Religious communities throughout the United States have at least one thing in common: retired sisters are aging in place and a higher percentage of sisters require skilled nursing care, assisted living, memory care, and supportive services.

For many, the facilities, staffing, and service delivery systems are not set up to provide health care for sisters with high acuity, moderate to advanced memory loss and cognitive decline, or other advanced frailties associated with the aging process. Your physical plant was just not designed to provide nursing care or advanced assisted living that aging sisters require today. It is nearly impossible for you to provide the full array of health care services to meet the needs of your aging sisters. More and more congregations with financial resources are partnering with outside operators to provide services, and congregations with limited means often partner with off-site Medicaid providers. Some congregations have converted a portion of their building to health care options designed to provide care for aging populations, while others have opened their doors to laity if licensed by the respective state agencies to provide care.

For many, however, providing the required care for aging sisters in the current health care environment without the assistance of a qualified provider is nearly impossible. Regulatory requirements for licensed options are extensive; maintaining staffing levels is exhaustive; and satisfying the customer—your sisters—is, well, challenging. As congregation resources are stretched thin, sisters may not be able to manage staff, services, or programs effectively. Costs explode and retirement savings are depleted faster than necessary. There are effective options some congregations pursue to minimize the financial strain, day-to-day burden, and shrinking resources of providing health care for the sisters. Three options for addressing these challenges are worth considering:

  • Continuing to provide care internally (status quo)
  • Moving to a qualified operator
  • Seeking out and contracting with a qualified operator

Can we all agree that maintaining the status quo is likely not the best option? If so, you have a fundamental question to answer: do we stay here and receive care in place from a qualified partner, or do we move to a health care provider’s location to receive our care? This is a necessary first step and the answer will guide you through the rest of the process. If you decide to stay on-site and not require your sisters to move to receive care, you have in effect decided to either: 1) provide the care yourselves, or 2) partner with an experienced health care operator.

How open are you to an outside operator providing your health care and long-term care for retired sisters? In our experience, many congregations cannot efficiently deliberate on this issue and struggle to recognize that an outside operator can provide a higher quality of care more effectively and efficiently than they can themselves. However, many who have moved beyond this discussion are able to engage partners in a mutually agreeable manner without losing their identity, control, or decision-making abilities.

Additionally, will you open your doors to the lay community and are your sisters okay living with laity? This is another fundamental question that must be addressed. For health care operations to be financially viable, the operator will need a sufficient volume of paying customers. This is a fiscal reality and often requires your doors to open to laity, including men. Integration of the laity into your community can have many benefits; however, you will need to work through many questions, including:

  • How will the private spaces remain private for sisters?
  • What impact will opening to the laity have on the spiritual life of the sisters, considering persons of many faiths would potentially move in?
  • How would you manage dining services, faith services and the chapel use, activities and other day-to-day life with the laity?
  • Where would the sisters reside? Would it be on the same floor as the laity? Could the spaces be separated?

Of significant concern to operators is the status of the physical plant. It is likely that your buildings are not designed and or laid out in a manner consistent with how senior communities are designed and built today. You will need to work with the operator to determine what renovations will need to be completed to make the options comparable to what is available outside your community today. These renovations could be extensive and expensive. Congregations with financial means will often assist with the renovations; however, there are situations where the partner will eventually own all the property and does not require the congregation to assist financially. You need to consider this when choosing the right partner.

Even if you decide to move to the operator’s location, the physical space considerations might remain. You will likely have to address your wish list to make the space yours. Some situations do not require significant renovation or investment in the buildings to effectively provide care for the aging sisters.

Whether you move or remain on your original site, you should consider partnering with an operator that can take over management responsibilities and relieve the day-to-day operational burden of the sisters currently providing care. Perhaps burden is not the right word. It is never a burden to care for loved ones but selecting a high-quality senior living operator to take over management operations would significantly free up the sisters for their mission, personal spiritual growth, and perhaps pursue meaningful work in the community. You would also have the peace of mind that your sisters are receiving the best possible care from professionals that are qualified, trained, and certified.

Furthermore, many congregations would like to relieve the financial and management burden of owning the real estate property and buildings, which should be discussed early on with any partners or operators you are engaging in the dialogue. Optimally, you would choose a partner open to purchasing the property and buildings at a future date, either outright or through a phased approach. At the least, you would want to choose a partner willing to help you identify a potential buyer.

Finally, when all options are exhausted and providing care for your sisters directly on-site or partnering is not a valid option, explore options in your community to place your sisters. Some congregations have committed to long-term agreements for entire floors or wings within an existing Catholic or faith-based option in the community. Many of the same questions need to be addressed regarding living with laity: allowing care to be provided by laity, cost of care and depletion of resources, etc. In addition, you need to fully assess your options and evaluate whether they would be a good fit for your sisters, which requires due diligence regarding their financial stability, reputation in the community, quality of care, staffing, delivery of care, and other metrics.

In Summary

You need to be thoughtful in selecting health care options for your sisters. Although there are quality for-profit and non-profit operators in this industry segment, not all of them will operate consistently with your values, morals, vision, and mission. Choosing the best fit is key to ensuring a mutually beneficial long-term solution.

Health Dimensions Group has partnered with Women Religious to provide management services for the care of their sisters. If you’d like more information on how HDG has worked with other congregations or to discuss options for providing care for your sisters, please contact us at or 763.537.5700.