As the health care system becomes more and more taxed by our aging population, where can we find additional support networks or structures?
Religious Congregations and Retirement Communities as Support Networks
Over the past twenty years, an extensive body of research has shown that persons with larger, more satisfying, and supportive social networks experience better physical and mental health, live longer, and use fewer healthcare services. There is also growing evidence that religious involvement is correlated with social support of a higher quality than that obtained from secular sources. Research further reveals that the support of religious congregations is more strongly associated with improved mental and physical health than is the emotional bonding provided by groups such as card clubs, women's or men's social organizations, or other secular organizations.
The emotional and spiritual support found in religious communities is also more durable, especially during times of illness and disability, which people frequently experience as they grow older. Congregational sustenance often increases when people become ill, and that support persists long after the sick person can no longer provide anything of tangible social value in return. This is because religious support is belief-based and, in the Christian tradition, is grounded on the biblical imperative to "love thy neighbor" as a service not only to others but also to God.
Such friendship grounded in faith is especially important to bereaved elders who would otherwise be isolated when they move to new communities after retirement. The experience of Dorothy Thomas, a widow of 86, illustrates the important role a supportive congregation can play in the life of an older single person. When she left the Midwest to live with her daughter and son-in-law in a small town on the East Coast, Dorothy tried unsuccessfully to find a Lutheran congregation as warm and nurturing as the one she had left behind. Discouraged, she felt periods of emotional isolation and questioned whether she had made the right decision in leaving the only home she had ever known and the large, welcoming Evangelical Lutheran Church in America congregation in which she had worshiped for decades.
Her distress was exacerbated by a growing list of health problems. She developed a heart arrhythmia, which required the surgical implantation of a pacemaker. Then, on seeking treatment for nagging, incessant lower-back pain, the orthopedic specialist told Dorothy that she had an untreatable deterioration of her vertebrae. Dorothy next developed a serious bone infection in her right foot following surgery and suffered an acute allergic reaction to the antibiotic used to treat it. She was sent to a rehabilitation hospital connected to a local nursing home. Finally, she was diagnosed with the type of chronic kidney disorder that often afflicts the elderly.
Dorothy struggled to regain her previous optimistic outlook but almost surrendered to the hopelessness of depression. It was not easy to feel positive about the future. While in the rehabilitation hospital, as she fought to overcome her own multiple ailments, she was surrounded by people her age or younger afflicted by stroke and end-stage kidney disease. But Dorothy was a person of faith who drew great strength from prayer and was confident a loving God would not forsake her if she did not turn her face from Him.
When her condition improved, she decided, she would "shop around" to find a church that filled her spiritual and social needs.
"I knew the church wouldn't come to me," she recalls with a warm smile, "so I would have to go to the church."
Even though she had been a Lutheran most of her life, Dorothy had been baptized a Methodist. So she and her daughter decided to attend Easter service at the town's United Methodist church. The welcome they received from the congregation was genuinely heartfelt. People with whom Dorothy had a nodding acquaintance from her pharmacy, library, and clinic stepped forward to greet her and introduce themselves. Dorothy returned the next Sunday and was delighted that they all remembered her name. They're treating me like I'm someone special, she thought.
Dorothy had always loved church music, and the Methodist hymns were familiar. But what she found most pleasant and intriguing were the church's three handbell choirs. The musical phrasing was intricate, and each performance was obviously the result of hours devoted to rehearsal. Even the children bell ringers played with the same concentration and pride as the junior and adult handbell choirs.
The church's music program was just one of several devotional and social activities available. This was an established congregation where generations of families worshiped. A group of older members had formed a Bible-study group led by a layperson and advised by the pastor. It had been years since Dorothy had read Scripture in an organized manner and, on joining the group, she was pleased to find that the sacred text that had once seemed somewhat remote was now fully accessible.
Dorothy Thomas still had the same health problems that had emerged after she left the Midwest. But the fellowship and genuine concern for her well-being she received from the members of her new church strengthened her spiritual and emotional core. Although the number of activities in which she can participate is fairly limited, Dorothy has become an enthusiastic member of the Bible-study group. Before every Sunday service and on Tuesdays twice a month, she joins her new friends to explore the meaning of the sacred Scriptures. This has sparked in her an unexpected interest in the people and geography of the ancient Middle East. She has begun to read historical accounts and fiction set during the biblical period. For the first time in her life, she can see Jesus and His disciples as real people, living in a recognizable land.
