JOURNAL OF THE CATHOLIC HEALTH ASSOCIATION OF THE UNITED STATES
HEALTH PROGRESS WINTER 2026
Aging & Longevity
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Assembly 2026 ST. LOUIS, MO | JUNE 2–4
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WINTER 2026
FEATURES
AGING & LONGEVITY
43 VENERABLE NELSON BAKER: WHAT WE CAN LEARN FROM THIS APOSTLE OF CHARITY Msgr. David G. LiPuma 50 MENOPAUSE: NAVIGATING FROM SYMPTOMS TO SOLUTIONS Tricia Steele
DEPARTMENTS 2 EDITOR’S NOTE BETSY TAYLOR 57 MISSION Exploration of the Soul Is Ever-Present in the Ministry’s Changing Seasons JILL FISK, MATM 60 ETHICS The Road to Revision: Updated ERDs Set Guidelines for Catholic Care NATHANIEL BLANTON HIBNER, PhD 63 FORMATION Survey: Senior Leadership Formation Is Fueled by Regular Cadence, Ample Time DARREN M. HENSON, PhD, STL 66 THINKING GLOBALLY Embracing Global Unity First in a ‘What’s in It for Me’ World BRUCE COMPTON
Illustrations by Jon Krause
4 HOW TECHNOLOGY IS RESHAPING CARE FOR OLDER ADULTS Kelly Bilodeau 10 HEALTH SYSTEMS CAN TAKE ACTION TODAY TO SUPPORT FAMILY CAREGIVERS. HERE’S HOW. Nicole Duritz and Rhonda Richards 15 ELIZABETH SETON CHILDREN’S BRIDGES CARE GAP BY BUILDING NEW CENTER FOR SEVERELY DISABLED YOUNG ADULTS Betsy Taylor, MS
69 COMMUNITY BENEFIT How Community Benefit Serves as a Living Expression of Catholic Health’s Mission and Commitment NANCY ZUECH LIM, MPH, BSN
33 POPE LEO XIV — FINDING GOD IN DAILY LIFE 72 PRAYER SERVICE
22 HEALTHSPAN: REIMAGINING WHOLE-PERSON WELLNESS AS A COMMUNITY GOAL Scott Neeley, MD 29 FROM INNOVATION TO IMPERATIVE: THE NEW ERA OF PALLIATIVE CARE DELIVERY Brynn Bowman, MPA 34 MAPPING A BETTER CARE PLAN FOR DEMENTIA PATIENTS AND THEIR FAMILIES Sr. Rosemary Donley, SC, PhD, APRN, FAAN 39 REFLECTION — BEHIND THE NEED TO ‘NO!’: WHY ACCEPTING CARE IS AS IMPORTANT AS GIVING IT Maureen Pratt, MTS, MFA
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EDITOR’S NOTE
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ifespan is broadly understood as the number of years a person lives, while healthspan generally reflects the number of years a person lives free from chronic disease or significant disability.
In his article about a program starting in California to support whole-person health, Dr. Scott Neeley, the president and CEO of Dignity Health Sierra Nevada Memorial Hospital, touches upon the difference between lifespan and healthspan. The BETSY distinction is among the topics TAYLOR discussed in this issue of Health Progress, which explores questions related to health at different ages, life transitions and how to support longevity and quality of life. It also considers the importance of relationships when providing care to those who cope with disability or chronic illness. Authors from AARP describe their latest findings related to caregiving across the United States, and make suggestions for what that may mean in terms of policy and societal change to support families and the workforce. Other articles in this issue report on how people want to age and technological advances that can assist both them and their care providers, whether at home or in a longterm care environment. Additionally, readers hear from the Center to Advance Palliative Care about strategies to ensure that palliative care equitably reaches patients with serious illnesses and their families. As we consider longevity, a thematic thread running through this issue is certainly that when it comes to care, the vision of the Catholic Church remains steadfast. Bruce Compton, CHA’s senior director of global health, details in his column how CHA and the organization’s Global Health Advisory Council have been in dialogue with leaders around the world, and points to how this moment provides a renewed reason to unify with those who are vulnerable to forge “new pathways
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of solidarity and service.” Lives depend on attention to our brothers and sisters most in need. An article from Msgr. David LiPuma, the pastor and rector of Our Lady of Victory National Shrine & Basilica in Lackawanna, New York, recounts the life of Venerable Nelson Baker and how his example and legacy continue to be remembered in Western New York almost a century after his death. Staffers at Catholic Health in the region pay tribute to his legacy of caring. The basilica he championed still draws visitors from far and wide, and his example of recognizing that responding to social needs is foundational to the overall health of an individual and a community still sparks inspiration today. I visited Elizabeth Seton Children’s campuses in Yonkers and White Plains, New York, where the organization is building a new center for young adults with complex conditions, a project that organizers have pursued for years. Thanks to everyone there, the staff and families, for letting me spend time with your beautiful children and young adults. As we turn to the new year, and the call of the work, I turn to 1 Corinthians as a touchstone for the importance of love in how we care for one another: “Love is patient, love is kind. It is not jealous, is not pompous, it is not inflated, it is not rude, it does not seek its own interests, it is not quick-tempered, it does not brood over injury, it does not rejoice over wrongdoing but rejoices with the truth. It bears all things, believes all things, hopes all things, endures all things. Love never fails. … (1 Corinthians 13:4-8)
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VICE PRESIDENT, COMMUNICATIONS AND MARKETING BRIAN P. REARDON
EDITORIAL ADVISORY COUNCIL Trevor Bonat, MA, MS, chief mission integration officer, Ascension Saint Agnes, Baltimore Sr. Rosemary Donley, SC, PhD, APRN-BC, professor of nursing, Duquesne University, Pittsburgh
EDITOR BETSY TAYLOR btaylor@chausa.org
Fr. Joseph J. Driscoll, DMin, director of ministry formation and organizational spirituality, Redeemer Health, Meadowbrook, Pennsylvania
MANAGING EDITOR CHARLOTTE KELLEY ckelley@chausa.org
Jennifer Stanley, MD, physician formation leader and regional medical director, Ascension St. Vincent, North Vernon, Indiana
GRAPHIC DESIGNER NORMA KLINGSICK
Rachelle Reyes Wenger, MPA, system vice president, public policy and advocacy engagement, CommonSpirit Health, Los Angeles
ADVERTISING 4455 Woodson Rd., St. Louis, MO 63134-3797, 314-253-3447; fax 314-427-0029; email ads@chausa.org. SUBSCRIPTIONS/CIRCULATION Address all subscription orders, inquiries, address changes, etc., to Service Center, 4455 Woodson Rd., St. Louis, MO 63134-3797; phone 800-230-7823; email servicecenter@chausa.org. Annual subscription rates are: complimentary for those who work for CHA members in the United States; $29 for nonmembers (domestic and foreign). ARTICLES AND BACK ISSUES Health Progress articles are available in their entirety in PDF format on the internet at www.chausa.org. Photocopies may be ordered through Copyright Clearance Center, Inc., 222 Rosewood Dr., Danvers, MA 01923. For back issues of the magazine, please contact the CHA Service Center at servicecenter@chausa.org or 800-230-7823. REPRODUCTION No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or any information storage and retrieval system, without permission from CHA. For information, please contact copyright@chausa.org. OPINIONS expressed by authors published in Health Progress do not necessarily reflect those of CHA. CHA assumes no responsibility for opinions or statements expressed by contributors to Health Progress. 2025 AWARDS FOR 2024 COVERAGE Catholic Media Awards: Magazine of the Year — Professional and Special-Interest Magazines, Second Place; Best Cover — Small, First Place; Best Special Section, Second Place; Best Special Issue, First Place; Best Regular Column — Spiritual Life, Honorable Mention; Best Coverage — Disaster or Crises, Third Place; Best Feature Article — Professional and Special-Interest, Third Place; Best Reporting of Social Justice Issues — Dignity and Rights of the Workers, Second Place; Hot Topic — Eucharistic Revival, Third Place; Hot Topic — 2024 Election, Third Place; Best Writing — Analysis, First Place; Best Writing — In-Depth, Second Place. American Society of Business Publication Editors Awards: Print — Special Section, National Bronze Award and Regional Gold Award; All Content — How-To Article, Regional Silver Award.
Produced in USA. Health Progress ISSN 0882-1577. Winter 2026 (Vol. 107, No. 1). Copyright © by The Catholic Health Association of the United States. Published quarterly by The Catholic Health Association of the United States, 4455 Woodson Road, St. Louis, MO 63134-3797. Periodicals postage paid at St. Louis, MO, and additional mailing offices. Subscription prices per year: CHA members, free; nonmembers, $29 (domestic and foreign); single copies, $10. POSTMASTER: Send address changes to Health Progress, The Catholic Health Association of the United States, 4455 Woodson Road, St. Louis, MO 63134-3797.
Nathan Ziegler, PhD, system vice president, diversity, leadership and performance excellence, CommonSpirit Health, Chicago
CHA EDITORIAL CONTRIBUTORS ADVOCACY AND PUBLIC POLICY: Lisa Smith, MPA; Kathy Curran, JD, MA; Clay O’Dell, PhD; Paulo G. Pontemayor, MPH; Lucas Swanepoel, JD COMMUNITY BENEFIT: Nancy Zuech Lim, RN, MPH CONTINUUM OF CARE AND AGING SERVICES: Indu Spugnardi ETHICS: Nathaniel Blanton Hibner, PhD; Brian M. Kane, PhD FINANCE: Loren Chandler, CPA, MBA, FACHE GLOBAL HEALTH: Bruce Compton LEADERSHIP AND MINISTRY DEVELOPMENT: Diarmuid Rooney, MSPsych, MTS, DSocAdmin LEGAL, GOVERNANCE AND COMPLIANCE: Catherine A. Hurley, JD MINISTRY FORMATION: Darren Henson, PhD, STL MISSION INTEGRATION: Dennis Gonzales, PhD; Jill Fisk, MATM PRAYERS: Karla Keppel, MA; Lori Ashmore-Ruppel THEOLOGY AND SPONSORSHIP: Sr. Teresa Maya, PhD, CCVI
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How Technology Is Reshaping Care for Older Adults KELLY BILODEAU Contributor to Health Progress
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rom smart scales that help doctors detect heart failure, to errand-running robots that drop off lab specimens and pick up medication, technology is increasingly finding a role in health care.1 These innovations help caregivers reduce hospital visits by detecting brewing health problems earlier and freeing up clinical staff from administrative burdens. High-tech tools are particularly valuable for clinical staff working with older adults in long-term care who have multiple chronic conditions. They also help older adults to safely live at home longer. A new after-hours telemedicine program at Maryville, a long-term skilled nursing care facility in Beaverton, Oregon, shows how tech is reshaping care. Instead of a middle-of-the-night phone call, remote providers now perform a video assessment on an electronic tablet, often averting a trip to the emergency department, said Liz Chua Alcantara, director of nursing at Maryville. Artificial intelligence (AI) is also becoming a valued tool for team members. At Providence, it helps reduce paperwork and physician burnout, said Dr. Scott Smitherman, chief medical information officer for the employed medical group in the Providence Clinical Network. And wearables like smartwatches, in-home sensors and fall indicators add a layer of connectivity and security for older adults living alone. In the next decade, technologies that once seemed futuristic, like robot assistants and strength-enhancing body suits, may become more commonplace in U.S. long-term care.2 However, as the use of technology rises, it’s elevating pri-
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vacy and security concerns, and creating a new time-consuming task: sorting through mountains of digital data. Facilities will need to solve those problems to help technology find its place alongside, not in place of, human caregivers. “We can’t pretend that technology takes the place of relationships,” said Dr. Myles Sheehan, a Jesuit priest and director of the Edmund D. Pellegrino Center for Clinical Bioethics at Georgetown University.
