INTRODUCTION
As people age, it is typically one of their deepest desires to remain in their homes for as long as possible, and to preserve their links with their families, their friends and their local communities. From both a human and an economic perspective, the effort to adopt a home- and community-based approach to the care of the elderly and the infirm is sensible and commendable. In the case of the Diocese of Camden and Catholic Charities this new and innovative approach to healthcare supportive services is driven by a desire to live the Gospel mandate of service to others, the command to “Honor thy father and mother,” and the call to serve those most in need of the healing presence of God in their lives.
CURRENT AND PROJECTED FINANCIAL SITUATION OF THE NURSING HOMES
In its new statewide managed care program, New Jersey will provide significant financial incentives for long-term-care companies to keep Medicaid recipients in the community for as long as possible, which will result in a cumulative reduction in nursing facility residents over the next five years. Although the number of individuals needing custodial nursing home services is projected to increase eventually, in the interim the financial viability of these three institutions operated in conjunction with the Diocese of Camden will be significantly destabilized.
These two factors result in projected losses over the next five years at Bishop McCarthy Residence, at St. Mary’s Catholic Home and at Our Lady’s Residence. In the past, the Diocese has made up the losses through loans. These advances, along with unpaid loans from the Diocese for construction and renovation costs, have resulted in a total unpaid indebtedness of over $8 million. Even if the Diocese would be able to advance the funds needed to continue their operations – and it is doubtful that it would be able to do so continuing into the indefinite future – such financial imprudence would undermine the ability of the Diocese to fund other ministries.
THE BLUE RIBBON COMMITTEE
Confronted with this difficult situation, in early 2014 Bishop Sullivan appointed a Blue Ribbon Committee to evaluate the ministry of these facilities, and to make recommendations regarding the future provision of services to the elderly in continuing the Diocese’s pastoral mission. The Committee included representatives of the medical, legal, academic, business, religious and health-care-provider communities.
The first meeting of the Blue Ribbon Committee was held on March 4, 2014. The Committee was given financial summaries and data on quality, and it was also provided with an explanation of the Medicaid program and its increasingly negative impact on the financial status of the nursing homes. There was also a discussion of the anticipated decline in occupancy resulting from the State’s managed care initiatives.
The Committee met again on March 31, 2014. The nursing home administrators, and a representative from each of the homes’ board of trustees addressed the Committee. An actuarial analysis was also presented demonstrating that, in states which have initiated managed care programs, nursing homes always experienced declines in occupancy.
At the third meeting of the Committee, on June 2, 2014, the members who had visited the nursing homes spoke about the high quality of care that they had observed. At this meeting the Committee also heard a presentation from Monsignor Charles E. Fahey, M.S.W., who is a priest from Syracuse, New York, and a former president of the American Association of Homes for the Aging, a fellow of the Gerontological Society of America and a fellow of the American College of Health Care Administrators. In his presentation, Monsignor Fahey said that – while church entities had provided housing and services for frail elderly people for many years – Medicare and Medicaid programs had led them into a medicalized model for their services to the elderly. He said that the provision of massive governmental assistance through the Medicare/Medicaid programs “changed the culture and care of the aging . . . to a professional/medical approach.” He added that there are “many threats to the viability of nursing homes” since people “prefer to remain at home rather than be institutionalized” and that governments “at all levels are instituting policies to minimize both short-term and long-term nursing home care.” He said that, however, there will be an increasingly large number of vulnerable individuals, and that dioceses “should offer encouragement and resources such as ‘tool kits,’ examples of ‘best practices,’ education, training and ongoing consultation” in building on and expanding existing structures to serve these individuals.
Each member of the Committee spoke at the July 9, 2014 meeting, addressing the question of whether there was a realistic possibility of continuing to operate the three facilities given the financial difficulties that the facilities face. This led to a discussion of how the Church’s ministry to the elderly in Southern New Jersey was to continue. A majority of the members of the Blue Ribbon Committee recommended that the facilities be sold, that they be marketed together, and that the net of the funds realized be re-channeled to address concerns through home-based and parish-based delivery services to those who are underserved, or not served at all.
THE SELECTION OF CENTER MANAGEMENT GROUP
Beginning in September of 2014, Raymond James & Associates, which Catholic Charities had previously engaged, undertook to contact a variety of real estate investors, religious and non-profit healthcare providers, and nursing home operators in order to determine their interest in a potential acquisition of the facilities. In marketing the three facilities, Raymond James contacted 151 potential purchasers and, after assessing initial interest, circulated confidentiality agreements to 48 potential bidders. Thereafter a formal Request for Proposals – which included such decision criteria as valuation of the portfolio, the treatment of employees, experience in New Jersey, the quality of care offered in current facilities and the commitment to Catholic values – was circulated. Thereafter, 16 interested parties submitted Indications of Interest and seven bidders were selected to move to the next stage of the process based on their responses to the Request for Proposals and their ability to meet the decision criteria. Additional due diligence included management meetings and site tours, as well as access to additional confidential documents and updated financial and operational data, with the field thereafter being narrowed to four potential bidders. Proposals were ultimately submitted by two bidders and a Letter of Intent with the Center Management Group was negotiated.
