By Julia Tong
In March, the executives of a Los Angeles nursing home were charged after 13 residents died during the COVID pandemic. Yet, another nearby nursing home, Kei-Ai Los Angeles, remains uninvestigated after 115 of its residents died of COVID.
Kei-Ai LA has been dubbed the “deadliest nursing home” in the US by senior advocates. Members of the local Japanese American community say that the problems there started well before the COVID pandemic even began.
Today, residents, loved ones, doctors, and other community members affiliated with the Save our Seniors Network (SOSN) are calling for an investigation into Kei-Ai LA.
“It’s very heartbreaking that because of their greediness, this happened to our parents,” said Francine Imai, a SOSN member whose mother passed away after being evicted from a Keiro facility. “And now, nobody is even paying attention to COVID at Kei-Ai LA. 115 unnecessary lives were taken because they did not follow proper protocol,” she said.
“Those 115 loved ones are not getting justice.”
The Keiro Sale
Kei-Ai was once owned by Keiro, a nonprofit managing four nursing facilities dedicated to the care of elderly Japanese American immigrants. Keiro’s sale to a for-profit corporation in 2016, however, created a deadly combination of lowered standards of care, lack of cultural competency, and resident evictions during the COVID pandemic that culminated in the outsized deaths at Kei-Ai Los Angeles.
Keiro opened its first nursing home in 1969. The organization, whose name means “respect to the elderly,” was originally dedicated to providing culturally sensitive care to Japanese seniors — which was essential in the city home to Little Tokyo and a sizeable, yet aging, Japanese American community.
In 2015, however, Keiro’s board shocked the community when they announced plans to sell the nursing homes to for-profit real estate developer Pacifica. At the time, board members argued that the sale was supported by the community, and was necessary to make up increasing financial troubles faced by the nursing facilities.
A public hearing is usually required when a nonprofit is sold to a for-profit company. Keiro successfully won a waiver of this requirement, arguing that they had sufficiently informed the public on the sale.
However, community members were outraged by the lack of transparency.
A 2016 petition to save Keiro garnered over 17,000 signatures; 16 Congresspeople signed a letter of support to Attorney General Kamala Harris. Advocates worried that the high standards of care and cultural competency that were unique to Keiro would be lost without public input and government oversight.
Their fears were well-founded. When the sale was approved in 2016, Attorney General Harris’s office imposed 13 conditions for a 5-year period, including mandates to maintain culturally competent care and one-year rent limits. Yet community members immediately observed that those conditions excluded essential elements such as bilingual staff, protection against evictions, and permanent rent control.
After the conditions of the sale expired in 2021, they say those predictions came true, with disastrous effects on seniors and their families.
“[The seniors] were just thrown out like a piece of paper.”
SOSN members say that Pacifica promised that no residents would be evicted during the COVID pandemic— a promise which was ultimately not kept.
In 2021, Pacifica announced the closure of Keiro facility Sakura Intermediate Care Facility (ICF), intending to convert it into high-rent apartments. All seniors were evicted, and many ended up at Kei-Ai LA, where they were infected by— and even died of— COVID.
Advocates say that the closure of Sakura ICF, which was a cornerstone of Keiro’s offerings, was devastating for residents and family members alike.
The ICF model is rare in the US: Unlike skilled nursing facilities, residents are allowed a level of independence, such as walking to dining rooms or doing their own activities. On top of that, Sakura ICF was beloved by residents and families alike for its high standards of culturally-informed care. Family members recalled that Japanese-speaking nurses provided personalized care to residents. Seniors ate Japanese staples such as tonkatsu and rice, and participated in activities like ikebana (flower arrangement), origami (paper folding), and singing traditional songs. Members of the local Japanese American community visited and bonded with the Nikkei elders.
“That facility was the best,” recalls Imai. Her mother, she says, thrived at Sakura ICF. “I don’t think any facility could even compare to that, ever.”
Trouble immediately began after the Pacifica sale in 2016, says SOSN member Kensaku Nakayama, whose father was a resident at Sakura ICF. He says residents observed a marked drop in food quality, a loss of cultural programming, a high turnover of staff, and a loss of bilingual Japanese nurses.
Many Sakura ICF residents were on Medi-Cal and Medicare, and could not afford the other facilities recommended by Pacifica. For instance, requests for humanitarian aid supporting 6 seniors unable to afford residence elsewhere was ignored by the Keiro board.
