Is there a shortage of sacramental care for the elderly in the U.S.?
In October, as the bishops’ synod on the Pan-Amazon region got under way, America reported on the lack of missionary priests in the nine-nation Amazon basin. Women religious and laypeople often provide most of the pastoral care for many isolated communities, including effectively assuming some responsibility for their sacramental care.
“Many people would come to us and say they needed to confess their sins. We always made clear we couldn’t forgive them in the name of the church. But we obviously listened to them, gave them a blessing and a hug,” said Sister Ivone Oliveira, who has spent 20 years working in the region.
Stories like Sister Oliveira’s may seem to represent a far-off problem to the North American church, but they mirror emerging realities closer to home, including a scarcity of sacramental care for the elderly. “So many priests are very generous,” said Alan Bowman, vice president of mission integration at Trinity Health, a national Catholic health care provider. “But it’s very, very difficult at times finding priests for sacramental ministry in senior living communities.” Mr. Bowman’s office is responsible for 62 senior communities across the country and manages another two dozen retirement centers for religious communities (as well as 93 hospitals).
Los Angeles, an archdiocese of 11 million Catholics with 1,047 diocesan and religious priests, has 12 Catholic residential communities for the elderly. Most of these are ministries of various religious sisters and brothers like the Little Sisters of the Poor and the Hospitaller Order of St. John of God.
But in retirement centers that do not have the benefit of a religious community’s support, finding a priest at all can be difficult. At one facility in Los Angeles the local parish had provided Mass once a month. The parish recently announced it would no longer do so, effective immediately. “There wasn’t much explanation,” the facility’s activity director said. (The director asked to remain anonymous in the hope that an arrangement might still be worked out with the parish.)
“Up until the last five or 10 years, Mass was offered every day. Then it was hard to get priests every day, then on the weekend. There were fewer priests in the parishes and they were being stretched thin.”
It was also unclear to the director whom to turn to not only for Mass but also for sacraments of anointing or reconciliation. “We used to call that parish, but I’m not sure that’s still available.”
Keeping sacraments accessible can be a challenge even for large Catholic health care providers like Providence St. Joseph Health, which runs senior care facilities in seven Western states. Karen Summers, chief mission integration officer, notes that in one of Providence St. Joseph’s Seattle facilities, “Up until the last five or 10 years, Mass was offered every day. Then it was hard to get priests [every day]; then it was hard to get priests on the weekend. There were [fewer priests] in the parishes and they were being stretched thin.”
That particular facility is still able to offer Mass three days a week plus a Saturday vigil; other locations in the Providence St. Joseph network have not been as fortunate. “In some of our long term care facilities, they have Mass once a month,” said Ms. Summers.
Mr. Bowman, a former Holy Cross seminarian, said that his personal connections with priests have often been more productive in securing sacramental care than official diocesan channels. “I have reached out to bishops through their vicar to ask for help and they apologize and tell me they just don’t have anyone,” said Mr. Bowman. “That’s not to say they’re holding back on me. Some have said they would love to help.”
There is some good news: Administrative sponsorship by religious communities can mean a blessedly reliable access to the sacraments for many senior residents at retirement sites. “Normally we have a chaplain who says Mass every day and sees to the spiritual needs of the residents,” said Sister Gertrude Hennessey, C.S.N., at the Nazareth House in Cheviot Hills. The home also offers a communal anointing of the sick at least four times a year for the 126 residents, though Sister Hennessey notes administrators would prefer to provide it once a month.
Likewise, St. John of God Retirement and Care Center in Los Angeles has a priest chaplain who offers daily Mass, anointings and the sacrament of reconciliation for the community’s 200-plus patients in its four facilities. “If he’s not here, we do a communion service in the chapel,” said Tom Maloney, pastoral service assistant at St. John. “But I don’t remember the last time we had to do that. He’s a real blessing.”
While the limited access to clergy is a real problem, some retirement homes are blessed with lay chaplains.
And at the Little Sisters of the Poor’s Jeanne Jugan Residence in the San Pedro community of Los Angeles, a recently ordained Norbertine priest serves as chaplain. “I haven’t heard of one of our homes that didn’t have daily Mass,” said Mother Marguerite McCarthy, L.S.P. “I don’t think any of homes would exist without the diocese making someone available for the sacraments.”
The aging of the clergy across the country—according to Georgetown University’s Center for Applied Research in the Apostolate, one third of U.S. Catholic priests are retired—also means many urban Catholic retirement communities are home to at least a few retired priests. “At this point we have more priests in residence than at any other time,” said Mr. Maloney, “I’d say roughly 15.”
“Sometimes we’ve had up to 25 or 30,” said Sister Hennessey. “Some are active and can say Mass. Up until a year ago, three or four of them went out to parishes to say Mass on Sunday.”