Paramount in the consideration and selection of Center Management Group was its reputation for the care provided to the residents of the facilities that it operates, and its willingness to assure the continued operation of these facilities as faith-oriented and Catholic.
After extensive negotiations an Asset Purchase and Sale Agreement was finalized which was approved by the boards of trustees of the facilities.
TRANSFORMATION TASK FORCE
Subsequent to the recommendation of the Blue Ribbon Committee that the three nursing homes be sold and the proceeds used to provide support to a home and parish-based health services operations, Bishop Sullivan appointed a Health Ministry Transformation Task Force to make recommendations regarding the types of new services and programs that the Diocese would be able to provide as part of its ongoing health care ministry. In his letter to the members of the Task Force, the Bishop said that he had “committed the Diocese to transform its health care ministry especially to the poor and the frail elderly through parish-based programs,” and he noted the need for creativity “in finding new means not only to support our work on behalf of the elderly, but to have a health care ministry which meets the needs that couples encounter concerning both their children and their own aging parents.” Representatives from Catholic Charities, the medical profession, nursing homes, the Diocesan Housing Services Corporation and the diocesan presbyterate were included as members of the Task Force, which met on September 24, 2014, October 8, 2014, October 29, 2014, and December 3, 2014. The Task Force noted, among other matters, (1) the importance of servicing people of all financial means, saying that the programs should therefore be offered free of charge, or on a sliding-scale basis, (2) the importance of considering partnerships with other organizations for programs and services that would not be provided directly, and (3) the need for flexibility in reacting to the response to new programs. Significantly, in its long history Catholic Charities of the Diocese of Camden has never imposed any religious requirement or test as a condition of receiving any of the vast array of services that it makes available, and the Task Force stated that the assistance should continue to be provided without regard to religious belief.
After a demographic analysis, estimates of the need for services, interviews, and a review of current health-related services offered by parishes in the Diocese, the Task Force recommended that the proceeds from the sale of the nursing homes be used to fund five specific programs.
Bishop Sullivan accepted these recommendations, and he directed that a program should also be included to address the needs of autistic children as they transition to adulthood, not only to provide assistance to them, but also to provide support-alternatives for their families.
THE DIOCESE OF CAMDEN HEALTHCARE FOUNDATION, INC.
In the expansion of its healthcare ministry, the net assets resulting from the disposition of the long-term care facilities will provide the financial basis for the development and implementation of these new programs, and thereby provide care to an even greater number of individuals in the familiar settings of their homes and communities. It will, of course, undertake this effort in an economically sustainable and realistic manner that responsibly addresses the call to be good and faithful stewards of God’s gifts.
After the payment of the outstanding indebtedness of the nursing homes and the costs involved in the sale, as well as the funding of the pension plan for the current employees, the net amount resulting from the sale of the facilities will be assigned to a trust, The Diocese of Camden Healthcare Foundation, Inc., which has been incorporated as a New Jersey not-for-profit corporation pursuant to Title 15A of the Revised Statutes, and will be established as a tax-exempt entity under Section 501(c)(3) of the Internal Revenue Code.
Applications will be made to the Foundation, on a regular basis, for funding to support six specific programs.
Parish Nursing / Stephen Ministries Programs
With the growth and expansion of the current Parish Nurse Program being supported through this new initiative, more individuals will have ongoing direct access to trained registered nurses who can screen, educate, and coordinate care needs for those seeking assistance to stay healthy, or to effectively deal with chronic health conditions in order to remain safer and more independent at home. As emotional needs constantly arise which are secondary to the issues of aging – such as separation, isolation, and the death of family members and friends, as well as the human struggles inherent in extending oneself for the care of others – the parish-based Stephen Ministries Program will be supported through this healthcare initiative. Staffed by trained, supervised and dedicated individuals, this will enable the provision of ongoing emotional and spiritual support, ministering in one-on-one relationships with care receivers.
Parish-Based Daycare Programs
Recognizing that social isolation is one of the most dreaded experiences of aging, this funded health ministry will provide ongoing support for the parishes located throughout the six counties in the Diocese to develop daycare programs for the elderly. It is intended that these programs will be developed in a consistent manner; however, they are to be operated and managed by individual parishes, thus developing the sense of local responsibility that will result in sustainability. They will provide the opportunity to bring the elderly together on a daily basis, at already-existing and available parish facilities, for physical activity, nutritious meals, social interaction and recreation, spiritual exercises, health screening, and monitoring of chronic conditions.
