Caring for retired religious

Health Progress, May/Jun 2001 by McDonough, Susan, Mulvihill, Nancy

Congregations Have Choices in Deciding How and Where to Provide Care for Aging Members

oday many communities of women and men religious (and dioceses as well) face a major problem: On one hand, an increasing percentage of sisters, brothers, and priests are elderly. On the other hand, the number of members able to provide care for older colleagues is dwindling. In some instances, the caregivers are themselves elderly and, in most cases, conducting the congregation's active ministry.

Over the last five years, a wide range of religious communities have turned to Covenant Health Systems, Lexington, MA, for help in developing eldercare plans for their members. Covenant has created plans for both large and small congregations. Such planning frequently occurs when new leaders take office. Unfortunately, it is also sometimes brought on by a crisis. Religious communities considering the development of eldercare resources have multiple needs. The needs of women and men religious vary, like those of other elderly people. They include supported housing, assistance with personal care, case management, assistance with medication, and nursing home care, depending on the independence of the individual and the care she or he requires.

It is nearly impossible for even large congregations to add the full array of eldercare services to their existing services, although a few have done so. At some point, members of most religious communities will need to receive care from lay staff, outside agencies (such as the Visiting Nurses Association), or facilities sponsored by other groups. Some congregations with financial resources have transformed their own primary facilities into eldercare institutions, either for aging members or (after some conversion) for religious and lay people alike. SEVEN IMPORTANT QUESTIONS In deciding whether to create eldercare services or to affiliate with a group already possessing such services, a congregation should conduct a thorough planning process. If it chooses the former, it will likely need to make structural changes. Such changes will require familiarity with the eldercare business. Before deciding to develop assisted living or other formalized eldercare setting, the community should answer seven important questions.

Should Local Religious Communities Undertake Eldercare? Most religious eldercare services will require financial support from their congregations, even when public funds are used to pay for care. Covenant, when approached by representatives of a religious community, generally asks them, "How long can you continue to provide your aging members with care without changing the current process?" If the answer is "only a few years," then we advise the community to begin exploring alternatives now. We also suggest that the community cast its financial projections over a period of at least five years, no matter which option it chooses.

Does the Congregation Itself Have the Necessary Financial Resources? To establish eldercare for its members, a congregation must have a very clear picture of its financial resources and the current cost of care provided. To do this, it should estimate the cost per person per month for each of its members. Some congregations calculate their housing and adminis-- tration costs on a global basis, rather than according to particular houses, floors, or other units. However, figuring costs globally makes it difficult to determine the expenses the congregation currently incurs in operating an infirmary or in caring for elderly members in other ways. To determine the costs of operation, it may be necessary to itemize expenses or, at a minimum, fully allocate costs. Where Should the Eldercare Facility Be Located? Many congregations, having spent many years in a particular geographic area, plan, appropriately, to centralize their eldercare in that area. Other congregations, whose members have been scattered throughout the diocese (or the nation) and have ties to many different areas, may need to organize their eldercare in multiple sites. And congregations devoted to missionary work overseas may need to create eldercare facilities in other countries.

Should a Congregation Create Eldercare Services for Its Own Members Alone? If the congregation is planning to establish such services, it should first determine the regulatory requirements involved and the availability of religious exemptions for:

* Zoning

* Certificate of need * Participation in Medicaid But if one of the congregation's reasons for developing formally licensed care is to gain access to the additional financial resources afforded by public benefits programs, it should not pursue this option until it first determines whether participation in such programs is possible.

Some states that make such exemptions available (including many in New England) are likely to grant the congregation fewer beds than they allow other organizations.

It should be recognized that a 40-bed nursing home for religious will have operational inefficiencies not found in a 123-bed home that welcomes both religious and nonreligious residents. It is nearly impossible for smaller facilities to pay their own way; most must be subsidized by their congregations. If, for instance, the cost of care per person per day is $110, yet public reimbursement is only $100 per day, then the congregation must make up the difference. Over the course of a year, that $10-per-person-per-day subsidy will cost the congregation $3,650.