CHANGING DEMOGRAPHICS INCREASE NEED
Technological advances are arriving right on time as the nation’s health care system faces unprecedented pressure. The number of older adults in the United States is growing rapidly. By 2050, the Population Reference Bureau estimates that there will be 82 million adults aged 65 and older, many of them in need of health support.3 At the same time, family dynamics have shifted, said Bob Kramer, founder of Nexus Insights and cofounder of The National Investment Center for
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Seniors Housing & Care. A growing segment of tronic monitoring systems in the medical record the population is aging alone. For those who do at Maryville alert staff members to troubling have family support, work schedules can make it changes in vital signs or potential drug interacdifficult for adult children to care for their aging tions, Alcantara said. This adds a layer of safety to parents. Assisted living or long-term care are help ensure nothing is missed during a busy shift. A wound app is used to measure and track healing, options, but many struggle to afford it. “There’s a huge group that either can’t or fears and video capabilities provide comfort to families they can’t afford to move into a senior living com- and patients. “If we have a resident who is conmunity,” Kramer said. Technology that enables fused and misses a family member, a video call is people to live at home longer is attractive because very helpful,” Alcantara said. it can stretch their dollars. “The home is becoming more capable, The COVID-19 pandemic accelerated the adoption connected and convenient than ever of new at-home services, including health care, and before. It offers, in a sense, a virtual form these offerings continue to of assisted living where you can curate all expand. “The home is becoming more capable, connected kinds of services.” and convenient than ever before. It offers, in a sense, a — BOB KRAMER virtual form of assisted living where you can curate all kinds of services,” Video technology also allows family members Kramer said. to communicate between visits, reduce transportation costs or be part of a last service or anointing if they can’t be there in person. As health care sysTECHNOLOGY IN USE The ability to track patient health remotely is cen- tem pressures and costs grow, experts hope that tral to home care. Technology gives caregivers these new tools will provide a bridge to connect peace of mind, monitoring everything from nutri- people when they cannot be together in the same tion and medication adherence to ensuring that place. the patient isn’t wandering. Hospital care is being delivered at home A TIME SAVER through the Centers for Medicare & Medicaid While many people think of technology in terms Services Acute Hospital Care at Home program.4 of space-age gadgets, some of the most meaningDevices play a crucial role in these initiatives. “I ful benefits of this growing electronic revolution think some great examples are things like inte- are surprisingly low-tech. One scarce commodity grated blood pressure monitors and scales for it delivers is time. The rise of AI, in particular, is congestive heart failure patients,” Smitherman helping to reclaim hours lost to nonclinical tasks. noted. Having a connected scale can motivate AI can be used to record patient and physician patients to weigh themselves regularly. One study encounters to generate the clinical note for the found that detecting body fluid increases using medical record.6 Providence is one of the organia specialized scale could allow doctors to spot zations using this technology, Smitherman said.7 twice as many heart failure events in patients.5 By “We’re seeing huge improvements in burnout catching fluid increases in real time, doctors can and even productivity in doctors who are using reduce costly hospital admissions with an inex- our AI, ambient scribing technologies,” he said. “A pensive intervention. doctor that is less burned out and is more focused However, not all home devices provide a on you is a better doctor.” clear return on investment, Smitherman said. It’s easy to be distracted by glitzier uses of AI, For example, home blood pressure monitoring is but getting it to relieve doctors of the daily papermore complex due to the volume of information work slog is just as important, he said. “Before and the number of patients who need monitoring. this, for every 10 minutes that doctors spent with Outside the home, technology also improves a patient, they were spending five minutes doing patient care in long-term care facilities. Elec- administrative tasks,” Smitherman said. Nurses,
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too, spend up to a third of their time on each shift carrying out nonpatient-facing tasks, according to a Journal of Nursing Management study.8 However, Providence’s AI adoption has been cautious. Lower-risk administrative tasks are fair game, but AI isn’t allowed to make clinical judgments, Smitherman said. Nonetheless, AI is still playing an important role that could expand over time. “I want to be treated by a doctor who’s using AI. I want my family to be treated by doctors who are using AI, both to reduce their burden, but also for things like looking up information,” Smitherman said.
MANAGING A GLUT OF DATA
For all the time technology saves, it’s also creating new time-intensive challenges. “There was a time when technology was the barrier,” Smitherman said. “Nowadays, the problem is more the avalanche of data and how we’re going to manage it.” Wearables, in particular, deliver vast amounts of information that’s only useful if someone can digest and interpret it, which is not always feasible for a physician at the end of a long workday. New data processing needs raise practical questions, such as how doctors are going to be compensated for the hours they spend poring over this data.
information with ambient sensor monitoring,” Fritz said. “We can’t get the different stages of sleep like they do with the wearable sensors. But we can understand whether or not somebody is having interrupted sleep, if there’s a change in sleep location, bathroom use, or time spent outside the home. And those are really some of the major things that you look at for management of chronic conditions.” Smart-home solutions may be one way to manage digital overload. Other AI tools could offer another. For example, doctors often don’t have sufficient time to review a complex patient’s chart prior to an office visit. “All of us would like to think that our doctor spent 30 minutes before you walked in studying all of your records, but obviously that’s not the reality,” Smitherman said. Eventually, AI could help provide a summary.
RISKS AND DRAWBACKS
The risk of a dangerous error or privacy and security breaches has slowed digital adoption. AI is prone to mistakes. Large language models sometimes generate false information if they can’t find a requested answer. These “hallucinations” present unique dangers in health care. A seemingly trivial error in a health care record could be serious if the doctor doesn’t catch it, Smitherman said. “You need “We’re seeing huge improvements in to balance that against the burnout and even productivity in doctors status quo, where many times doctors were missing stuff in who are using our AI, ambient scribing their own documentation,” he added. technologies. A doctor that is less burned Facilities should have proout and is more focused on you is a better cesses in place to ensure the benefits of technology outdoctor.” weigh the drawbacks. “Here at Providence, we have estab— DR. SCOTT SMITHERMAN lished an AI guardrails comRoschelle Fritz, a UC Davis Health researcher mittee that carefully reviews any new product and associate professor at the Betty Irene Moore that uses AI for safety, etc.,” he said. Other risks include the potential for bias, School of Nursing, said the answer may lie in solutions that offer a snapshot of patient health trends which can be inadvertently built into algorather than a deep dive into data. She’s researching rithms, and abuse of monitoring devices to essenunobtrusive smart-home sensors in volunteers’ tially spy on patients in their homes. Helping residences. The system uses AI to track move- patients understand technology well enough to make informed decisions about its use is also a ment trends and to flag concerning changes.9 “When people don’t feel well, they move dif- challenge, particularly for patients who might not ferently,” Fritz said. Ambient sensors eliminate be tech savvy, Fritz said. Technology adoption also risks increasing the need for wearables and the flood of granularlevel data. “We can even get pretty good sleep existing inequities, she said. While tech tools may
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just starting to move into the U.S. health care market, it’s likely that adoption will move quickly in the next five years, said Fritz. “Technology is changing so fast, and its ubiquity is deepening all the time,” she said. However, while technology can play an important role in care, it’s no replacement for human connection. Treatment decisions still depend on MOVING INTO THE FUTURE These potential pitfalls will need to be addressed a strong doctor-patient relationship. “You have to as new technologies move into the home and into ascertain not just what’s the biomedical good, but care facilities. To get a glimpse of the future, look what is the good for that person as a human being,” to Japan, Kramer said. The country has one of the Sheehan said. “Are we respecting true autonomy oldest populations in the world, coupled with and dignity and their deepest spiritual needs?” Human connections are what keep people extremely low immigration and birth rates. In recent years, it has had to be innovative to meet moving forward, Kramer said. “High tech will not the health care needs of its people. As a result, the replace high touch. It enables high touch,” he said. Facilities and families that adopt technology need to pay “High tech will not replace high touch. It close attention to the voices of those they serve. “Listen enables high touch.” carefully to the people who — BOB KRAMER are supposedly being helped by the technology to see that Japanese long-term care system is on the leading they really are getting their biological, psychoedge of tech adoption. They’re using robot com- logical, social and spiritual needs met in the way panions, exoskeleton body suits, which are wear- that we would in a regular healing encounter,” able robotic devices that increase strength or Sheehan said. mobility, and smart adult diapers, equipped with sensors that can tell you not only when someone’s KELLY BILODEAU is a freelance writer who soiled or wet, but whether they’re dehydrated, specializes in health care and the pharmaceutical industry. She is the former executive editor of Kramer said. “Much of the technology that’s commercial- Harvard Women’s Health Watch. Her work has ized in Japan to serve older adults was actually also appeared in The Washington Post, Boston developed in the U.S., but there was no commer- magazine and numerous health care publications. cial market for it. There was no felt need,” Kramer said. NOTES But in Japan, where 60- to 80-year-olds are 1. David Raths, “ChristianaCare Piloting Robots to often caring for people who are even older, tech- Support Nurses,” Healthcare Innovation, May 25, 2022, nology is essential. An exoskeleton body suit can https://www.hcinnovationgroup.com/clinical-it/ make it possible for a 67-year-old to care for and nursing/news/21269000/christianacare-pilotinglift an 85-year-old, Kramer said. With limited staff, robots-to-support-nurses. smart diapers can allow workers to work effi- 2. Brett Arends, “Future Nursing Homes Will Be Run by ciently without constantly checking on residents, AI and Robots. Why That Might Not Be a Bad Thing,” he said. One study found that Japanese facili- Morningstar (MarketWatch), July 30, 2025, ties that used robots to help with patient-related https://www.morningstar.com/news/marketwatch/ tasks — such as lifting, moving or bathing — and 2025073086/future-nursing-homes-will-be-run-byto track and report data experienced lower staff ai-and-robots-why-that-might-not-be-a-bad-thing. turnover and saw gains in productivity and care 3. Mark Mather and Paola Scommegna, “Fact Sheet: quality.10 Aging in the United States,” Population Reference Now facing similar demographic pressures, the Bureau, January 9, 2024, https://www.prb.org/ U.S. could follow Japan’s lead, Kramer said. While resources/fact-sheet-aging-in-the-united-states/. many of these technologies, including robots, are 4. Hospital-at-Home, American Hospital Association, be accessible to everyone in a country like Japan with a national health care system, in the U.S. it could create a divide between the haves and havenots. “Whether or not Medicare pays for something is huge,” she said. When technology is covered, it helps ensure equitable access.
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https://www.aha.org/hospitalathome. 5. “Scale That Measures Fluid Retention Improves Prediction of Heart Failure Events,” Duke Clinical Research Institute, March 20, 2024, https://dcri.org/news/scalemeasures-fluid-retention-improves-prediction-heartfailure-events. 6. Grace Niewijk, “AI in the Exam Room: 5 Things to Know About UChicago Medicine’s New Note-Taking Tool,” UChicago Medicine, January 2, 2025, https://www. uchicagomedicine.org/forefront/patient-care-articles/ ai-ambient-clinical-documentation-what-to-know. 7. CHA has a number of resources related to AI and ethics on its website, www.chausa.org. For instance, one recent article details artificial intelligence work at Providence, and another is among articles delving more into AI: Sara Vaezy, “Artificial Intelligence With a Purpose at Providence,” Health Progress 106, no. 4 (Fall 2025): https://www.chausa.org/news-and-publications/ publications/health-progress/archives/fall-2025/ artificial-intelligence-with-a-purpose-at-providence; Julie Minda, “Ethicists Have Critical Role to Play as Artificial Intelligence Use Increases, Says Webinar
Presenter,” Catholic Health World, January 22, 2025, https://www.chausa.org/news-and-publications/ publications/catholic-health-world/archives/january2025/ethicists-have-critical-role-to-play-as-artificialintelligence-use-increases-says-webinar-presenter. 8. Silvia Grosso et al., “Prevalence and Reasons for NonNursing Tasks as Perceived by Nurses: Findings From a Large Cross-Sectional Study,” Journal of Nursing Management 29 (2021): 2658-2673, https://doi.org/10.1111/ jonm.13451. 9. Rebecca Badeaux, “Smarter Homes, Smarter Care: How a Nursing Professor Is Shaping the Future for Older Adults,” UC Davis Health, March 5, 2025, https://health. ucdavis.edu/news/headlines/-smarter-homes-smartercare-how-a-nursing-professor-is-shaping-the-futurefor-older-adults-/2025/03. 10. Josh Stowe, “Using Robots in Nursing Homes Linked to Higher Employee Retention, Better Patient Care,” Keough School of Global Affairs, University of Notre Dame, January 8, 2025, https://keough.nd.edu/newsand-events/news/using-robots-in-nursing-homeslinked-to-higher-employee-retention-better-patientcare/.