Where so many others her age, burdened by the same health problems, would have submitted to despair, Dorothy has been virtually rejuvenated by her spiritual renewal. Although age has taken a toll, her devotional energy remains robust. In turn, this renewed interest in religion has kept her physically and mentally active.
"I'm too busy to feel depressed," she says. "Besides, I know now that everything is in God's hands and if I simply follow His will, my life will be fulfilled."
Dorothy has found a spiritually satisfying "home" in her new church. Like the hospitalized elderly patients who participated in earlier research studies, she draws emotionally protective sustenance from membership in the large and active congregation. In turn, this shields her from the depression that blights the lives of so many older people with multiple health problems. Maintaining a positive attitude based on faith and on the social support she receives at church, Dorothy Thomas has not surrendered to the "frail elderly" status that afflicts so many single men and women her age with deteriorating physical health. Every Saturday, she has her hair done at the town's beauty parlor in order to look nice for church. She drives her own car to Sunday service and Bible study. And Dorothy eagerly anticipates the church's annual cycle of bazaars, picnics, and the monthly ritual of Communion.
"I'm too busy now with church and all my new friends to feel sick," Dorothy says.
Dorothy Thomas is fortunate to live in a comfortable home with her daughter and son-in-law. For millions of other older Americans, this is not an option. Retirement often means leaving behind the familiar and emotionally bolstering neighborhoods and religious congregations they have known for years. Many gravitate toward rapidly expanding Sunbelt states such as Florida and Arizona that offer warm weather, lower taxes, and more affordable housing.
But, whether or not they migrate south, increasing numbers of older people sell their homes and move into the thousands of continuing care retirement communities (CCRCs) around the country. These facilities offer three levels of accommodation: independent living, assisted living, and nursing home care. Retired people can choose among a wide variety of housing options ranging from rental studio apartments subsidized by the U.S. Department of Housing and Urban Development to luxury condominiums and villas. CCRCs are found in every state, and many are associated with religious denominations.
Luther Manor in the Milwaukee suburb of Wauwatosa is typical. Affiliated with the city's Evangelical Lutheran Church in America congregations, the community comprises several buildings on a quiet, tree-lined, twenty-nine acre campus. Whenever possible, the not-for-profit organization encourages independence among the nine hundred residents. Almost half occupy comfortable studio, one-bedroom, or two-bedroom independent living retirement apartments. There are 157 supportive/assisted living one-room and two-room apartments for those who need limited weekly nursing or rehabilitative care. And the Luther Manor Health Care Center provides 254 beds in a skilled nursing home facility. To meet residents' needs, the community employs six hundred full- and part-time employees and relies on four hundred adult and teenage volunteers, many from local churches.
Like hundreds of other religiously affiliated CCRCs in America, Luther Manor emphasizes services and activities that benefit the whole person, physically, mentally, and spiritually. The dining room provides nutritious, appetizing meals, served in a relaxed and pleasant atmosphere. This is an important contribution to the well-being of the elderly, who often do not take the time to cook and eat well when living alone. Companionship is fostered through social gatherings such as informal card games in the comfortably furnished public rooms and sunny atriums. Craft and hobby clubs are active, and exercise classes are popular. Many residents participate in winter bowling leagues and summer golfing on the course adjacent to the campus.
Because Luther Manor's vision, mission, and philosophy are guided by a common Christian heritage and the shared values of the residents and staff, spiritual needs are emphasized. The official mission of Luther Manor is to "show God's love for older adults by providing a comprehensive and compassionate program of excellent housing, care and services contributing to the wholeness of body, mind, and spirit." This is meant to affirm and nurture the spirituality of each person, according to his or her individual beliefs and identity.
Religious services of several denominations are offered in the chapel. During Advent and Holy Week, the pace of devotional activity increases, with additional services and visits from church choirs. Even frail, bedridden elderly residents can maintain their spiritual connection to emotionally comforting worship. Chaplains visit Luther Manor regularly, their presence reassuring those afflicted by the inevitable health problems of advancing age. But, again, Luther Manor's guiding philosophy is to foster independence and personal autonomy among residents, no matter what their age.
