This is another article in our series discussing issues pertinent to religious congregations
The trends are clear and unmistakable…we are aging, and so are our institutes. That news is well documented. The challenge is how we will respond to these trends in a way that is meaningful and looks to the future with a comprehensive and holistic plan.
With these trends come new challenges but also the opportunity to create a life-giving and flexible environment to support members through the many stages of aging, promoting grace and dignity. As members continue to transition from active ministry to a time in their lives when their needs are changing, communities must anticipate their needs, and respond and communicate to their members in a thoughtful yet prudent manner.
Issues associated with retirement include the following:
- Overarching philosophy toward service delivery
- Quality of life
- Quality of care
- Anticipated demand
- Utilization of physical space
- Financial capacity
A comprehensive plan that addresses each of these issues is essential in attending to the needs of members with respect to retirement.
Actively managing the issues associated with aging requires the development of a comprehensive philosophy regarding aging and retirement for the institute as a whole. This will provide a context for creating programs to help members of the institute, residents of the retirement facilities, and leadership address issues associated with transitions, particularly through later stages of life.
Questions that might be considered in the development
of such a philosophy include:
- Is the notion of retirement accepted within the institute? Do members feel a diminishment of their value to the institute or lack of self-worth if they are not actively working in ministry?
- How are members encouraged to prepare for and accept the transitions associated with aging?
- Will there be a system that seeks to optimize the health and well-being of the aging members?
- Will there be active case management to ensure that needed services are provided?
- Will there be an integrated approach to addressing the psycho-social-spiritual needs of members as well as their physical care needs?
- Will local home and community-based programs be used to assist members of local houses as they support the aging members with whom they live?
- When are members expected to transition to a more supportive setting?
A holistic approach to a philosophy of service for aging members will help to ensure that members transition through life stages in a way that promotes respect and dignity.
Quality of Life
Whether members are living in local communities or retirement facilities, their quality of life is influenced significantly by their surroundings and their access to support that promotes a positive self-image and a sense of self-worth. Seniors often report issues of chronic boredom and loneliness. In local communities, members are often able to participate in local ministries; this activity provides meaning and the affirmation that comes with a life of service to others. In religious retirement facilities, it is often the case that members are not actively engaged in the life of the facility. Residents are often left to pray on their own and administrators report that members often prefer to stay isolated in their rooms. While this might be a frequently encountered attitude, it may be caused by depression and a sense of loss. It takes concerted effort, skill, and experience to identify the psycho-social-spiritual needs of the resident.
Finding the balance between time for contemplation and engagement in activities that strengthen and renew the mind, body, and spirit is essential for creating a life-giving community. If aging members could see that, when it is time for them to transition from their local community to a retirement facility, they will be able to remain engaged in meaningful ways in the activities of the institute, it would make their transition process less painful.
Many progressive retirement communities in the general public have challenged themselves to create life-giving environments for their residents. Aging members of religious communities are viewed with respect for their wisdom and the contributions they have made through their years of service. Finding ways to engage, challenge, and benefit from the wisdom of these respected community elders provides the opportunity to escape the historical warehousing approach to retirement living.
Quality of Care
In our experience, virtually all leadership teams express confidence in the quality of the care of their members.
With respect to community operated retirement facilities, this is often based on the perception that the facility is well staffed so, therefore, the care must be good. It is often the case that the residents receive attention when their care needs require it. They live in an environment that attends to their comfort. In many cases, however, proactive individual resident care assessment and care planning does not occur. The opportunities for enhancing the care provided in the facility arise primarily from the challenge of balancing attention to the clinical needs of the residents with the tendency to provide the comfort of a home-like environment.
The experience of religious retirement facilities as well as that of the general nursing home population is that individuals now have more acute clinical needs when they enter a nursing facility. This will increase the demand for medical services in religious retirement facilities and increase the expectations of the nursing staff. It is also likely that as individuals age in place, there will be an increasing need to develop a system that intentionally integrates the various levels of retirement living into a continuum of care with respect to long-term care services.
