NEW! The Fellowship of Brethren Homes and the Association of Brethren Caregivers are now offering the Peace Church Long-term Care Insurance available to anyone connected with the Church of the Brethren. Click here to link to more information about this program.
Steve lived alone in the house that he had shared with his wife for 35 years until her death. One day neighbors found him wandering around the block, apparently disoriented while
taking a walk. After consulting with several doctors, he was diagnosed with Alzheimer’s Disease. Following the diagnosis, Steve and his family decided he would move into a Brethren retirement community. Once there Steve soon became involved with the activities available at the facility; socials, choral programs, barbecues, chapel. He was thriving with being reconnected to a larger community. His family members no longer worried about his daily living environment and care.
To provide financial resources for Steve’s care, the family home was sold. Steve’s family understood that he would need additional care in the coming years and the proceeds from the family home would quickly be depleted. It was likely that Steve would need to rely on financial support from a charity fund provided at the Brethren retirement community and, when that was exhausted, the commitment by the home to care for all residents regardless of their ability to pay for their own care.
Uncompensated care is non-reimbursed care provided to residents at Brethren retirement communities whose daily living costs are not covered by normal revenue: Their own assets, family ability or willingness to pay, private-pay insurance, Medicaid or Medicare. The Church of the Brethren homes see it as their mission to care for persons even if they do not have the funds. In fact, each of the 23 Brethren-affiliated retirement centers was originally founded with the vision of caring for widows and orphans who did not have the financial resources to care for themselves. Yet, today the fiscal reality of providing care at levels mandated by state and federal governments for the elderly has created an untenable burden for Brethren homes.
As these Brethren-related agencies struggle to live out the vision to care for all older adults, they also request that individuals, congregations and districts engage the issue of uncompensated or compassionate care. This complex issue is worthy of study because of the many layers of personal and institutional responsibility for the Church of the Brethren. The following paper lays out the problem and suggests some ways to assist the retirement communities of the Church of the
Brethren to live out Jesus’ teaching of caring for one another.
The financial difficulty brought about by uncompensated care first emerged through discussions of the Fellowship of Brethren Homes. All of the Brethren retirement communities participate in the Fellowship of Brethren Homes, a ministry of the Association of Brethren Caregivers. The concern was brought to the September 2002 Board meeting of the Association of Brethren Caregivers, which asked the Fellowship to research the extent of the difficulties caused by uncompensated care. To that end, an Uncompensated Care Committee was established to assess the scope of the problem and determine how homes are managing the challenge. A questionnaire was distributed to administrators and, of 23 questionnaires provided to the Brethren homes, 18 were returned throughout the course of 2003.
Survey results revealed that uncompensated care is costing one location nearly $4 million annually, or roughly 13 percent of that home’s annual operating budget. Some homes have annual appeals to help offset the losses; others have established “Good Samaritan”-style annual funds and/or endowment funds, the interest income of which helps pay down the deficit of compassionate care. Some have no such mechanisms in place. For the 18 homes responding $740,342 was raised in 2002, (congregational gifts or endowment income) against total uncompensated care of $14,393,615. That means that church support for uncompensated care amounts to 5.1 percent of the actual loss. Even if much higher levels of giving to the charity support funds were successful, it would only scratch the surface of this financial challenge.
Future Care Needs for Older Adults Will Only Increase
The 2000 census estimated that there are 35 million Americans over the age of 65 (roughly 13 percent of the U.S. population), which represents a 15 percent increase from 1990. That number is expected to explode over the next 30 years, with a projected 70 million Americans over the age of 65 by the year 2030 (20 percent of our population). Perhaps most telling is that the over 85 population (currently estimated at 4.2 million), is expected to grow at an even faster rate during the next 30 years. The challenges presented by this literal aging explosion are exacerbated by deepening economic uncertainty and the ever-increasing pressure upon government-funded reimbursement programs such as Medicaid and Medicare. With the rate of health care costs dramatically rising and the return on investments continuing to decline, it is apparent that the uncompensated care challenge faced by the 23 Brethren retirement communities will increase exponentially. Nevertheless, Jesus’ instructions in Matthew 25 to care for those who are hungry or thirsty or a stranger or sick and needing care remains at the heart of who we are as Brethren. Indeed, many Brethren Retirement Communities were founded upon these very words of Jesus.
With the challenge before us, how do we respond as members of the community of faith? We believe that the responsibility lies collectively with each brother and sister in the Body of Christ, with local congregations, with districts, with the denomination and with each of the Brethren retirement communities.
Our Response as Individuals
Recognize Our Responsibility: Each member in the community of faith is called to be careful/diligent stewards/managers of the resources that God has provided. This calling extends to taking responsibility for planning for all phases of life, including the very real likelihood of needing care as we age. Recent statistics suggest that nearly 3 out of every 4 persons will require some form of assistive care as they age. Much of this care is provided in assisted living and nursing home facilities like the Brethren retirement communities, although an increasing amount is provided through home health services delivered in the senior’s home.
Commit to Planning: Many live in denial as they approach their senior years, believing that they will be the exception and will not require such care. Thus, they fail to plan. It has been said that “If we fail to plan, we plan to fail!” With the average monthly cost for nursing home care exceeding $5,000, the cost of failing to properly plan can be devastating both to seniors and their families, and to the Brethren facilities that often shoulder the challenge of providing this costly care at reduced rates for those who have sometimes simply failed to plan.