Lucille and Ervin Platt, a couple in their mid-eighties who have lived at Luther Manor for several years, are typical residents. Erv Platt worked for decades as a skilled industrial craftsman after service overseas in World War II. Lucille Platt is a retired bookkeeper who still volunteers her services at their church. Their early retirement years were active and fulfilling, as each took great satisfaction in maintaining their suburban home and garden. Erv was proud of his rose bushes and bountiful vegetable plots. But as they grew older, keeping up the house and yard became increasingly difficult. Eventually, they decided to sell their home and move to Luther Manor.
But the idea of downsizing to a one-bedroom apartment—even a unit as large and modern as the one they chose—was initially intimidating. The Platts, however, soon discovered the many advantages of living at Luther Manor. Their building was a hospitable neighborhood, devoid of any institutional atmosphere. Although there were a variety of organized activities, they were free to participate or not according to their own wishes. And the first harsh Wisconsin winter spent in their new home made Erv realize that he would never again have to worry about shoveling a sidewalk or clearing a driveway. Because the community performed all maintenance, Erv was no longer responsible for house painting, cleaning rain gutters, or plumbing repairs.
But their third-floor apartment's balcony was an excellent location for a small flower-and-vegetable garden. By the middle of their first summer at Luther Manor, they had luscious tomatoes and flowering plants growing in pots on their balcony. An affable man with a trove of jokes, Erv was soon golfing regularly with other men from the community. The couple also quickly developed a circle of friends among the people they had met in the community dining room. Erv Platt continued his volunteer work, driving other elderly people to medical appointments, while Lucille volunteered as a receptionist in their building and donated crocheted crafts to the gift shop.
Several years after they sold their home and moved to the community, the Platts enjoy a life that does, indeed, enrich them—body, mind, and spirit.
"We are very happy living here," Lucille says.
One the reasons that Luther Manor is able to provide such a high level of service and specialized care—including day care for Alzheimer's and other dementia patients—is the unusually high ratio of volunteers to paid employees (400 volunteers to 600 paid staff). These volunteers—who devote over sixty thousand hours of their time each year—range in age from teenagers to over 90.Many are from local congregations; others are residents of the community. Their activities include operating coffee carts that serve home-baked cookies (and cheerful conversation) with coffee and tea to the residents. The volunteers' popcorn cart makes a regular circuit through the buildings, serving residents, staff, and visitors. Volunteers take part in sewing and craft classes, assisting those with limited vision or reduced manual dexterity. Volunteers also staff the old-fashioned ice cream parlor and gift shop. Transporting frail residents of the nursing home by wheelchair is one of the volunteers' most important responsibilities. This provides the bedridden with priceless mobility and a sense of belonging to a larger, caring community. In the adult day-care facility, volunteers patiently feed Alzheimer's patients, relieving paid staff of this task.
It is safe to say that Luther Manor would not be able to provide the high level of personal care and genuine concern for the physical, mental, and spiritual needs of the residents if it were not for the hard work and devotion of the volunteers. In turn, religious faith motivates many of these volunteers to serve.
And it is financial support for Luther Manor from local churches, businesses, and individuals that has helped the community build and maintain its tasteful facilities and comfortable accommodations over the past forty years, while keeping costs to a minimum. The nonprofit Luther Manor Foundation assists residents in all the housing areas of the community who have exhausted their financial resources. With these subsidies, no resident has ever had to leave because of inability to pay. The Luther Manor Foundation's Promise for Generations Campaign also provides ongoing support for renovations and capital improvements, and assists congregations and community-based services that help the elderly remain in their homes for as long as their health permits and they so desire. Charitable gift annuities offer an attractive option for contributors wishing to give to Luther Manor but who need a lifetime income. When the annuity holder dies, the balance is transferred to the foundation. A number of people contribute dedicated gifts in support of special needs at the community, such as nursing care or the Alzheimer's facility. Many remember Luther Manor in their wills. And congregations regularly give through the Luther Manor Auxiliary, direct financial gifts, or special donations.
This financial support is typical of church-affiliated retirement communities across the country. The security these contributions provide is not dependent on increasingly scarce government subsidies. And the quality of life in religiously associated retirement homes is usually superior to that of purely private or government-run and managed facilities that lack the important component of spiritual care.