Due to the COVID pandemic, families of evicted residents were also unable to visit other facilities to ensure their loved ones would fit there. And the move itself was traumatic for seniors, who were especially vulnerable to COVID infection and struggled to adjust to a new location, care, and life.
“It’s just not fair to them. That when they loved and called the facility their home, and were actually very happy— they were evicted,” Imai says. “They were just thrown out like a piece of paper.”
Finally, and perhaps most importantly, evicted seniors entirely lost access to cultural care— a critical factor for the mental and physical wellbeing of Japanese American elders.
Those afflicted with dementia, Alzheimer’s, or related conditions frequently suffer from “first in last out” memory: They retain memories from their youth, but lose those that come later. As a result, many Japanese American seniors became reliant on their native language to communicate what they needed.
As a result, cultural sensitivity is especially important in an environment like an ICF, Nakayama says, where elders have more independence, and rely on bilingual nurses for care and companionship.
“You deal with those little things that make life, which you don’t have to deal with if you’re in a hospitalization situation,” he says. “So the in-language communication and the cultural sensitivity is actually really, really critical.”
Culturally rooted care is also essential in ensuring residents are satisfied and happy with their lives in care facilities. For instance, Nakayama’s mother especially loved singing: As a child, she frequently sang in choruses in Japan. Now, as she ages, the music popular in her younger days became especially important to her again. Singing became central to her happiness at the ICF, and delayed further mental decline.
This also, Nakayama points out, applies to the cultural food, activities, and celebrations that are essential to maintaining residents’ quality of life.
“It’s not just recreation. It’s not just what would be called a ‘culturally sensitive activity.’ It’s actually a very, very important component of who they are, and who they used to be. And you take that away, and it has a huge effect on their mental status and well-being.”
When Nakayama was forced to move his mother from Sakura ICF to a non-Japanese facility, he witnessed the consequences of losing these cultural elements firsthand. Isolated, disconnected, and lonely, his mother’s mental state rapidly declined.
“Her demeanor, activity, and her mental status has really degenerated over the last six months or so since she’s been transferred,” Nakayama said.
“I think it’s [because of] the transfer. I think it’s the difference in the care that she used to receive at Sakura ICF versus what she’s getting now.”
115 deaths: Inside the “deadliest nursing home in CA”
Numerous families, meanwhile, transferred their loved ones from Sakura ICF to Kei-Ai LA. Among them was Margaret Leong, who was asked to move her father from Sakura ICF during the pandemic. Keiro staff recommended Kei-Ai LA; however, due to the COVID pandemic, she was unable to visit the facility. She says she only agreed to the transfer after Kei-Ai staff promised that the COVID wards were entirely separate from memory care.
Unbeknownst to her, however, Kei-Ai LA became a COVID-designated facility. This designation allows nursing homes to admit symptomatic COVID-19 patients to reduce hospital overflow. Kei-Ai claims that they followed quarantine protocols that would prevent infection to the rest of the unit: For instance, the COVID isolation ward had entirely separate staff and no crossover between the rest of the facility.
But many family members—including Leong—say they were not properly notified that Kei-Ai LA had become a COVID-designated facility. And they further claim that safety procedures were not properly followed at the facility— resulting in the preventable spread of a virus that claimed over a hundred residents’ lives.
Leong, for instance, says she called to speak to a staff member that usually cared for her father. Yet when she did, she was told that the member was in the COVID wing.
“So that means that they were going back and forth,” said Leong. “And that’s how I believe COVID spread throughout the entire facility.”
The mismanagement of her COVID-positive father by staff, she says, underscored how the facility failed to follow COVID protocol.
By the time Leong’s father tested positive, enough residents were sick that he was not moved out of the memory ward. Keiro staff informed Leong and her sister that her father was asymptomatic.
However, Leong became worried when she received no communication from their father, who usually called often. The Echo Show they installed in his room to communicate with him directly had abruptly cut off. Leong and her sister called the facility repeatedly, but were informed they could not speak to their father.
When Leong’s sister managed to call the Echo Show, she saw their father lying in bed with an oxygen mask. A nearby staff member told her that he needed oxygen due to being out of breath from physical therapy, and shut off the connection.
The sisters only learned the truth at a SOSN march a few weeks later: Their father, a Kei-Ai doctor told them, was sick enough to require hospitalization. Due to a lack of available beds, he was kept at Kei-Ai and put on oxygen.