QUESTIONS FOR DISCUSSION This article points out that technology can help provide some solutions for people and their care providers as they age, but is no substitute for meaningful interactions or appropriate staffing levels. Both the late Pope Francis and Pope Leo XIV have been clear that technology is effective when it supports humans and their relationships and does not dominate or replace them. 1. What are you experiencing in your work environment related to the use of technology and care for older populations? Are there ways that technology makes it easier for you to focus on improved patient care? 2. Does increased use of technology make it harder to genuinely connect with those you work with and care for? What could your system do to better foster teamwork, collaboration and feelings of belonging? 3. Is your organization planning and budgeting now for technology upgrades? What sort of education, training and shifts in responsibility might you anticipate? 4. As your organization increases the use of artificial intelligence (AI), what guardrails do you have in place to ensure that bias is not present and that all patients have access, regardless of their status or financial resources? 5. As the “loneliness epidemic” deepens in our society, what concerns and hopes do you have about how AI can either worsen or help to lessen this reality?
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Health Systems Can Take Action Today To Support Family Caregivers. Here’s How. NICOLE DURITZ and RHONDA RICHARDS AARP
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hen Alma Valencia, a mother of two in Pasadena, California, left her job in fashion to care full time for her mom living with dementia, she didn’t receive formal training or much guidance. “You just learn as you go,” she said. Her days quickly filled with medication management, feeding, bathing and navigating benefits paperwork, alongside parenting and household duties. “Sometimes it feels like you’re on an island by yourself,” she admitted. Valencia’s experience, which she shared when the 2025 edition of Caregiving in the U.S. was released by AARP and the National Alliance for Caregiving, is the reality for millions of families today.1 Family caregivers shoulder complex clinical tasks and major costs. Four bipartisan bills, new Medicare caregiver training codes and the Centers for Medicare & Medicaid Services’ (CMS) Guiding an Improved Dementia Experience (GUIDE) Model give hospitals and other providers practical tools that can help.
THE LAY OF THE LAND
In 2025, an estimated 63 million Americans — nearly 1 in 4 adults — are providing care to adults or children with chronic conditions or disabilities — a 45% increase since 2015.2 Tasks are increasingly clinical — including wound care, injections and complex medication regimens — yet only a minority receive related training. Only 11% of family caregivers receive any formal training to prepare them to assist with activities of daily living — such as bathing and
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dressing — and instrumental activities of daily living — such as preparing meals and managing finances — while two-thirds of caregivers help with at least one activity of daily living, and only 22% of caregivers receive training in handling medical or nursing tasks. Despite this, the majority of caregivers assist with these tasks.3 At the same time, more than half (58%) of family caregivers advocate with providers, community services or government agencies on behalf of their loved one. One in 4 wants help managing paperwork or navigating eligibility for services. Financially, caregivers spend more than $7,200 on average annually out-of-pocket — roughly a quarter of their income — on home care, home modifications, assistive technology, respite care, transportation and more.4 For Catholic health care and the broader health environment, caring for caregivers is integral to caring for patients as
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The average age of caregivers is
51
38% Men
The average duration of caregiving is
Women still account for the majority of caregivers
61% Women
5.5
YEARS
♥ 1 IN 4
of American adults are family caregivers
Source: Caregiving in the U.S. Research Report, July 2025
they are an essential part of the care team. It’s also practical: When caregivers are trained, equipped, supported and connected to resources, readmissions fall, adherence improves and burnout is less likely.
POLICY THAT MEETS FAMILIES WHERE THEY ARE
With a growing and diverse population of caregivers experiencing strain and feeling a lack of support, these findings reveal a call to action is needed by all involved to develop systems that can provide meaningful relief for family caregivers. AARP supports a suite of bipartisan proposals designed to ease the financial and administrative challenges that make caregiving harder than it needs to be: The Credit for Caring Act, which is also supported by CHA, would create a targeted, nonrefundable federal tax credit to help offset a portion of out-of-pocket caregiving expenses for eligible working family caregivers.5 The Lowering Costs for Caregivers Act
would allow adults to use tax-favored health savings accounts, flexible spending accounts, health reimbursement accounts or Archer medical sav-
ings accounts to pay qualified medical expenses for their parents or parents-in-law — even if they aren’t a tax dependent.6 The Alleviating Barriers for Caregivers (ABC) Act would direct Medicare, Medicaid, the
Children’s Health Insurance Program and Social Security to simplify processes and communications so caregivers can more easily navigate benefits, saving time and frustration without feeling like they need a full-time case manager.7 The Connecting Caregivers to Medicare Act would inform people about the voluntary
option for people with Medicare to allow family caregivers to access their health information through 1-800-MEDICARE. For those who use this option, it can make it easier for their caregivers to communicate with Medicare to help their loved one or advocate on their behalf. As of this writing, this bill has not been introduced yet in the current Congress. However, the first three have been introduced and referred to the Senate Finance Committee and the House Ways and Means Committee or to both the House Ways and Means Committee and House Energy and Commerce Committee.8
When caregivers are recognized as part of the care team, they report greater confidence and stronger connections to community services. For providers, including caregivers in care planning can mean fewer discharge delays, reduced readmissions and better patient outcomes.
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BUILDING PROFESSIONAL SUPPORT FOR CAREGIVERS
Policy matters, but practice is just as essential. Health care professionals are central to supporting family caregivers. When caregivers are recognized as part of the care team, they report greater confidence and stronger connections to community services. For providers, including caregivers in care planning can mean fewer discharge delays, reduced readmissions and better patient outcomes. AARP has developed a new Healthcare Provider Resource Hub to help clinicians and systems build this support into routine practice.9 The hub: Highlights successful hospital programs that support family caregivers. Provides strategies for action and implementation. Offers stories and insights from leaders driving change in caregiver support. Hosts expert discussions on the benefits of involving family caregivers in care planning and delivery. With CHA’s network of more than 650 hospitals and 1,600 long-term care and other health facilities in all 50 states, AARP hopes these resources may be shared widely, equipping front-line staff with proven tools and amplifying impact across Catholic health systems.
CAREGIVER TRAINING TO LESSEN RISKS AND FEARS
Clinical leaders often ask, “How do we make time
for caregiver education?” Medicare has given a practical answer. In the 2024 and 2025 Physician Fee Schedules, released by CMS, codes for caregiver training services were finalized and expanded so clinicians can bill for training family caregivers to carry out patient care plans.10 (Key codes include CPT Codes 97550–97552 and 96202–96203, which became effective in the 2024 calendar year, and HCPCS Codes G0539-G0540 and G0541–G0543, which became effective in the 2025 calendar year. More details are available in the fee schedules.) CMS has also clarified that caregiver training services can be furnished via telehealth. This was temporary for 2025 but will be permanent under the final Calendar Year 2026 Medicare Physician Fee Schedule rule. Paying for caregiver training aligns incentives. Providers are compensated for teaching, beneficiaries get safer care at home, and family caregivers gain confidence and competence. Valencia, the caregiver mentioned earlier, initially watched YouTube videos for help learning skills. However, these codes could have meant learning wound care directly from her mother’s clinicians — with fewer risks and less fear.
GUIDING CAREGIVERS TO DEMENTIA SUPPORT
More than 6 million Americans live with dementia, with 14 million projected cases expected by 2060.11 Because many people with dementia also have multiple chronic conditions, providing sup-
Hours of Care Provided per Week
Average Hours of Care
27.3 hours
Less than 1 hour
10%
1–8 hours
33%
9–20 hours
22%
21–40 hours
11%
41+ hours
24%
65%
0-20 hours
35%
21+ hours
Source: Caregiving in the U.S. Research Report, July 2025
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Training and Information Needs of Caregivers The top areas caregivers said they need/needed more help or information.
Managing emotional/physical stress
30%
Keeping recipient safe at home
27%
Managing recipient’s paperwork/ eligibility for services
26%
Activities you can do with recipient
19%
Making end-of-life decisions
14%
Choosing a home care agency, assisted living facility or nursing home
14%
Managing your own personal finances
13%
Using technology to care for recipient
13%
Managing recipient’s challenging behaviors
12%
Finding non-English language materials
3%
Note: Respondents could select more than one response. Source: Caregiving in the U.S. Research Report, July 2025
port and managing their care can present mental, physical, emotional and financial strains for caregivers. For people living with dementia and their family caregivers, Medicare’s Guiding an Improved Dementia Experience (GUIDE) Model offers care coordination, caregiver training, respite and 24/7 support.12 CMS launched GUIDE in July 2024, and, as of late 2025, said it had 327 organizational participants nationwide. Hospitals, nursing homes and other providers can refer eligible patients to providers who participate in the GUIDE model. For Valencia, GUIDE could have offered structured respite and around-the-clock advice, reducing her isolation and giving her mother’s care
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team a clearer line of sight into caregiving challenges at home.
CAREGIVER SUPPORT
With the growing demand for family caregivers to serve as the primary source of support for older adults with chronic conditions or other disabilities, efforts to support, train and provide financial relief for caregivers can help lessen the stress and challenges. Clinicians can take steps to help support them through multiple avenues, from education to connecting them to financial and administrative support: Identify the caregiver. Ask, document and flag the primary family caregiver (and others if
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appropriate) in the electronic health record. Train and bill. Help map common diagnoses to enable opportunities for appropriate caregiver training services. Use CPT and HCPCS codes to report caregiver training services as appropriate, including telehealth options. Refer to GUIDE (for dementia). Create a referral pathway to local GUIDE organizations (participants) or dementia care programs. Connect families to resources. Share AARP’s Family Caregiving Guide,13 resource guides14 and resource line at admission and discharge. Visit www.aarp.org/caregiving for more details. Leverage CHA networks. Through its network of Catholic hospitals, long-term care and other health facilities, CHA can be a powerful partner in disseminating caregiver-support strategies and tools across systems nationwide.
FAITH, MISSION AND THE WORK AHEAD
Catholic health care’s tradition calls health care professionals to accompany the patient and their family. Family caregivers aren’t “visitors” — they are part of the care team. As the population ages and longevity extends, our systems must treat them that way by recognizing, including and engaging, training (if they would like it) and supporting them. If Valencia’s health team had been able to bill for caregiver training, enroll her mother in GUIDE, and point her toward a modest but meaningful tax credit and clearer Medicare navigation, her sacred work of caregiving could have continued with less fear, fewer avoidable complications and a little more breathing room. That is a vision CHA and AARP share, and it’s achievable — now. NICOLE DURITZ is director of family and caregiving for AARP. RHONDA RICHARDS is government affairs director for AARP. NOTES 1. Caregiving in the U.S. 2025 is a research report that draws from a national online survey completed by approximately 6,800 family caregivers aged 18 and older. “Caregiving in the U.S. 2025,” AARP and National Alliance for Caregiving, https:// www.aarp.org/pri/topics/ltss/family-caregiving/ caregiving-in-the-us-2025/; Beth Pinsker, “America’s 63 Million Family Caregivers Are Mostly Unpaid, Stressed and Begging for Help,” MarketWatch, July
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24, 2025, https://www.marketwatch.com/story/ americas-63-million-family-caregivers-are-mostlyunpaid-stressed-and-begging-for-help-632690ff?. 2. “Caregiving in the U.S. 2025.” 3. “Caregiving in the U.S. 2025.” 4. Laura Skufca and Gerard ‘Chuck’ Rainville, “Caregiving Can Be Costly — Even Financially,” AARP, June 29, 2021, https://www.aarp.org/pri/topics/ltss/ family-caregiving/family-caregivers-cost-survey/. 5. “S.925–Credit for Caring Act of 2025,” Congress. gov, https://www.congress.gov/bill/119th-congress/ senate-bill/925?. 6. “S.1565–Lowering Costs for Caregivers Act of 2025,” Congress.gov, https://www.congress.gov/ bill/119th-congress/senate-bill/1565?. 7. “S.1227–ABC Act,” Congress.gov, https://www. congress.gov/bill/119th-congress/senate-bill/1227. 8. “S.3766–Connecting Caregivers to Medicare Act of 2024,” Congress.gov, https://www.congress.gov/ bill/118th-congress/senate-bill/3766. Note this bill has not been reintroduced yet in the current 119th Congress. 9. “Support Family Caregiver Integration: Tools for Healthcare Delivery,” AARP, https://www.aarp.org/ caregiving/medical/healthcare-professionals/. 10. “APTA Practice Advisory: CPT Codes for Caregiver Training Without the Patient Present,” American Physical Therapy Association, March 28, 2024, https://www.apta.org/contentassets/44f3909dba914b a1a3c92ab0090492b2/apta_practice_advisory_ caregiver_training_codes.pdf; “Medicare and Medicaid Programs; CY 2025 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; Medicare Prescription Drug Inflation Rebate Program; and Medicare Overpayments,” Federal Register, December 9, 2024, https://www. federalregister.gov/documents/2024/12/09/202425382/medicare-and-medicaid-programs-cy-2025payment-policies-under-the-physician-fee-scheduleand-other. 11. “Guiding an Improved Dementia Experience (GUIDE) Model,” Centers for Medicare & Medicaid Services, https://www.cms.gov/priorities/innovation/ innovation-models/guide. 12. “Guiding an Improved Dementia Experience (GUIDE) Model.” 13. “AARP Family Caregiving Guides,” AARP, https://www.aarp.org/caregiving/prepare-to-careplanning-guide/. 14. “AARP’s Family Caregiver Resource Guides,” AARP, https://www.aarp.org/caregiving/care-connect/ resources/.