But when a religious denomination takes an active role in a government-subsidized retirement community, the experience of both residents and staff is enriched. Canterbury Court, a low-income independent living community of 150 apartments sponsored by the U.S. Department of Housing and Urban Development, is located in West Carrollton just south of Dayton, Ohio. It is a perfect example of such a facility. As part of Episcopal Retirement Homes, Inc., the community overlooks a quiet courtyard and six acres of nicely landscaped grounds. All of the residents live on low incomes, including small Social Security retirement pensions or disability benefits.
But even though residents' financial resources are restricted, Episcopal Retirement Homes provides a variety of extra services and facilities to make life at Canterbury Court pleasant and fulfilling. The community offers free transportation to local banks, supermarkets, malls, and restaurants. The well stocked lending library is a center of social activity. And the twice-weekly subsidized meals also foster social contact, as do the regular free exercise classes. Gardeners among the residents can take advantage of the large plot and the greenhouse. There is a full program of entertainment and recreation each week.
But the schedule of spiritual activities is perhaps the most personally fulfilling aspect of life at Canterbury Court for many people who live there. The Reverend Deacon Dolores Witt is the chaplain. She leads a vigorous ecumenical ministry that includes regular worship, healing services and Bible study, and pastoral visits to the sick. Chaplain "D.," as she is known, is an energetic person in her sixties who lived all over the world when her husband was a career military officer. She approaches her ministry with a mixture of deep faith, compassion, and practicality.
Dolores Witt recognizes that many residents have suddenly found themselves in greatly reduced financial straits because of the turmoil in the stock market and the downturn of the economy. They had not planned to retire to a low-income community, and react to the unexpected condition in different ways. Some retreat into an emotional shell, seldom venturing out of their apartments; a few abuse alcohol. But many others rediscover their religious faith and the spiritual side of their lives.
For those seeking spiritual enrichment, Chaplain Witt offers a variety of devotional activity that includes a Sunday healing and Eucharist service, twice weekly Bible study, and extra worship and liturgical music programs during Advent and Easter. She even gives an annual blessing of the animals to which the residents can bring their treasured pet companions for benediction.
"I'm fully aware that loneliness can gnaw at a person's well-being, especially someone elderly whose family doesn't visit very frequently," Dolores Witt points out. "So I always leave the door to my office wide open."
People often drop by to ask her to pray with them. "Sometimes their anguish is obvious, and I learn that they've just been diagnosed with a serious illness such as cancer, a heart condition, or heard of a death in the family. At times like these, a compassionate hug is perhaps just as healing as a formal prayer."
Chaplain Witt understands the deep need of a distressed person to be heard, or simply to be touched. "I talk about the healing touch that Jesus delivered to his flock," she says. "People empathize when I tell them, 'A hug a day keeps the doctor away.'"
This approach to her ministry at Canterbury Court seems to work. She is proud of the three devout sisters, aged 90, 92, and 97, who live independently in their own apartments and regularly join the community congregation for worship. One 96-year-old lady never misses a service or a Bible-study class. On Easter 2002, the chaplain baptized a woman 80 years old. "You're never too old to find faith, "Dolores Witt says.
Norma Jarrett, 80, is a resident of the community whose faith and emotional well-being have actually been strengthened by overcoming the adversity of serious health problems. She suffered her first heart attack when she was only 54 and has also survived cancer. After moving to Canterbury Court four years ago, she became an active member of Chaplain Witt's faith community and devoted herself to volunteer work. She did kitchen duty and drove more frail elderly residents to supermarkets and medical appointments.
On August 6, 2002, she had driven another resident to a doctor's appointment and was sitting in the waiting room, paging through a magazine. Then the world around her went black. Norma Jarrett had suffered sudden cardiac arrest.
"It wasn't another heart attack," she recalls. "I just died."
Physicians from the clinic rushed to the waiting room to administer CPR, and the staff called paramedics. She remained in cardiac arrest for a prolonged period until she was revived at a local hospital. Norma had an internal pacemaker- defibrillator surgically implanted and remained, unconscious, in the intensive care unit for several days.
"Then I woke up," she says, "and they sent me home."
For the next two weeks as Norma recovered in her apartment, Chaplain Witt visited two or three times a day, and another resident, Helen Brooks, volunteered to spend nights with her.