Get the Facts: An alarming number of persons believe that government programs of Medicaid and Medicare will provide for their care should those needs arise. However, these persons fail to realize that Medicare offers essentially no long-term care benefits. Likewise, Medicaid is fundamentally a health plan for the poor and is under increasing pressure to survive in its present form. In 2001 (the most recent data available), Medicaid paid $47 billion for nursing home care. Much of that money goes to persons truly in need. However, according to one earlier study, “as much as 22 percent goes to families that could afford to pay for months or even years of their own nursing home care.” (Wall Street Journal, Feb. 25, 2003.) God’s people are not called to rely upon the uncertainty of government programs or to artificially impoverish themselves in order to avail themselves of benefits intended for the truly needy. Thus, all individuals in the Body of Christ have a responsibility to get the facts about paying for long-term care needs, to seek competent counsel concerning the planning options available to them to provide for their future care needs, and to undertake appropriate advance planning for aging as an act of life stewardship. For many, this planning could include acquiring a long-term care insurance policy or utilizing other means of savings and investments to provide for their care in their senior years. Most people have chosen to insure their homes for the risk of fire and their health for the risk of illness. They do not think twice about maintaining such coverage despite the statistically minimal risk of catastrophe to home or body. Why would these same people not choose to insure for other catastrophic losses? As individuals become informed of the real risks and costs of long-term care needs, many will indeed be motivated to plan more effectively.
Another concern addresses moral issues in long-term care funding is the tendency of the elderly to make pre-need distributions of accumulated assets to heirs, creating an artificial impoverishment. There is a growing sense that the church, through the Association of Brethren Caregivers and the homes, needs to mount an educational effort which speaks not only to personal stewardship of assets and long-term care insurance, but also to the moral issues attending unfair or fraudulent asset management.
Our Response as the Greater Body of Christ
We recognize that congregations, districts and the denomination face many challenges of their own in these difficult days and cannot serve as the primary source for funding the uncompensated care obligations of the Brethren retirement communities. However, we do believe that congregations and districts should view the Brethren retirement communities as an extension of their own ministries to those who are aging and their families.
Congregational Response: Many congregations provide both monetary and volunteer support as well as board level leadership to the Brethren homes. These are gifts of time, talent and treasure that each of the communities truly celebrate and depend upon. However, as the costs of providing uncompensated care continue to mount, we urge each congregation, district and denominational leader to challenge and encourage those within their care to plan for all phases of their lives. Our Brethren retirement communities should not be viewed as just another organization seeking to get some time in front of a congregation or church board.
District Response: Districts should seek to partner with local Brethren retirement facilities in educating their constituents of this critical aspect of life planning and to connect persons with the vital caregiving ministries of the Brethren retirement communities. There are several models of district/retirement center partnerships. In one district, the retirement center, working together with the district board, carries out the program of an older adult ministry. In another, the CEOs of the retirement centers meet quarterly with the District Minister. One district, in reference to the uncompensated care concerns, has a study committee made up of representatives from the retirement center and from the district.
Districts and retirement centers have much to contribute to each other. Theirs is a two-way pathway.
The Response of Brethren Retirement Communities
The Brethren retirement communities are undeniably faced with what appears to be an insurmountable challenge. Nevertheless, with God’s help, there are opportunities for the 23 communities to take the lead in creatively addressing the uncompensated care challenge (some would say “crisis”). The following action areas are suggestive, and are proffered primarily for purposes of collaboration, not standardization:
1. Collaboration on the development of uncompensated care policies that provide clear and consistent parameters for the use of the limited uncompensated care resources that are available in order to maximize the benefits received from the use of these monies.
2. Collaboration on the development of financial and management tools which allow all facilities to monitor and manage their uncompensated care costs and to assist in projecting future costs. Consider models that are currently available to address uncompensated care issues and develop creative pricing structures to address the costs of uncompensated care.
3. Collaboration on the establishment of “best practices” for Brethren facilities surrounding the issue of uncompensated care.
4. Exploration and development of long-term care insurance plans and programs that could be made available at reduced costs to individuals throughout the denomination, particularly those between the ages of 45 to 60, where cost of such insurance is generally modest.
5. Collaborative development of educational programs and materials for use on an ongoing basis throughout the denomination to resource individuals, congregations and districts. There is a tremendous amount of misunderstanding and misinformation surrounding long-term care planning. The 23 Brethren retirement communities are best-positioned to provide timely and accurate information on this vital area of life stewardship.
Conclusion
The 23 Brethren retirement facilitates serve in an increasingly complex and challenging ministry to seniors and their families. The mounting cost of providing uncompensated care is a financial Goliath in our midst. Yet, God is not calling the Church of the Brethren to shrink from the difficult challenge before it. Rather, individuals need to take responsibility for properly planning for their care needs in later life. Congregations, districts and the denomination are asked to challenge and educate their constituents. All are encouraged to partner with the Brethren retirement centers on providing the kind of compassionate care for the seniors in their charge.
This article was presented to the 2004 Annual Conference delegates in a booklet format. It has been reproduced without editorial alteration in format consistent with other Health Promotion Sunday materials.
NEW! The Fellowship of Brethren Homes and the Association of Brethren Caregivers are now offering the Peace Church Long-term Care Insurance available to anyone connected with the Church of the Brethren. Click here to link to more information about this program.