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Elizabeth Seton Children’s Bridges Care Gap by Building New Center for Severely Disabled Young Adults BETSY TAYLOR, MS Health Progress Editor
T
o allow for a hydrotherapy session for a 12-year-old resident of Elizabeth Seton Children’s Center in Yonkers, New York, staffers act in concert with one another. Before Abigail Gonzalez even reached the pool, administrators and employees here raised money to cover a battery-operated, portable ventilator for her. Specialists in adaptive equipment at the center constructed an apparatus with a floating raft cushion, plastic boxing and pool noodles to keep the breathing equipment dry as it floats in the pool, and to keep the child’s airways clear. A lift has been used to lower the girl into the 92-degree water, and occupational therapists Antonella Gini and Maritza Rodriguez cradle her head and part of her body above water and part below. They do this so that she can better feel the differences between gravity on land and floating in the water, and because sensations like this can improve respiratory mechanics, as the center’s Director of Respiratory Services Yelena Yadgarova explains. Certified nursing assistant Devi Ready monitors the child’s health while she’s in the pool. Abigail’s complex diagnosis includes neuromuscular scoliosis and cerebral palsy with spasticity that affects her arms and legs. “She’s obviously comfortable, awake, engaging with us. That’s a positive,” Gini says. Abigail’s having “the recreation of being free, of being a child, and just having the experience of being in the pool,” adds attending pediatrician Linda Volpe. The hydrotherapy pool — in a humid room with mosaic tiled walls that include a sea turtle and sea horses — can be customized with bubbles, and
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the lights brightened or dimmed depending on a child’s response. Today, soft string music plays, and it takes a beat before it’s clear it’s a Taylor Swift song playing — the preferred soundtrack of many a 12-year-old girl. There’s room for 169 youth at this long-term care center. Due to the medical complexity of their health, children often stay here for years receiving care for complex genetic disorders, physical and intellectual disabilities, and life-threatening medical conditions. Children with severe disabilities who receive interventions are living longer than they used to, in large part due to medical and technological advances. Yet, staff at Elizabeth Seton Children’s Center found that when children aged out of their facility at 21, about one-third of them died within the first year or two.1 They say the facilities the teens and young adults moved into did not have the same staffing levels and supports needed for around-the-clock care of the medically fragile.
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Courtesy of Elizabeth Seton Children’s
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Physical therapist Maritza Rodriguez, left, and occupational therapist Antonella Gini, right, support Abigail Gonzales, now 12, in a hydrotherapy session that allows her to relax and alleviate muscle stiffness at Elizabeth Seton Children’s Center in Yonkers, New York.
REENVISIONING WHAT’S POSSIBLE
To respond to this need, the organization is building the Elizabeth Seton Young Adult Center on its other campus, about 13 miles northeast of the center in White Plains, New York. A ground blessing was held in August 2025, and the five-story, $156 million Housing and Urban Developmentfinanced project is slated to open in 2028. Additional fundraising is ongoing. Elizabeth Seton Children’s Chief Executive Officer Patricia Tursi says, “It gives parents and guardians peace of mind to know that their child will be cared for.” The young adult center will be unique in the number of medically complex young adults it cares for with room in time for 96 residents, and because the facility, unlike other nursing homes, will be designed for young adults. Stephanie Gabaud, 28, is among those who has been advocated for and planning the young adult center. A resident of Elizabeth Seton Children’s, Gabaud, who has spina bifida, came to the center as a baby, returned home for a time and has now lived in the center for years as her medical needs
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warranted. Well-known for her work raising awareness about the center, she champions this project, and says it will make a real difference for young people. She talks about dances and games, 3D-printing and a chapel designed with windows to celebrate the young people who reside at Elizabeth Seton and the religious figures who hold meaning for them. Gabaud, who has been blessed by Pope Benedict XVI and Pope Francis, says her faith is incredibly important to her. She feels spiritually close to figures like Elizabeth Seton, and Gabaud has drawn from her faith before, during and after incredibly complex surgeries and painful recoveries. “I just feel the Holy Spirit going through me,” she says.
CAREGIVERS WITH AN EYE FOR DETAIL
Care this complex can be an endeavor of inches, rather than yards. When residents who staff care for are nonverbal, as almost all the children and young adults at Elizabeth Seton Children’s are, care providers gauge their muscle tightness,
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BUILDING ON TRADITION
The Sisters of Charity Ministry Network sponsors Elizabeth Seton Children’s. The sisters’ charism calls for them “reaching out to the most vulnerable and reading the signs of the times,” says Butler. Elizabeth Ann Seton founded the Sisters of Charity in 1809 in Maryland. The sisters’ many endeavors include the founding of schools and hospitals, and the Sisters of Charity of New York’s roots of the current-day Elizabeth Seton facilities
Courtesy of Elizabeth Seton Children’s
breathing rate, vocalizations and eye movements to understand how they’re feeling and what kind of day they’re having. Paul Butler, DMin, director of spiritual care and mission integration for the organization, explains of the staff as a whole, “They’re so attentive to details, the way a child moves their eyes, moves their head.” Art teacher Allison Klein says, “After 10 years, you know what some kids appreciate or don’t appreciate.” Each child is unique in how they communicate. She knows sign language for those who can sign, and also the personal reactions and responses of individual students. Today, she is building sculptures with residents and explaining gesso — a mixture used in art to coat surfaces — to them, as she shows a virtual video tour of a sculpture park on a screen behind her. “I’ve fallen in love with them,” she says of the children. “I came here and said, ‘Now I know where I belong.’” From the outside, the center blends in with the hotels, strip malls and offices around it. But it’s surrounded by a garden and adaptive playground, and inside a chapel and brightly decorated classrooms show the distinctions. Much of the artwork is placed up high or on the ceiling for youth in wheelchairs or beds who may have an easier time looking at the ceiling rather than the floor. Classrooms have specialized equipment built into them, including oxygen and suctioning equipment for when it’s needed.
A ground blessing was held on Aug. 15, 2025, in White Plains, New York, for the new young adult skilled nursing facility for those with medically complex conditions aging out of pediatric care. Resident Stephanie Gabaud, now 28, and the CEO of Elizabeth Seton Children’s, Pat Tursi, right, are among those who have been raising the profile of the project and raising money to make it a reality.
separate governance. Elizabeth Seton was canonized in 1975, the first U.S.-born saint.2 The vision of the sisters, the years of advocacy and New York state’s commitment in recent decades “I’ve fallen in love with them. I came here to funding for people with and said, ‘Now I know where I belong.’” disabilities have allowed Elizabeth Seton’s services to — ALLISON KLEIN grow. “New York is a maverick in funding and providtie back to The New York Foundling, which cared ing this care,” Tursi says. She says about 99% of for medically fragile children and still provides the center’s current residents receive Medicaid many social services. In 2005, the children’s cen- funding. The state then passed legislation in 2021, ter became independent of The Foundling, with establishing the specialty nursing home as a dem-
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Courtesy of Elizabeth Seton Children’s
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Elizabeth Seton Children’s Center resident Eman Asran, 22, has her makeup done by her mother, Rasha Farghaly, before Elizabeth Seton Children’s school prom in 2024.
onstration program for medically fragile young adults aging out of pediatric care. It also allowed teenage and young adult residents to remain with Elizabeth Seton Children’s until the new center is complete. It’s expected that learnings from the young adult center may be shared more widely with other organizations caring for young people with medical complexities.
AN ADAPTIVE SCHOOL DAY
At the existing center, the elevators are referred to as “the school buses,” as employees bring children in wheelchairs and on ventilators from the “neighborhoods,” rooms where they sleep, down to the ground floor classrooms. Nurses, teachers, aides and therapists work together throughout the school day. In a prekindergarten classroom, kids learn about the days of the week, with adaptive equipment like a large, mobile button a child can tap to hear a prerecorded message from the teacher related to the day’s lesson. In another room, children play football, with staffers placing
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the football in children’s hands and throwing it for those who are unable, aiming for a target with a net. An assistant places one of her hands against the hand of a child as they clap together to celebrate a touchdown. In a gaming room with large screens, the Nintendo settings for Super Mario Kart allow for modifications that make it easier for young people with different abilities to play. One resident uses an adaptive joystick, while another is in a wheelchair next to a therapeutic recreation assistant who plays on his behalf. “We have some residents that don’t do the active gaming, but they feel the competition,” explains James Maxson, director of creative arts therapies and a music therapist. The center also has a room for music therapy, including devices that allow children to hear or feel different sound waves, the pluck of piano strings or percussive beats. Therapists work with children in these rooms to rouse or soothe them, while assessing and conducting range of motion and breathing exercises.
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Elizabeth Seton also cares for children at its White Plains location’s school and rehabilitation center. Children come to this campus during the day, spending time in class and receiving services like occupational therapy and physical therapy, learning braille and using adaptive ways to communicate. Staff say these methods can range from basic to high tech, from using an eye gaze board to simple sign language to voice output technology. The students let their teachers know, “I’m here. It’s me,” says the principal on this campus, Stephanie Harris. Building support and connections for families remains important, with an approach of, “Welcome to the family. We’re here to help you and your child,” Harris says. Parents and guardians can participate in a virtual meet-up group for parents. Dr. Maria Pici, chief medical officer at Elizabeth Seton Children’s Rehabilitation Center, located in the same building, says the center’s approach is to combine therapies that work together for a child. As therapists hold one child alongside an exercise ball, she says movement is important, as when children move, they can develop a goal and work toward it. For some children, that goal may be working to sit or stand, and that can be helpful for their care and function. The majority of children at this school also transfer out of these programs or graduate to other schools as they make progress. The new center to be built on these grounds will be for young adults who need high-acuity, around-theclock care. Anticipation for it is high.