As she regained her strength, a firm conclusion formed in Norma's mind: It had not been an accident that cardiac arrest had struck while she was sitting in the waiting room of the doctors' office and they could intervene immediately. Had she not been serving as a volunteer driver that afternoon, she would have been home alone, and no one would have found her for at least a day. "By then," she says, "it would have been too late."
Norma has no doubt about what occurred on August 6, 2002: "It was all the Lord's will, a miracle. Don't ever tell anyone that God doesn't revive the dead."
Obviously, it is impossible to test in a scientific manner the nature of the circumstances that took Norma Jarrett out of her apartment that day and placed her in the hands of skilled physicians moments after her heart stopped beating. But it is clear that she has experienced a complete recovery, with absolutely no lingering fears of recurrent heart problems haunting her. While people with less profound faith might be tormented by anxiety and sink into depression following such a crisis, Norma feels spiritually reborn.
Today, she has resumed her active role in the Canterbury Court community, volunteering and enriching the lives of those around her.
Beyond conventional spirituality, the residents also generously contribute their time and limited money to help those in need. Each Christmas, they buy toys for 150 poor local children. One person even dipped deeply into her small savings account to donate a brand-new bicycle. The residents of Canterbury Court also purchase kits of school supplies and toiletries for distribution to victims of disaster such as the hurricanes that devastated Central America.
"As a community, we may not be affluent in the conventional sense," Chaplain Witt comments, "but we enjoy priceless blessings."
If Canterbury Court represents a church-affiliated facility with a spiritual life much richer than the financial resources of the residents, the Shell Point Retirement Community near Fort Myers, Florida, is a center of affluence. A CCRC that has attracted thousands of residents to its tasteful independent and assisted living units and its nursing home over the past thirty years, Shell Point has been called "the crème de la crème" of Florida retirement communities. It is located on the Gulf Coast and offers its residents an amazing variety of recreational activities, ranging from swimming pools, golf, tennis, and windsurfing to concert and lecture series. For those who can afford to live there, the community provides the "golden years" opportunities to which so many aspire, but that relatively few older Americans can actually afford.
Shell Point has not neglected the spiritual needs of its residents. The Village Church is located at the heart of the island on which Shell Point stands. It is a member church of the Christian and Missionary Alliance and is administratively separate from the overall community. The church owns its strikingly handsome modern building that includes a fifteen-hundred-seat auditorium in which musical presentations, lectures, and large assemblies take place.
A large number of the eighteen hundred current residents of Shell Point— who represent over twenty denominations—participate in regular services and small-group Bible study and worship. Although they live comfortably, Pastor Kenneth Nesselroade notes, many residents are searching for a deeper meaning in their lives.
"They've been 'successful' in the conventional sense for so many years," Rev. Nesselroade says, "that people often confront an emotional and spiritual void as they face their later years."
That turmoil is exacerbated among residents who have come to the community without family nearby and must confront loneliness on a daily basis. "Frankly," Rev. Nesselroade comments, "there are some people here who have come to die comfortably. But there are many others who want to live well and completely. We try to steer them toward volunteer work."
Seven hundred members of the community are in fact regular volunteers. Some help the frail elderly in the King's Crown Pavilion nursing facility (which includes an Alzheimer's unit and a hospice), where they distribute mail, dress hair, and offer their friendship to the residents. Again, religiously oriented compassion motivates this volunteerism. Both the recipients and the contributors of this generosity benefit.
Rev. Dr. Susan Stranahan, who has her graduate degree in public health and earlier spent seventeen years in nursing, is the chaplain at the pavilion nursing facility. Like Pastor Nesselroade, she is a compassionate person with deep insights into the needs of the elderly. Her work taxes all of her ability on a daily basis. The pavilion has four floors with one each devoted to dementia and hospice care. Almost all the residents of the pavilion have previously lived in other accommodations at Shell Point or are from nearby Fort Myers. Most are Protestant and possess a wide variety of individual faiths and spiritual values. Even though the pavilion's well-organized volunteer auxiliary is active in feeding, mail distribution, and individual personal visits with the bedridden residents, loneliness is still a concern.
So Chaplain Stranahan oversees a vigorous devotional program that begins with a Sunday afternoon service led by volunteer members of the church congregation. She also relies on volunteers to conduct hymn singing and Bible study during the week.