Non-Medical Home Care Service Program
This program, which will involve the development of a Non-Medical Home Care Agency, will provide in-home services to assist frail elderly and disabled individuals who are limited in their abilities to be totally independent in their activities of daily living, yet are safe and well enough to live at home under proper care and supervision. This will require time to develop due to state regulatory demands and the business organization that must be formed to support it. In regard to long-term financial sustainability, these services are Medicaid-eligible for those who qualify, while others will pay on a sliding scale according to their means.
Senior Health and Wellbeing Membership Program
The development of this program, in accordance with the recommendation of the Task Force, will create an opportunity to establish a database to promote and announce new programs and the availability of services. It will, as well, be an important tool in providing important health and lifestyle information and in offering a forum for needed feedback if the overall mission perceptively addresses the actual needs of the elderly and those who assist them.
Care Coordination / Consultation and Resource and Referral HelpLine Programs
There is a need that exists for support services which address the health, safety, and emotional and spiritual well-being of the elderly and disabled, the Diocese will provide professional Care Coordination and Consultation, along with a Resource and Referral HelpLine programs.
Qualified nurses, social workers, and other trained individuals will provide care coordination and consultation services to assist those in need of help, and their families, to negotiate the often-confusing and complex maze of healthcare and emotional support services available to them in the region where they live. This personal interaction will also help to identify emerging health concerns so they can be addressed early, before they might lead to more serious problems and the need for hospitalization or long-term care.
Autistic Children Transitioning to Adulthood
In order to assist families of autistic children, programs and services will be developed that help create smooth transitions across the lifespan and improve access to care, particularly for underserved members of our communities. Since children with autism cycle out of government and other similar support programs upon reaching adulthood, work will be necessary to develop creative means to assist them and their families in having access to protective housing, meaningful jobs, and healthcare services as needed in order to provide a stable and dignified family life for those affected.
THE ESTABLISHMENT OF THE DIVISION OF HOME
AND PARISH-BASED SERVICES
As Catholic Charities and the Diocese move from a focus on institutional long-term care facilities into healthcare programs centered on the homes and communities of those serve, they must consider various issues. These issues include, of course, an evaluation of the needs of those they intend to serve, capital investment requirements, a realistic timeline for implementation, the licenses and certifications needed, the important question of “saturation” (to determine whether an actual need exists), and the ability to use volunteers to supplement paid staffing. In order to address these matters, in November of 2014 the Diocese of Camden hired Deacon Gerard Jablonowski as the director of the newly-formed Division of Home and Parish-Based Services. He is the former president and chief executive officer of St. Francis Medical Center in Trenton, and had served as a member of the diocesan Health Ministry Transformation Task Force.
The programs to be offered, in accord with the recommendations of the Task Force and at the direction of Bishop Sullivan, are being designed to provide ongoing assistance and support primarily for the frail elderly and disabled, addressing their physical, spiritual, emotional, and behavioral needs. The overriding purpose is to remain responsive to the needs of God’s most vulnerable people and their families by delivering care where people are most comfortable and best able to receive it – at home and within their community. These services and programs are intended to help these individuals maintain a healthier, safer, and better quality of life than would otherwise be available to them – living in their homes within their local communities as they face the challenges of aging and/or disability. These new programs will address physical, spiritual, and emotional needs through a holistic approach to care, and every point of contact will include pastoral aspects of care that can bring health, comfort, and a sense of well-being to each individual served. These dimensions of care are what Catholic Charities and the Diocese of Camden see as essential to the total welfare of the most vulnerable, whose needs they serve. These programs will serve as a new basis for a transformed health ministry that stretches back decades and has touched the lives of countless individuals who have sought – and who seek – care and comfort.
ABOUT CENTER MANAGEMENT GROUP
Founded in 1999, Center Management Group, led by its principal, Charles-Edouard Gros, is a leader in the operation and management of high quality healthcare providers. Center Management Group is dedicated to providing all of its residents with the highest quality health care in a homelike environment. The team at Center Management Group possesses a keen understanding of the vast array of issues that face the frail and elderly population, individuals in need of rehabilitative services, those who are sick and those who are in need of emergency care. Center Management Group has vast experience in providing skilled nursing, independent living, and assisted living care, sub-acute care, rehabilitation therapy, adult day care programs, and personal home care.
CONCLUSION
It is the goal of the Diocese of Camden and Catholic Charities to refocus the decades-old ministry to those in need in Southern New Jersey by relieving the burdens of healthcare confusion, access, and affordability, and doing so with a sense of responsible stewardship of what God has provided through the goodness and generosity of so many. The spirit of care and service that has been the hallmark of the efforts of the Diocese of Camden and Catholic Charities in caring for the elderly will help to enable those most vulnerable to enjoy the dignity of a meaningful life in communion with their families and their local communities.