SHARED APPROACH TO CARE
Hugh and Renee Kelly are parents to three children, 15-year-old twin boys and 20-year-old Sophie, who currently lives at Elizabeth Seton Children’s and needs care as a young adult. Sophie laughs and smiles when she’s happy, cries or makes a face when she’s sad. She enjoys cuddles and kisses from her family. “She really thrives when she listens to music, has music therapy or when she’s with other kids,” her dad says. She has a duplication of the third chromosome that affected normal brain development. She has seizure disorder, microcephaly, vision and hear-
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ing loss and uses a gastrostomy tube. For 11 years, her family cared for her in a two-bedroom apartment in Jackson Heights, New York. “We did it because we didn’t think anyone [else] could provide the level of love and care that she needed,” Hugh says. Moving her to Elizabeth Seton Children’s “was one of the hardest parenting decisions I’ve ever made in my life.” But of Elizabeth Seton Children’s, he says: “It’s a place of healing, love and hope.” For severely compromised and sick children, families can rest assured their child receives care 24 hours a day. “For someone not a child, and not an elderly person, finding an appropriate care facility for them doesn’t exist until they build this one,” he says of the young adult center. He described how many people feel a level of hurt when encountering a child with special needs, and may be inclined to turn away, rather than wrap their arms around them, whether literally or figuratively. But the Kellys say that is what the staff at Elizabeth Seton Children’s do. They especially credit the Sisters of Charity for living out their mission in a committed and authentic way, and say those who work at the center create a place that offers joy, with an annual prom with homemade decorations, lip sync competitions, word games and crafts. The new center will provide the next step of complex, and also loving, care. Hugh says, “We’re grateful we don’t have to have any anxiety about that.” BETSY TAYLOR is the editor of Health Progress. She previously was a reporter at several newspapers and at the Associated Press. She spent the fall of 2024 at Stanford University as a program affiliate of the John S. Knight Journalism Fellowship. NOTES 1. Lisa Eisenhauer, “Center Would Fill Care Gap for Profoundly Disabled Young Adults,” Catholic Health World, September 1, 2019, https://www.chausa.org/newsand-publications/publications/catholic-health-world/ archives/september-1-2019/center-would-fill-care-gapfor-profoundly-disabled-young-adults. 2. “The Life of Saint Elizabeth Ann Seton,” Seton Shrine, https://setonshrine.org/elizabeth-ann-seton/.
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duq.edu/globalhealthethics
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Healthspan: Reimagining Whole-Person Wellness as a Community Goal SCOTT NEELEY, MD President and CEO, Dignity Health Sierra Nevada Memorial Hospital
A
s Americans and their health care systems struggle with both escalating costs and the growing complexity of a fragmented payer-provider landscape, a sobering truth looms over this essential social function: Despite operating the most technologically advanced and expensive health care system in the developed world, the U.S. produces health outcomes that lag behind every other industrialized nation — and even some developing ones. Life expectancy, years of healthy disabilityfree life or healthspan, rates of premature death, infant and maternal mortality, and the prevalence of chronic disease, obesity and mental illness in the United States all trail those of other member nations of the Organisation for Economic Co-operation and Development (OECD). This is despite the U.S. spending more per capita on health care than any other country — $12,914 per person in 2021,1 compared with the OECD average of $4,488.2 While lack of universal access, fragmentation, high delivery costs, underinvestment in primary care, and the chronic underfunding of mental health services contribute to these outcomes, the uncomfortable reality is that the medical care we provide — no matter how sophisticated — accounts for only about 20% of an individual’s health outcomes.3 Genetics certainly play a role, but it is now well established that the social determinants of health — income, education, housing, access to nutritious food and physical safety — along with individual behaviors, account for the vast majority of health outcomes and longevity. In recent years, the field has also begun to
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reckon with the profound effects of trauma and chronic stress on both physical and mental health. These forces heighten the risk of substance use disorder, chronic illness and early mortality, while eroding the sense of safety and belonging that promotes healing. Conversely, faith, contemplative practice, purposeful living and nurturing relationships have been associated with improved health outcomes.4 If we are serious about addressing America’s declining health metrics and rising costs, we must broaden our focus beyond treatment to include the deeper, integrated work of promoting whole-person health. This begins by acknowledging that the prevailing biomedical model — which treats the human being as a collection of discrete organ systems, and the mind as an abstract entity housed in the brain — is no longer adequate. Neuroscientist Candace Pert famously coined the term bodymind to capture the inseparability of these domains.5 By omitting the hyphen, she signaled that while “body” and “mind” are conceptually distinct, they are biologically inseparable. Modern biology now confirms this unity: Emotions influence immune function, gene expression and even the microbiome,
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FIGURE 1
Foundations of Healthspan Interactions of the bodymind with three domains of being promote healthy living Spirit-HeartConsciousness Physical
Spiritual
Food Activity Sleep Substances/Toxins Environment Medications/Therapies Safety Shelter
Bodymind
Social
Physical
Social
while physiological states shape mood, cognition and motivation. A practical way to visualize whole-person health is through three interconnected domains — physical, social and spiritual — each interacting dynamically with the bodymind, the integrated human organism that engages with all three. Together, these domains define the terrain of healthspan (see Figure 1 above).
THE PHYSICAL DOMAIN: FOUNDATIONS OF DAILY LIVING
Health care leaders often refer to the physical and social domains when discussing the social determinants of health, and the evidence base is formidable.6 Hundreds of prospective and population-based studies demonstrate that healthy diet, regular physical activity, restorative sleep, and avoidance of smoking and alcohol misuse significantly increase longevity and reduce the risk of cancer, cardiovascular disease and neurodegenerative disorders. The lifestyle plus factors
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Faith Prayer Love Contemplation Meditation Purpose Healing Compassion
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Relationships Shared interests Support Companionship Connection Peer groups
described by Dr. Eric Topol, director and founder of Scripps Research Translational Institute, in his book Super Agers: An Evidence-Based Approach to Longevity, represent the most concrete and accessible avenues for improving healthspan — but they are only part of the path toward true wholeperson wellness. Emerging research suggests that these behaviors act not only through risk reduction but also through physiologic optimization — improving mitochondrial (the cellular organelles that convert nutrients into usable energy) function, reducing systemic inflammation, and enhancing cellular repair mechanisms that slow biological aging.7 Regular aerobic activity, for example, is associated with increased brain-derived neurotrophic factor levels, promoting neuroplasticity and cognitive preservation into late life. Diets rich in whole foods, omega-3 fatty acids and polyphenols have been linked to improved metabolic flexibility and reduced incidence of frailty. Adequate sleep, long overlooked in population health, is
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now recognized as a pillar of immune regulation and memory consolidation. When viewed together, these physical determinants of health embody a truth both ancient and modern: that the bodymind is not a passive recipient of disease, but an adaptive system capable of repair and renewal when its foundational needs are met.
THE SOCIAL DOMAIN: CONNECTION AS MEDICINE
The adage that human beings are social animals is both self-evident and profoundly substantiated by research. Social relationships predict not only emotional well-being but also physical survival. Meta-analyses involving hundreds of thousands of participants have shown that social isolation increases mortality risk as much as smoking 15 cigarettes a day, while loneliness predicts higher rates of cardiovascular disease, stroke, depression and dementia.8 The Harvard Study of Adult Development — which is composed of two groups of men, the Grant Study and the Glueck Study, and now spans more than eight decades — provides a deeply human window into this science. Among men followed from adolescence into late life, the single most powerful predictor of health status at age 80 was the quality of their relationships at age 50. Those with stronger relational health — trust, belonging and emotional safety — were significantly less likely to develop chronic disease or cognitive decline. In effect, love and connection serve as buffers against physiological wear and tear, moderating stress responses and supporting immune function.9 These findings remind us that health is not produced in isolation, but in community. The relationships that sustain us — families, friendships, neighborhoods and peer groups — constitute a form of public health infrastructure every bit as essential as hospitals and clinics. In the same way that clean water and sanitation transformed 19th-
century health outcomes, rebuilding social cohesion may well define the next frontier of 21st-century medicine.
THE SPIRITUAL DOMAIN: THE REALM OF SPIRIT, HEART AND CONSCIOUSNESS
The spiritual domain — the realm of spirit, heart and consciousness — encompasses faith, prayer, meditation, contemplation, compassion and the lived experience of purpose and meaning. It is through this dimension that the bodymind experiences coherence, belonging and transcendence. Increasingly, evidence shows that these qualities are not merely existential comforts but potent biological and behavioral determinants of health and longevity. People who live with a clear sense of purpose consistently demonstrate lower all-cause mortality, reduced risk of cardiovascular disease and slower cognitive decline. In the Rush Alzheimer’s Disease Center’s Rush Memory and Aging Project, older adults with higher purpose scores were nearly 50% less likely to develop Alzheimer’s disease and experienced slower global cognitive decline.10 A meta-analysis of more than 50,000 participants confirmed that a strong sense of life purpose is associated with a substantially lower risk of dementia.11 Finally, in a meta-analysis of more than 130,000 participants, those with a higher sense of purpose in life had a 17% lower risk of all-cause mortality and a comparable reduction in cardiovascular events.12 Spiritual and contemplative practices appear to work through overlapping mechanisms. Regular meditation and prayer are associated with lower circulating inflammatory cytokines, reduced cortisol reactivity and enhanced vagal tone, all markers of physiologic resilience.13 Mindfulness-based stress reduction programs have been shown to improve glucose metabolism and blood-pressure regulation and even preserve telomeres, the protective structures at the ends of chromosomes,
When viewed together, these physical determinants of health embody a truth both ancient and modern: that the bodymind is not a passive recipient of disease, but an adaptive system capable of repair and renewal when its foundational needs are met.
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which seem to shorten as a function of biological HealthSpan Nevada County. This new commuaging.14 Functional MRI studies demonstrate that nity organization is dedicated to promoting and long-term meditators maintain greater cortical facilitating behaviors across all three domains — thickness and connectivity in regions governing empaTaken together, the data illuminates what thy, attention and emotional centuries of spiritual tradition have balance.15 Taken together, the data taught: that contemplative awareness illuminates what centuries of spiritual tradition have and purposeful living are not ancillary to taught: that contemplative health but central to it. awareness and purposeful living are not ancillary to health but central to it. Spiritual engagement — physical, social and spiritual — that demonstrawhether through faith, service or mindful pres- bly enhance both health outcomes and human ence — appears to fortify both the neural circuitry fulfillment. Startup funding from both partners has and the molecular architecture of well-being. In doing so, it extends an individual’s healthspan not enabled early operational support, and a growing only by preventing disease, but by deepening their coalition of local leaders is now shaping the orgaexperience of meaning, compassion and connec- nization’s governance and strategy. The founding vision is clear: to help all residents of Nevada tion that define a life well lived. County live longer, healthier and more meaningful lives by aligning local systems, organizations INTEGRATING THE THREE DOMAINS: and community assets around evidence-based A COMMUNITY MODEL FOR HEALTHSPAN Recognizing the opportunity to improve health health-promoting practices. Working with policy strategist Micah Weinoutcomes and healthspan on a communitywide basis, Nevada County has begun translat- berg, PhD, the group engaged community stakeing this framework into action. Dignity Health holders in a series of sessions from late 2024 into Sierra Nevada Memorial Hospital and Nevada early 2025 to identify the core pillars of the initiaCounty in California have partnered to launch tive: food, social connection, activity, and youth
FIGURE 2
Healthspan is Community Wellness
Movement
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Youth and Family
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and family (see Figure 2 on page 26). These pillars form the operational backbone of HealthSpan Nevada County. A guiding white paper, developed by the working group, outlines the governance structure, metrics and early-stage priorities.16 An executive director has been appointed to advance implementation, expand partnerships and identify early demonstration projects designed to strengthen one or more domains of healthspan while reinforcing the others. This local effort embodies what the evidence has long shown: that longevity and well-being are not the product of medical technology alone, but of daily environments that support purpose, connection, nourishment and movement. HealthSpan Nevada County seeks to make those supports not exceptional, but ordinary, woven into the fabric of community life.