The recommended chaplain-to-patient ratio is a maximum of one to seventy, she remarks. However, she is the only trained professional chaplain for the 218 pavilion residents.
"I could certainly use two or three full-time assistants,"Chaplain Stranahan says. "But the volunteers work so hard, we're not neglecting anyone's spiritual needs."
Her honest appraisal of the situation underscores an issue that will become more pressing as our elderly population grows inexorably. At first glance, there is a world of difference between the relatively small HUD-sponsored community of Canterbury Court and the sprawling, prosperous Shell Point campus with its palm trees, landscaped gardens, and marina. But, even in a community as comfortable and financially well endowed as Shell Point, the physical health consequences and emotional impact of aging are inevitable. And, whether older people are affluent or live on small fixed incomes, their spiritual requirements will have to be addressed along with their physical health. In this regard, aging is the great equalizer.
Rev. Dr. Chester Tolson, a Presbyterian minister from southern California, spent thirteen years as Rev. Robert Schuller's director of development at the huge Crystal Cathedral, known to millions of American and worldwide television viewers. Dr. Tolson is an active member of Churches Uniting in Global Missions, an alliance of approximately a hundred of the largest mainstream Protestant, Roman Catholic, and Pentecostal congregations in North America. One of the organization's main concerns has become how to address the "tri-level" nature—mind, body, and spirit—of elderly people.
"The leaders of our churches are aware that all healing is divine," Dr. Tolson comments. "What takes place in hospitals today is nothing short of miraculous. Medical intervention and prayer complement each other, not compete." Therefore, the spiritual life of the elderly is an essential part of their overall health and well-being.
Today, Dr. Tolson focuses on the retirement options of our rapidly aging population. The vast majority of the elderly, he points out, are religious, and hope that their spiritual needs can be met as they age.
"For most people," he says, "easy and guaranteed access to church is just as important a consideration as security, housing choices, and physical location." As the multi-million cohort of the Baby Boom generation reaches retirement, Tolson predicts, most will seek a community near a church, or one such as Canterbury Court or Shell Point that offers a variety of devotional options.
Dr. Tolson says a growing movement will see large,"megachurch" campuses expand to include integral retirement communities of older people who share a bond of faith. Because membership in a congregation played a vital role during all their previous adult life, they do not want to enter retirement separated from active participation in their church.
"So offering senior housing will become a priority for large churches—not just in the traditional retirement zones of the Sunbelt—but nationwide," Tolson suggests. "I am very passionate on this subject. Tens of millions of today's Baby Boomers will soon need secure communal residential communities that meet their spiritual and health needs and provide the mental stimulus necessary for meaningful later life."
Older people want both to volunteer and to find fulfillment in mentoring and being in regular contact with school children. So, many church retirement communities will have their own K-12 schools at which residents can volunteer.
A practical model for this type of private, church-affiliated community is for retired people to use the proceeds from the sale of their homes to buy a condominium on the congregation's campus. The monthly fees are within reach of income from savings, pensions, and Social Security. These large church communities will provide "one-stop" social support, spiritual activities, and medical services. Alternatively, churches can offer accommodation on a rental basis, which is the case at the large First Assembly of God Life Center in Tacoma, Washington.
Rev. Tolson is involved in the planning of megachurch communities using innovative means to raise capital: After design is final and purchasers' down payments on their housing units reach 90 percent of development capital (or an agreed percentage), 70 percent of their down payment is returned so that residents can use it for monthly fees, food services, and medical expenses.
"This is the wave of the future," Dr. Tolson predicts confidently. "In coming years, we're going to see such communities rising on church campuses across America."
If he is right, the mental, physical, and spiritual needs of millions of elderly people will be met within the nurturing sanctuary of their familiar congregation.
But, whatever the retirement option the elderly choose—from remaining at home to more structured independent or assisted living—their growing numbers in coming years will place an increasing strain on America's financial and human infrastructure. It is obvious that there will also be a growing need for volunteers to meet the needs of our older people.
From Harold G. Koenig, M.D. and Douglas M. Lawson, Ph.D. with Malcolm McConnell, Faith in the Future: Healthcare, Aging, and the Role of Religion (Philadelphia: Templeton Foundation Press, 2004), 113-24.