But retired priests cannot make up for an empty chaplain’s position. Nazareth House is currently looking to fill one. Sister Hennessey is confident she can find someone, but she said the priests in residence are not so sure. “Our clergy are telling us, we’re not going to get somebody. They volunteered to hang in there [as volunteers].”
Both Ms. Summers and Mr. Bowman are quick to point out that while the limited access to clergy is a real problem, their facilities are at the same time blessed with lay chaplains certified by the National Association of Catholic Chaplains. “Our chaplains are just amazing ministers,” Ms. Summers said. “We’ve worked really hard over the years to cultivate the level of professionalization in our ministers.” The expectation, she explains, is that they “perform at the highest level of spiritual support.”
Facilities run by religious communities in Los Angeles also rely on the pastoral presence of lay and religious chaplains. “We’re always on duty and on call,” said Mother McCarthy, at Jeanne Jugan. “Our main mission is serving the poor and accompanying them when they’re in the dying phase. It’s the summit of our lives to help them and their families as they’re preparing for eternity.”
“People who have lived the life of faith need, in their sickness or elder years, the presence of a person who is going to journey with them through the dark places.”
But Ms. Summers noted that even if “the priests do play a smaller role” given their numbers, “it is a significant and integral role to our patients and residents, especially the current generation of Catholic elders.”
At the same time, the training and service provided by lay chaplains is leading others to ask the same questions being posed at the Amazon synod. “I had a chaplain working for me who was caring for a family that desperately wanted their dying mother to receive the sacrament of the sick,” recalled Mr. Bowman. “She called the local parish, but the pastor was gone on retreat. She called 12 parishes; the priests were all gone.
“It was a diocesan retreat. And the family says, ‘You anoint mom.’ She says she’s not authorized by the church to do that, and they say, ‘But you’ve been our chaplain. We understand [your hesitancy], but can you?’”
“And finally she did, but she made it very clear, ‘This is not the sacrament. I am praying with your mom.’ Later she confessed it to the bishop; he said it was totally unacceptable and told me to make sure she never did that again.”
“Some chaplains get very frustrated,” Mr. Bowman said. “They try very hard to meet the people’s needs in a way that is very respectful of current church teaching.”
He notes that decades ago, there were conversations between the Catholic Health Association, the National Association of Catholic Chaplains and the U.S. Conference of Catholic Bishops about the possibility of authorizing some chaplains to provide sacramental ministry under dire circumstances. A former president of the N.A.C.C. himself, Mr. Bowman wonders if it is worth revisiting that question: “Maybe deacons and board-certified Catholic chaplains could be authorized by the bishops to provide more ministry in these nursing homes.”
“Some of these seniors gave to their parish their entire lives, and then they move to a [Catholic] senior community, and they are forgotten,” said Mr. Bowman. “And I don’t want to put this on the priests; that’s not at all the case. The priest in the parish where I’m at has three parishes he’s responsible for, and he’s older than I am, and I’m old enough to retire.”
At the U.S. Conference of Catholic Bishops, Dr. Marc DelMonico serves as the director of certification for ecclesial ministry. His office certifies theological and pastoral competencies for a range of ministries, including pastoral care for the elderly. Part of the work of the lay chaplain in retirement homes, he explained, is to be “a sort of connective tissue to the ordained ministry of the church”—that is, to pay attention to the sacramental needs and desires of the people they serve and help convey them to local clergy.
But he acknowledged the problem of a system in which the ministers providing the ongoing care to residents have to stop in moments of urgent need to go elsewhere in search of priests who are themselves more and more taken up with other responsibilities. “Lay chaplains experience real anxiety [in these situations], and how do we do deal with that reality?” he asked.
“These are really great people doing this really great work,” said Dr. DelMonico, “and at times they want to be able to accompany those they’ve connected with because they have a deep love and care for them. But in a certain way they are prevented from doing that, in spite of all their competency and training.”
He noted that the situation is complex: “Often this kind of conversation gets pitched as ‘Bishops won’t let laypeople do the things that priests have typically been required to do.’ And I don’t disagree; that’s a truth. I also think they are in some measure restrained from doing that because of standing Vatican precepts.”
But he, too, hopes these issues can be discussed. “People who have lived the life of faith need, in their sickness or elder years, the presence of a person who is going to journey with them through the dark places and help them toward hopefully renewed health or the life to come.”
“The sacraments of reconciliation and anointing are of course vital; we want people to have access to priests for that sacrament,” he said. “But people pour out their souls to people they trust, and those who are good ministers respond with the recognition of the reality that God offers.
“The lay minister cannot offer sacramental absolution, but there’s nothing that says they can’t offer the Good News of the Kingdom of God that says Jesus forgives those who repent in their hearts.”