A MODEL FOR COMMUNITY REALIGNMENT AROUND WELLNESS
The work unfolding in Nevada County represents more than a local innovation; it signals a shift in how communities across the country might reclaim ownership of their health. In an era of rising chronic disease and unsustainable health care costs, the HealthSpan model offers a replicable pathway — anchored in science yet grounded in local relationships. By investing in food security, physical activity, social connection and purpose-driven living, communities can address the root causes of disease while cultivating resilience, fulfillment and equity. The potential return on investment is immense: Every additional year of healthspan — a year lived free from chronic illness and disability — translates into lower health care expenditures, improved productivity and stronger civic participation. The Nevada County experience offers a prototype for other rural and midsized regions seeking to realign their health care and social systems around wellness rather than illness. It demonstrates how health care organizations, public agencies, community nonprofits, schools, businesses and residents can co-create solutions that transcend institutional boundaries. What begins as a local collaboration can evolve into a national movement — a reframing of health policy to prioritize whole-person vitality across the lifespan. As health care leaders, our task is to redefine success — not by the number of procedures
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performed or margins achieved, but by the sustained well-being of the people and places we serve. Extending lifespan is no longer enough; the opportunity before us is to extend healthspan — and, in doing so, to restore humanity to the heart of health care. DR. SCOTT NEELEY is president and CEO of Dignity Health Sierra Nevada Memorial Hospital. NOTES 1. “California Health Care Almanac,” California Health Care Foundation, August 2023, https://www.chcf.org/ wp-content/uploads/2023/02/NationalHealthSpending Almanac2023.pdf. 2. “Health Spending Per Capita–Country Rankings,” The Global Economy, https://www.theglobaleconomy.com/ rankings/health_spending_per_capita/OECD/. 3. Chenyu Li et al., “Realizing the Potential of Social Determinants Data in EHR Systems: A Scoping Review of Approaches for Screening, Linkage, Extraction, Analysis, and Interventions,” Journal of Clinical and Translational Science 8, no. 1 (2024): https://doi.org/10.1017/ cts.2024.571. 4. Lucinda Rachel Grummitt et al., “Association of Childhood Adversity with Morbidity and Mortality in U.S. Adults,” JAMA Pediatrics 175, no. 12 (2021): https://doi. org/10.1001/jamapediatrics.2021.2320; Harold G. Koenig, “Religion, Spirituality, and Health: The Research and Clinical Implications,” ISRN Psychiatry 2012, no. 1 (2012): https://doi.org/10.5402/2012/278730. 5. Candace B. Pert, Molecules of Emotion: Why You Feel the Way You Feel (Scribner, 1997). 6. Yanping Li et al., “Impact of Healthy Lifestyle Factors on Life Expectancies in the U.S. Population,” Circulation 138, no. 4 (2018): 345–355, https://doi.org/10.1161/ CIRCULATIONAHA.117.032047; Yanping Li et al., “Healthy Lifestyle and Life Expectancy Free of Cancer, Cardiovascular Disease, and Type 2 Diabetes: Prospective Cohort Study,” BMJ 368, no. l6669 (2020): https://doi. org/10.1136/bmj.l6669. 7. Dr. Eric Topol, Super Agers: An Evidence-Based Approach to Longevity (Simon & Schuster, 2025). 8. Julianne Holt-Lunstad, Timothy B. Smith, and J. Bradley Layton, “Social Relationships and Mortality Risk: A Meta-Analytic Review,” PLOS Medicine 7, no. 7 (2010): https://doi.org/10.1371/journal.pmed.1000316. 9. George E. Vaillant, Triumphs of Experience: The Men of the Harvard Grant Study (Belknap Press of Harvard University Press, 2012); Robert Waldinger, MD, and Marc Schulz, The Good Life: Lessons from the World’s Longest Scientific Study of Happiness
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(Simon & Schuster, 2023). 10. Patricia Boyle et al., “Effect of a Purpose in Life on Risk of Incident Alzheimer Disease and Mild Cognitive Impairment in Community-Dwelling Older Persons,” Archives of General Psychiatry 67, no. 3 (2010): https://doi.org/10.1001/archgenpsychiatry.2009.208. 11. Angelina Sutin et al., “Sense of Meaning and Purpose in Life and Risk of Incident Dementia: New Data and Meta-Analysis,” Archives of Gerontology and Geriatrics 105 (2023): https://doi.org/10.1016/ j.archger.2022.104847. 12. Randy Cohen, Chirag Bavishi, and Alan Rozanski, “Purpose in Life and Its Relationship to All-Cause Mortality and Cardiovascular Events: A Meta-Analysis,” Psychosomatic Medicine 78, no. 2 (2016): https:// doi.org/10.1097/PSY.0000000000000274. 13. Richard Davidson and Bruce McEwen, “Social Influences on Neuroplasticity: Stress and Interventions
to Promote Well-Being,” Nature Neuroscience 15, no. 5 (2012): https://doi.org/10.1038/nn.3093. 14. Elissa Epel et al., “Can Meditation Slow Rate of Cellular Aging? Cognitive Stress, Mindfulness, and Telomeres,” Annals of the New York Academy of Sciences 1172, no. 1 (2009): https://doi.org/10.1111/ j.1749-6632.2009.04414.x. 15. Madhukar Dwivedi et al., “Effects of Meditation on Structural Changes of the Brain in Patients with Mild Cognitive Impairment or Alzheimer’s Disease Dementia,” Frontiers in Human Neuroscience 15 (2021): https:// doi.org/10.3389/fnhum.2021.728993; Sara Lazar et al., “Meditation Experience Is Associated with Increased Cortical Thickness,” NeuroReport 16, no. 17 (2005): https://doi.org/10.1097/01.wnr.0000186598.66243.19. 16. “HealthSpan Nevada County Collaborative Community Wellness Proposal,” HealthSpan Nevada County, May 2025.
QUESTIONS FOR DISCUSSION Dr. Scott Neeley, the CEO and president of Dignity Health Sierra Nevada Memorial Hospital, points out that medical care accounts for only about 20% of a person’s health outcomes. But he describes the HealthSpan project in Nevada County, California, as a way for the health system to partner with others to gauge what’s already working, to encourage healthy behaviors, and to promote the need for healthy mind, spirit and community connections for overall wellness. 1. What does this realignment around wellness rather than illness make you consider about how your health care setting responds to social determinants of health? 2. Have you worked on collaborations outside of your health care setting? What were some of the stumbling blocks? How were they resolved? 3. What did you learn from this article about reducing loneliness and addressing trauma and stress that you didn’t know previously? Have you thought about ways to support this for patients, your work colleagues and for yourself? What’s one way you look after your own health that others might find helpful to try? 4. Looking beyond the physical domain of healthy living, how do your lived mission and values contribute to the spiritual and social domains of health for your patients, families, staff and communities?
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From Innovation to Imperative:
The New Era of Palliative Care Delivery BRYNN BOWMAN, MPA CEO for Center to Advance Palliative Care
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n 2024, the American Medical Association updated its Code of Medical Ethics to establish that physicians have an ethical responsibility “to address the pain and suffering occasioned by illness and injury and to respect their patients as whole persons. These duties require physicians to assure the provision of effective palliative care whenever a patient is experiencing serious, chronic, complex or critical illness, regardless of prognosis.”1 For the nation’s largest and most influential physician association to take this step is an indication that in a few short decades, palliative care has evolved to be a critical component of quality care for people with serious illness and their caregivers. The question is no longer whether to deliver palliative care, but how to deliver high-quality palliative care to all patients who need it.
AN EVOLVING SPECIALTY
In the late 1990s, a pioneering group of health care leaders developed a new model of care for patients with serious illness: palliative care. These leaders recognized that while medicine had made great strides in treating diseases, far too often patients and families experienced suffering due to the physical, psychological, social or spiritual effects of serious illness. Palliative care emerged as a team-based specialty focused on providing relief from the symptoms and stressors of serious illness, with the goal of improving quality of life and aligning care with a patient’s goals and preferences. It is appropriate at any age and stage in a serious illness, and palliative care teams collaborate with a patient’s other clinicians to provide an extra layer of support. For patients, the benefits of palliative care
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include reduced symptom burden and improved quality of life. High-quality palliative care also produces value for health care organizations, including reductions in hospital admissions and readmissions, hospital length of stay and total costs of care.2 Based on the strong value proposition for palliative care, today approximately 84% of U.S. hospitals with more than 50 beds provide palliative care, and access to palliative care is increasing in community settings, including clinics, long-term care settings and patients’ homes.3 Most states have developed formal structures for state-level palliative care advocacy, and a growing number of accountable care organizations and health insurance plans have contracted with palliative care programs to provide services for their members with serious illness.
AN IMPERATIVE FOR MORE EQUITABLE CARE
While examples of disparities exist in all facets of U.S. health care, for patients with serious illness, the stakes could not be higher. The evidence tells us that Black and Hispanic patients receive poorer-quality pain management and clinical communication than do white patients, which results in preventable suffering.4, 5 Social
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risk factors exacerbate the challenges of coping with a serious illness, including patients’ financial capacity to access services and medications, families’ availability to provide caregiving support to loved ones, and health literacy barriers to care plan adherence. These are the issues that interprofessional palliative care teams are expert at addressing. While health care organizations cannot address all the root causes of social inequality alone, palliative care teams are well-positioned to identify and address the disproportionate suffering faced by minoritized populations when they are diagnosed with a serious illness. For Catholic health care organizations, which are committed to improving health and well-being for marginalized and vulnerable patients, palliative care is a core strategy to equitably ensure dignity in serious illness and at the end of life.
BARRIERS TO UNIVERSAL PALLIATIVE CARE
While most U.S. hospitals now offer palliative care, low staffing numbers can result in palliative care delivered only to those patients who are sickest or at the end of life — meaning that patients who would benefit from palliative care earlier in the disease course do not receive services. For people living with a serious illness for months or years, access to palliative care in the home or community is essential — not just in moments of crisis when a patient is in the hospital. Community-based palliative care programs can ensure that patients’ symptoms are well-managed to prevent crises, assess for spiritual and social needs over time, address family caregiver burdens, and work with patients to understand their goals of care as a disease progresses. However, while there is no comprehensive national directory of community-based programs, we know that in many communities patients are not able to access palliative care services.6 To understand why this is the case, we must first recognize that health care organizations are not required to provide palliative care — which means that palliative care access is contingent on the commitment of health care leaders. Program financing can also present challenges. While both
If palliative care is a win-win for patients and for health care organizations, why isn’t it universally available? Catholic health systems were among the early adopters in the movement toward standardized, high-quality access to palliative care for patients with seriFor health care organizations to realize ous illness. This should not be the benefits of specialty palliative care surprising, as both the driving philosophy behind palliative for their patients, programs must be care and the services provided by palliative care teams are adequately equipped to deliver quality fundamentally aligned with care, both in terms of the makeup and the Ethical and Religious Directives for Catholic Health Care size of the team. Services (ERDs), with a focus on dignity, whole-person care and informed decision-making. And yet, both fee-for-service billing and health plan contractinside of Catholic health and across U.S. health ing opportunities have improved for palliative care more broadly, gaps remain in palliative care care teams in recent years, leaders of communityaccess and quality. based programs must ensure efficient and effecWe can think about palliative care availability tive operations to directly cover the costs of their in three ways: services. As we see elsewhere in health care, financial 1) Is a specialty palliative care program oper- pressures put care quality at risk in palliative care. ating in the setting where a patient receives High-quality palliative care requires an interprocare? fessional team equipped to address not just a 2) Does the program have capacity to see the patient’s physical symptoms, but also their spiripatient? tual, social and psychological needs. That means 3) Do the program’s services meet quality stan- that chaplains, social workers and nurses are core dards for palliative care? members of the palliative care team, despite not
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being able to bill for their services. For health care organizations to realize the benefits of specialty palliative care for their patients, programs must be adequately equipped to deliver quality care, both in terms of the makeup and size of the team.
