyake, who suggests that each person take charge of his or her well-being with self-directed planning. Occasionally, Maggi may still worry about who will take care of her in her waning years, but for now she is focused on taking good care of herself.