Because there is typically little, if any, outside perspective provided in reviewing the quality of care in unlicensed religious facilities, it is often difficult to assess, in an objective manner, the effectiveness and efficiency of care provided. There may be formally documented policies and practices that are not applied in practice. Care decisions are often made informally, based on personal knowledge and interaction with the resident. Areas of concern we have identified most often in our reviews of religious retirement facilities include:
- Nursing assessments at admission and after a change in health status
- Use of therapies
- Dietary and nutrition services
- Pharmacy services
- Psycho-social and pastoral care services
Leadership and retirement facility management should discuss and determine the operating philosophy that should be applied in the facility, particularly determining the degree to which formal standards of practice will be identified and implemented. This would include determining, for example, the extent to which:
- Resident assessments will be conducted
- Care plans will be created and followed
- Documentation will be provided
We appreciate that this discussion should occur in the context of the relatively unique nature of an unlicensed religious retirement facility and the sensitivity to the personal preferences of individual members. Once the operating philosophy has been determined, operating policies and practices should be aligned accordingly.
Through the use of mortality tables available in software programs such as TRENDS, many institutes are finding that the demand for retirement services may increase slightly over the next few years, level off, and then decrease. Generally, it appears that, for most religious institutes, the need for space for retired sisters will remain relatively stable for the next 10 years. After this period, the need will diminish significantly. Given this, careful planning is required to ensure that needed capacity is available in the near term and that excess capacity is not created unintentionally. Even now, religious retirement facilities, similar to the trends in the general population, are experiencing declining occupancy. Members prefer to remain in their local communities where they can engage in ministry and maintain relationships. A move to a long-term care facility is delayed for as long as possible, often past the point where life safety has become an issue.
The need for service is often created at the local community level. Members want to remain independent and stay in their local community for as long as they are able. There are services available in the general community, through state and federal programs, that can be accessed to enable this. As the members in the local house age, the ability of “younger” members in the house to fully attend to the needs of older members is challenged; it becomes less practical for the younger members to provide support to those who are becoming increasingly more frail. If the institute has developed an integrated system of care for aging members that spans the continuum, the use of a community nurse to integrate available support services can be an effective way for members to maintain independence. This has implications for the utilization of space maintained for retirement living.
Facility requirements for an aging community take time to consider, process, and implement. Not only does functionality need to be adapted in many cases, the number, size, and location of residential and supportive living facilities should be prospectively planned. To the extent that excess capacity exists now or is anticipated to in the near future, the institute may want to begin planning how it will transition the amount of real estate retained. In addition, any capital investment in a facility should be approached in the context of current needs, future needs, facility constraints/adaptability, financial capacity, and future transition plans.
How to pay for the current and future healthcare/retirement liability is a major question facing institutes. This question is often raised in conjunction with the desire to provide adequate funds to support the mission of the institute. While a percentage of institutes have sufficient resources to maintain their retirement facilities, others struggle to do so. In reconfiguration discussions, members are typically promised that they will not have to move to a retirement facility away from their historical community. This often leaves the combined institute with excess capacity after reconfiguration occurs.
In the face of declining occupancy, excess capacity, and aging buildings, many institutes have asked whether they can or should:
- Invest in upgrading their facilities
- Continue to operate as they have
- Participate in government programs
- Pursue alternative approaches to service delivery
- Consolidate operations with another institute
While the answers to each of these questions require careful analysis, they should all be considered in the context of the institute’s long-range plan for its future, philosophy of retirement service delivery, and available resources.
Institutes are faced with a declining resource base from which to support members, and ministry institutes should also anticipate that the need for retirement services will diminish over time. In this light, options and implications with respect to providing retirement services should be explored and thoroughly examined before commitments of resources are made. Projections of member demographics and financial capacity are essential to good decision making. Collaboration and partnership have often been a part of the history of religious institutes; it is becoming more prevalent in reconfiguration dialogues and ministry co-sponsorships. Toward this end, opportunities to collaborate with other institutes by sharing space or other resources and to participate in community-based retirement programs, such as PACE (Program of All-Inclusive Care of the Elderly), represent viable options to leverage available resources and access expertise.
In summary, addressing issues of retirement will consume a larger percentage of time and attention within institutes as the percentage of aging members continues to increase. Advances in the philosophy and approach to providing service to this population generally have resulted in better options to create life-giving opportunities for members. Institutes that understand the need to develop a comprehensive plan for retirement and who study, adopt, and adapt these advances, such that retirement services become a center of excellence within the institute, can enable their members to transition through the aging process with grace and dignity.