A ROAD MAP FOR PALLIATIVE CARE
Health care organizations across the country are innovating to ensure that palliative care reaches the patients and families who need it. Several strategies can help an organization to better address their patients’ palliative care needs. Primary Palliative Care Education While patients whose needs are most complex should be seen by the specialty palliative care team, all caregivers have the opportunity to assess and address the palliative care needs of their patients with serious illness. That’s why many organizations are integrating palliative care into their education initiatives, focusing on skills such as communicating with patients about care goals, prognosis and decision-making, managing pain and symptoms, and supporting the needs of family caregivers. A plethora of primary palliative care education resources exist for clinicians from all professions, including those offered by the Center to Advance Palliative Care (CAPC), VitalTalk, the End-ofLife Nursing Education Consortium and others. Broad-based education enables treating teams to address patients’ basic palliative care needs, ensuring that specialty palliative care resources are available for high-need patients. Bridging Gaps Through Telehealth For small or rural care organizations, fielding a specialty palliative care team may not be feasible — but telehealth can be employed to connect palliative care consultants with patients and treating clinicians. Whether to discuss care decisions, such as hospice with patients and families, or to advise on management of complex symptoms, telehealth partnerships can bring palliative care services when in-person care is not available. Telehealth can also help to extend the capacity of specialty palliative care teams working in community settings, providing virtual touchpoints with patients between in-person visits. Standardization To ensure that palliative care capacity is equita-
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bly and reliably applied to patients with complex needs, health care organizations can develop standard criteria for palliative care consults. Often called “triggers,” these criteria comprise patient or disease factors that indicate to a treating clinician that their patient would benefit from palliative care. Standardized referral triggers can be integrated into electronic health records as automated alerts, which can help ensure that palliative care reaches the right patients, in the right place and at the right time.
A CALL TO ACTION
Patients living with serious illness — and their families — deserve person-centered care that reflects their values and priorities and provides the best possible quality of life. These goals are central to health care organizations and achievable through provision of high-quality palliative care. CAPC is proud to be a partner of CHA and to provide tools and technical assistance to help Catholic health care organizations advance their palliative care strategies. BRYNN BOWMAN is CEO for the Center to Advance Palliative Care. She is also an assistant professor with Brookdale Department of Geriatrics and Palliative Medicine at Icahn School of Medicine at Mount Sinai. NOTES 1. “AMA Code of Medical Ethics,” American Medical Association, https://code-medical-ethics.ama-assn.org/ ethics-opinions/palliative-care. 2. “America’s Readiness to Meet the Needs of People with Serious Illness: 2024 Serious Illness Scorecard,” Center to Advance Palliative Care, https://www.capc.org/serious-illness-scorecard/. 3. “The Case for Hospital Palliative Care,” Center to Advance Palliative Care, https://www.capc.org/ documents/246/. 4. “Health Care for Black Patients With Serious Illness: A Literature Review,” Center to Advance Palliative Care, https://www.capc.org/health-care-for-black-patientswith-serious-illness-a-literature-review/. 5. “The Health Care Experience of Hispanic Patients With Serious Illness: A Literature Review,” Center to Advance Palliative Care, https://www.capc.org/health-careexperience-hispanic-patients-with-serious-illnessliterature-review/. 6. “America’s Readiness to Meet the Needs of People with Serious Illness,” Center to Advance Palliative Care.
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Finding God in Daily Life
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Vatican Media/Abaca/Sipa USA
If it is true that the weakness of the elderly needs the strength of the young, it is equally true that the inexperience of the young needs the witness of the elderly in order to build the future with wisdom.” — Pope Leo XIV’s message for World Day for Grandparents and the Elderly on July 27, 2025
Mapping a Better Care Plan for Dementia Patients and Their Families SR. ROSEMARY DONLEY, SC, PhD, APRN, FAAN Professor of Nursing at Duquesne University
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hile age is not synonymous with dementia, dementia is more common in those 75 and older. The Centers for Disease Control and Prevention reports there are more than 6 million Americans living with dementia, and it affects more women largely due to their longer lifespan.1 The symptoms of dementia affect people’s memory, thinking and social abilities, and greatly interfere with their daily lives. Dementia-related illnesses can dramatically change and shorten the lives of patients and negatively affect their families and communities. Alzheimer’s is the most common manifestation of dementia. People often think that Alzheimer’s disease, a degenerative brain disease, is a synonym for dementia. It is not. Several diseases cause dementia. Among them are Lewy body dementia, often associated with parkinsonism, vascular dementia, frontotemporal dementia and Huntington’s disease.2 Although each disease has its unique pattern, all dementias are characterized by loss of cognitive functions and the ability to carry out activities of independent living. People can also have more than one disease that causes dementia, which is known as mixed dementia. Because of the complex manifestations of dementia, it is not easy to recognize or diagnose, especially in its early stages. Although no single test can diagnose dementia, there are tools, resources and educational materials available to help providers recognize it, along with supportive services and recommended plans of action they can encourage patients and their families to follow. There is a growing understanding of the preclinical phase of dementia, and the importance of early detection, but one key step for many care providers is understanding and recognizing chronic
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illnesses that include dementia symptoms. Alzheimer’s Disease Scientists know that signs of Alzheimer’s disease are present in the brain years before symptoms appear. The early presence of plaques and the ability to detect their presence drives the search for drugs that may delay the onset of active disease. There are also patterns that alert health care providers that their patients may be displaying symptoms or comorbidities associated with Alzheimer’s disease. These symptoms alert providers that a self-amplifying inflammatory response may be damaging the central cortex.3 Lewy Body Dementia The third most prevalent type of dementia, Lewy body dementia, is difficult to diagnose4 because its symptoms overlap with Alzheimer’s and other mental illnesses.5 Men ages 60 and older are most at risk for Lewy body dementia.6 People with Lewy body dementia have memory loss and diminished visual-spatial awareness. Difficulty in moving is an early symptom of the illness; memory problems appear later.
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Parkinson’s disease dementia, a subtype of their ability to use language. Often diagnosed in people between the ages Lewy body dementia, while easier to diagnosis, is more difficult to treat than Lewy body disease of 40 and 65, it causes 10% to 20% of dementias,9 because medicines to treat parkinsonism — for and is often misdiagnosed as Alzheimer’s disease. example, carbidopa-levodopa — cause confusion.7 Movement disorders constitute the main Huntington’s Disease difference between Lewy body dementia and Huntington’s disease, a rare genetic disease, Alzheimer’s. Difficulty moving appears early destroys neurons in the brain affecting a person’s in Lewy body disease, while memory problems thinking ability, planning and the person’s ability develop later; however, it may not cause short- to focus on what is being said. People with this condition have uncontrolled and inappropriate term memory loss. People with Alzheimer’s or Lewy body demen- movements and symptoms of mental disease. Huntington’s disease has an early onset, and tia have trouble thinking, being alert and paying often people with the disease show sympattention. In Lewy body disease, these toms in their early 30s or 40s. When symptoms come and go. Hallucinathe disease develops before age tions may also be present among 20, the condition is called people with it early in the juvenile Huntington’s disillness, unlike those with An Aging Population ease. Huntington’s disease Alzheimer’s who do not causes perseveration, hallucinate until the later The U.S. Census Department reports that lack of impulse control stages of the disease. the number of Americans aged and changes in sexual While there is no cure 65 and older is projected to increase drive, including hyperfor Lewy body demenfrom 58 million in 2022 to 82 million sexuality for some, and tia, its symptoms can be by 2050, which means their share of lack of awareness of managed. the population is projected to increase behavior. It is as if they from 17% to 23% by 2050. no longer know themVascular Dementia selves. Patients may be Vascular dementia, or Source: https://www.prb.org/resources/ fact-sheet-aging-in-the-united-states/ slow to process thoughts, multi-infarct dementia, is find words or learn new the second most common information. cause of dementia. It typically Movement disorders associated affects people between the ages with Huntington’s disease include choof 55 and 75.8 Slightly more men than women have this condition. Those affected have rea and other involuntary movements that affect mini-strokes, which block small blood vessels in the muscles, specifically those in the arms, legs, the brain and injure cortical cells. As more cere- face and tongue. It also causes muscle rigidity bral vessels are damaged, symptoms of dementia and contracture. Huntington’s disease patients appear. Risk factors for it include diabetes, ath- have difficulty in speaking, swallowing, walking erosclerosis, hypertension, smoking and previous or maintaining posture and balance. People with Huntington’s disease may not be strokes. able to control voluntary movements. Many with this condition are unable to work, perform daily Frontotemporal Dementia Frontotemporal dementia is an umbrella term for activities, communicate with others or live indea group of brain diseases that mainly affect the pendently. They may be depressed, irritable and frontal and temporal lobes of the brain. In fron- withdrawn. They may have concerns that they totemporal dementia, parts of the frontal and passed the gene that causes the disease to their temporal brain areas atrophy. Symptoms of this children before they had a diagnosis. They sleep disease depend on the part of the brain that is poorly and feel tired. The depression seen in permost affected. Some people with it have person- sons with Huntington’s disease is thought to be ality changes, and become socially inappropriate, related to brain atrophy rather than mental illness. impulsive or emotionally unstable. Others lose As the disease progresses, the person loses weight.
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Mixed Dementia When a person has more than one disease causing dementia, it is known as mixed dementia. Symptoms may be similar to or indistinguishable from single diseases. While it is estimated that more than 50% of those with dementia have coexisting pathology, only a small percentage of patients get dually diagnosed.10
WAYS TO ASSIST
apartment complexes, they should aim to attend the facility’s programs. Activity and engagement with people and other pastimes prevent loneliness and may help delay the progression of dementia.11 Because the rate of progression of the disease is not predictable, families need to be attentive to their loved one’s safety, rest, nutrition, skin care, infection and pain management. As the disease progresses, those with dementia need care 24 hours a day. Health care providers can alert families to the resources in the community to assist patients and families to manage dementia. Because early manifestations of dementia may not be obvious, and its symptoms such as forgetfulness, losing objects, like cell phones or car keys, or getting lost can initially seem like absent-mindedness or routine aging, it is important to determine the diagnosis early. Persons with signs of
Health professionals should help patients and families find supportive, community-based services. Initially, most families opt to keep their loved ones at home. As people with dementia spend a lot of time in the house, their homes should be attractive and safe. Their family may decide to move into a onestory home with accessible bathrooms, if possible. Ideally, there should be a nice view from the porch and Complete physical exams are important to windows. distinguish routine aging from dementia Most older people want to stay in their own homes. If symptoms. Identifying ways to lessen their spouses are living, they want to live together. Often, symptoms can improve quality of life and children or relatives no lonmay even slow disease progression. ger live down the street. For those who remain in their own residences, homes need to be assessed for dementia should have comprehensive neurologisafety. Visiting nurses are skilled at these assess- cal examinations, such as cognitive assessments ments, and their suggestions may be received and CAT and PET scans which can reveal amyloid better than those offered by children or other plaques. A new blood test that measures the level relatives. of amyloid in the blood is about 90% effective in However, it is very difficult to care for a person identifying Alzheimer’s disease.12 24 hours a day, seven days a week, especially if the Complete physical exams are important to disperson is awake at night, wanders or engages in tinguish routine aging from dementia symptoms. unsafe or combative behaviors. The decision to Identifying ways to lessen symptoms can improve place a parent, spouse or loved one in a nursing quality of life and may even slow disease progreshome or memory care unit is very difficult. It may sion. Consider factors that may make it harder for be one of the most difficult decisions that a fam- people to communicate or to voice their concerns. ily makes. For example, people with dementia should have There are many programs supporting home eye and hearing tests. Cataract surgery, hearing care that can improve the lives and well-being of aids and walkers can significantly improve their the person with dementia and ease the burden on lives. These aids are important because loss of families: Meals on Wheels, congregate eating cen- vision and hearing and a lack of physical activity ters, senior centers, senior day care, home health increases dementia risk and, as of today, there is care, personal attendants and audiobooks or pod- no medicine to cure any of the diseases causing casts. People with dementia should exercise regu- dementia.13 Of critical importance is the identifilarly to maintain their mobility and improve their cation of the type of dementia for developing a safety. They should be encouraged to participate care plan. in organizations and clubs. If they live in senior Home care nurses can help caregivers and
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Dementia is still a poorly understood disease. Catholic hospitals, health systems and nursing homes can offer workshops on dementia and provide support groups for families, caregivers and patients. families as the condition of the patient changes with finding others to assist with food procurement and preparation, cleaning, laundry and patient care. If or when care becomes overwhelming, nurses can help families select a memory care unit or another long-term care setting.