Leung immediately moved her father out. Her father survived the infection, but she says she’s still “furious” about the situation— especially given the facility’s high death rate.
“My dad’s so stubborn. I think he willed himself back to life,” said Leong. “But the other residents that did catch COVID —it’s a 300-bed facility and when you have 115 deaths, that’s ridiculous.”
“It’s starting to feel very personal that it’s because we’re Asian.”
For many Japanese seniors, the Keiro sale and subsequent mistreatment at Sakura ICF and Kei-Ai LA opened up old wounds. Pacifica’s lack of transparency and care, they say, was all too reminiscent of the discrimination and internment many of them had faced as youth.
One of those seniors was Imai’s mother, who was born in an incarceration camp. Francine’s grandparents had owned Fukuyama Hardware in Little Tokyo, LA until it was seized by the US government during World War II. Carrying only 2 suitcases of possessions, they were subsequently imprisoned in Arizona, where Imai’s mother was born in 1943.
The circumstances of her mother’s death, Imai says, mirrored those of her birth. Only four months after being evicted from Sakura ICF, Imai’s mother passed away. During the period after the eviction, Imai watched as her mother rapidly declined.
“[My mother] was born in a camp, and… they didn’t allow her to have a peaceful death,” Imai says.
“It’s just really sad to me that the Japanese Americans that worked hard to build the country, that were put in camps— their last breath of life did not end in justice,” says Imai. “It’s like nobody cared about what was happening at the facility. And it’s starting to feel very personal that it’s because we’re Asian.”
After all, the 115 COVID deaths at Kei-Ai LA were not isolated incidents. As a whole, it is symptomatic of the decreased standard of care after the Pacifica acquisition in 2016, which disproportionally harmed Japanese American seniors.
Despite the AG’s condition of sale mandating culturally sensitive food and activities, families observed a decline in cultural offerings. Leong recalled her mother was given “terrible” tasting sandwiches; Nakayama observed that the increasingly Caucasian-oriented menus did not even include rice. High staff turnover lead to the loss of bilingual nurses who were essential to care.
Compounding these factors is the history of poor treatment at Kei-Ai LA. According to a group of Congressional representatives, the facility had an “incredibly high” staff turnover rate of 99.4%. (In fact, Alal LLC, the company managing Kei-Ai, had previously been sued for wage theft, denying employees mandatory break times, and other labor law violations.) The facility also received 37 health citations in 3 years— which amounts to nearly 4.5 times the average number of citations for nursing homes nationwide. The facility also received 105 complaints of abuse, neglect, and rights violations between 2015 and 2021— 50% of which were found to be substantiated.
Pacifica Companies did not respond to requests for comment.
The recent Silverado investigation and charges have left some Japanese American families frustrated by what they perceive as a lack of prioritization from the government on the Kei-Ai deaths.
“Why did the other facility in the Caucasian neighborhood get investigated? Why is it that we’ve been asking for so long and there’s no investigation? That’s just really what’s hurting my heart,” says Imai.
Today, SOSN holds town halls, press conferences, and is circulating a petition as it calls for a comprehensive investigation into Kei-Ai. They are joined by Rep. Judy Chu, Maxine Waters, and Jimmy Gomez, who have called on the Center for Medicare & Medicaid Services (CMMS) to investigate, as well as Rep. Ted Lieu.
“Due to these disturbing trends of poor care, lax infection control and problematic ownership structure, we write to request a review of Kei-Ai, its owners, and its pattern of substantive patient care,” reads the letter to CMMS, co-signed by Chu, Waters, and Gomez.
The investigation won’t bring the 115 seniors who died at Kei-Ai LA back. But SOSN hopes that a full investigation will hold Pacifica accountable, and prevent the issues affecting Keiro from happening again.
“The aim is to make certain that issues are fixed and that it never happens to other communities,” reads a press release from SOSN. “SOSN seeks reparations and justice for covid deaths, eviction trauma and past broken promises.”
Ultimately, Imai says, the investigation is crucial for the Japanese American community. It will ensure the voices of a marginalized community are heard— and that families get the restitution they deserve.
“Japanese people, or Asian people or the earlier generations, they will keep quiet. They will not voice themselves. So, we’re trying to be their voice,” she says.
“And we just want justice for the families.”
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