MEDICAL AND NURSING MANAGEMENT
Health care professionals can encourage conversation about the impact that dementia has on patients and families. Many people want to deny early signs of dementia. They are unwilling to talk about it or seek help until the disease can no longer be denied. Nurses and others can encourage patients and families to become familiar with research. Dementia is still a poorly understood disease. Catholic hospitals, health systems and nursing homes can offer workshops on dementia and provide support groups for families, caregivers and patients. Catholic health systems can also invite state and federal lawmakers to tour their memory care units and encourage them to support funding for dementia research. Health care providers can work with professional and other organizations, like dementia associations; medical, nursing and social work organizations; and AARP. Families of persons with dementia can advocate members of Congress and the pharmaceutical industry to fund research and support clinical trials of drugs to manage dementia. It is also important for families and the public to learn to identify early signs of dementia. Patients with dementia and their families need a plan of care. This includes the person with dementia making plans for a will. They also need to name a person with durable power of attorney. The patient and his or her family must talk about what they want as their disease progresses and what they want to happen at the end of their lives. These conversations are hard, but they may reduce family conflict and guilt.
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Catholic health care can offer those with dementia spiritual care and support. A diagnosis of dementia may allow a person to address symptoms, settle their affairs and prepare for their end of life and death. Through spiritual care, patients can spiritually and emotionally close any unresolved matters, providing them with a sense of peace and comfort. SR. ROSEMARY DONLEY, SC, is a professor of nursing and holds the Jacques Laval Chair for Justice for Vulnerable Populations at Duquesne University School of Nursing in Pittsburgh. NOTES 1. “About Dementia,” Centers for Disease Control and Prevention, August 17, 2024, https://www.cdc.gov/ alzheimers-dementia/about/index.html; “Why Is Dementia Different for Women?,” Alzheimer’s Society, March 3, 2025, https://www.alzheimers.org.uk/blog/ why-dementia-different-women. 2. “Lewy Body Dementia,” Mayo Clinic, https:// www.mayoclinic.org/diseases-conditions/ lewy-body-dementia/symptoms-causes/syc-20352025. 3. “What is Alzheimer’s Disease?,” Alzheimer’s Association, https://www.alz.org/alzheimers-dementia/ what-is-alzheimers. 4. “Lewy Body Dementia,” National Institutes of Health, https://www.ninds.nih.gov/health-information/ disorders/lewy-body-dementia. 5. “About LBD,” Lewy Body Dementia Association, https://www.lbda.org/about-lbd/. 6. Dr. Ece Bayram, “Men Are at Greater Risk for Lewy Body Dementia than Women, but Why? New Study Seeks Answers,” Lewy Body Dementia Association, December 12, 2023, https://www.lbda.org/men-areat-greater-risk-for-lewy-body-dementia-than-womenbut-why-new-study-seeks-answers/. 7. “Parkinson’s Disease Dementia,” Alzheimer’s Association, https://www.alz.org/alzheimersdementia/what-is-dementia/types-of-dementia/ parkinson-s-disease-dementia. 8. “Vascular Dementia,” Dementia Society of America,
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https://www.dementiasociety.org/ vascular-dementia. 9. “Frontotemporal Dementia,” Mayo Clinic, https://www.mayoclinic.org/diseasesconditions/frontotemporal-dementia/ symptoms-causes/syc-20354737. 10. “Mixed Dementia,” Alzheimer’s Association, https://www.alz.org/alzheimersdementia/what-is-dementia/types-ofdementia/mixed-dementia. 11. “Small Amounts of Moderate to Vigorous Physical Activity Are Associated with Big Reductions in Dementia Risk,” John Hopkins Bloomberg School of Public Health, https:// publichealth.jhu.edu/2025/small-amountsof-moderate-to-vigorous-physical-activityare-associated-with-big-reductions-indementia-risk; Amal A. Wanigatunga et al., “Moderate-to-Vigorous Physical Activity at any Dose Reduces All-Cause Dementia Risk Regardless of Frailty Status,” Journal of the American Medical Directors Association 26, no. 3 (2025): https://doi.org/10.1016/ j.jamda.2024.105456. 12. “Accurate Blood Test for Alzheimer’s Disease,” National Institutes of Health, August 13, 2024, https://www.nih.gov/ news-events/nih-research-matters/ accurate-blood-test-alzheimer-s-disease. 13. Dr. Gill Livingston et al., “Dementia Prevention, Intervention, and Care: 2024 Report of the Lancet Standing Commission,” The Lancet 404, no. 10452 (2024): https://doi.org/10.1016/S0140-6736(24) 01296-0.
A Guide for Planning & Reporting Community Benefit 2025 EDITION
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REFLECTION
Behind the Need to ‘No!’: Why Accepting Care Is as Important as Giving It
MAUREEN PRATT, MTS, MFA Author and Founder of The Peace in the Storm Project
I
needed a toothbrush. One simple, preferably soft-bristled toothbrush. And I could not find one anywhere in my apartment. Ordinarily, this would not be such a problem. At that time, after nearly 20 years of living on my own with often debilitating lupus and other conditions, I was used to fending for myself. And, of course, these days, I could have ordered the much-needed item and multiples from an app. Yet, this was before the easy, instant delivery systems that sprang up during the COVID-19 pandemic, and on this night, I could not get the toothbrush myself. I was felled by a significant lupus flare, nauseous from immunosuppressive medication, and weakened by an unidentified “bug” that made my limbs ache and my mouth feel like it had a permanent bad taste and furry lining. Thus, the reason why I needed the toothbrush. Oh, I was in a very bad way, but I still hung onto bleary hope that I could handle the situation by myself. I dragged myself into the hallway and all but took apart the shelves of my storage cupboard to see if I had stowed away a spare toothbrush. I had to have one, I reasoned. What seemed like hours later, I sat on the floor and stared at the contents of the cupboard and several closets, all now strewn about me. If I could have cried, I would have, but with Sjögren’s syndrome also flaring, my eyes could not produce tears. There was no toothbrush.
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Another wave of the bug began to surface, and then I knew: I had to phone a friend. I still hesitated, thinking that I didn’t want to inconvenience anyone, but knowing that the real reason for my reticence was that I was embarrassed and fearful of rejection. Finally, trembling from the bug, the flare and the frustration, I dialed a night owl friend who lived nearby. I got voicemail. I called two other people and didn’t reach them. Finally, the last person on my list, the most unlikely (I thought), answered. Apologizing between nearly every sentence, I explained my need for (Oh, didn’t I sound ridiculous?) a toothbrush (How idiotic to not have one?) and braced myself for excuses and a gentle, but firm, refusal (Here it comes). Instead, I heard, “Yes.” My friend was happy to help and willing to go to the late-night store, which was blocks away. Eager to bring anything else I needed, my friend
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AGING & LONGEVIT Y
said, “Don’t worry about paying me back,” and “Thank you for letting me help.” It wasn’t until I hung up that I realized I’d been holding my breath.
ACCEPTING A HELPING HAND
agonizing hours in denial and frustration before giving in (for example, my toothbrush incident). How often do we think that the more we distance ourselves from someone’s willingness to help, the more we deny that someone the ability to exercise their Christian calling? Someone who helps us is being helped by us, too. Early Christians understood the delicate, yet powerful, connective tissue of community that is the caregiver-care receiver nexus. From these formative times, Catholic health care providers, especially religious, learned to first see Christ in the patient and know that the patient would see Christ in them, in the form of a caregiver. This way of relating unfolded a profound, multidimensional mutuality of having “love for one another” that has had a profound influence for centuries, exemplified in my friend’s willingness to bring me a toothbrush — and thank me for it!
The notion of me helping someone who was helping me might sound roundabout, but it struck me then, as it does now, with a force beyond a more standard consideration that caregiving is all about the caregiver. The person in need of care is indispensable, too, if the full meaning of “love one another” is to be manifest in us. Or, to put it another way, without people to care for, we would not be able to care. Caring for others is at the heart of the Christian life. It is what Jesus did and what he taught others to do. In the Gospel of John, we encounter Jesus’ exhortation: “I give you a new commandment: love one another. As I have loved you, so you also should love one another. This is how all will know GAINING UNDERSTANDING THROUGH VULNERABILITY that you are my disciples, if you have love for one Yet, sometimes, this relationship is obscured by another.” (John 13:34-35) our framing of caregiving as one-sided: the takeIn the Acts of the Apostles, we learn of how the charge, rational approach of the person trying to early Christian community, people of the “Way,” help, for example, an adult son or daughter decidwere “together and had all things in common; they ing “Mom isn’t safe at home, so we have to move would sell their property and possessions and To be a caregiver, there has to be a divide them among all recipient of care, and most times (not all according to each one’s needs.” (Acts 2:44-45) times) the person with the need has to Throughout Church history, caring in ways accept someone’s proverbial outstretched grand and intimate has hand. Therein lies the problem for overly fostered countless works of mercy, inspired proindependent, proud or (dare I say it) fessional medical pracstubborn individuals bent on resisting help titioners and the growth of hospitals, encouraged at all costs. uplifting social change in dark eras of history, and moved adult children to care for parents in their her” that dismisses the reactions to gradual or later, vulnerable years. sudden vulnerability by the one needing care. However, to be a caregiver, there has to be a High emotions on both sides can be akin to the recipient of care, and most times (not all times) development of dramatic weather conditions durthe person with the need has to accept someone’s ing the tornadic season in the Midwest, fomentproverbial outstretched hand. Therein lies the ing a crisis of colossal and, perhaps, unreasonable problem for overly independent, proud or (dare proportions. However, as I experienced in a “perI say it) stubborn individuals bent on resisting fect storm” of chronic illness — a plaguing bug, help at all costs. Those of us who think we can do late hours and personal frustration — such a reacit all ourselves might balk or outright reject the tion is not impossible, nor is it irrelevant. hand extended and the love it represents or spend As the caregiver to my mother, I witnessed
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this kind of tempestuous resistance to receiving help in all forms. God bless her, she fought aging and infirmity with every ounce of her being — which made caring for her nothing short of arduous. However, having lived my own version of “I can do it on my own,” I understood the questions beneath the refusals. I had asked them myself in my own way: First, I ask for a toothbrush, then what? How much longer will people be ready to help before they get tired of me asking? What if people think I’m really slipping, if I forget to have an essential item on hand? What if, someday, I really need help, and it’s not there? My own experiences of vulnerability helped me to be more aware of the layers of emotion in the dear mother for whom I cared. Of course, she did not want others to assist her with her daily activities; she’d been just fine for more than 80 years. Absolutely, she had survived her own personal storms without someone guiding her or (worse!) carrying her along. I was not there to “boss her around,” but to walk beside her, reassure her of my love and to listen. As I blurred the lines of “caregiver-care receiver” and looked upon the whole experience as holy and more circular than linear, my approach with my mother softened in a grace-filled way. I became more patient, and I was able to walk with her companionably — all gifts received through the act of giving.
The experience of needing help and of giving care is also a relational dynamic that, much like the caregiver-care receiver nexus, prepares us to recognize our own vulnerabilities and opens us to others. By doing so, we better enable ourselves to love someone else who needs care. Scripture recognizes the important role of the person who needs care. The lepers in Luke 17:11-13 defy purity laws and meet Jesus as he enters a village to ask him to heal them. “The whole town” brings people in need of cures to Jesus in Mark 1:32-34, and in Mark 9:14-29, a desperate father seeks Jesus’ help for his son who is sick. These examples and others help us understand that seeking and accepting care goes hand in hand with caregiving. Through our experiences of vulnerability, we learn, when it is our turn, how to better care for someone else. And the more we participate in this continuum of mutual caring, the more we strengthen the Christian community and truly love one another. MAUREEN PRATT is the founder of The Peace in the Storm Project, a national, parish-based ministry of accompaniment for caregivers and persons living with chronic illness and ongoing pain. She is also the author of several books, including Peace in the Storm: Meditations on Chronic Pain and Illness and Peace in the Storm for Caregivers.
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Venerable Nelson Baker:
What We Can Learn from This Apostle of Charity MSGR. DAVID G. LiPUMA Pastor and Rector, Our Lady of Victory National Shrine & Basilica
Nearly a century after his death, his legacy lives on in Western New York and beyond. Fr. Baker’s mission of caring for those who need it most has flourished and grown. Today at OLV (Our Lady of Victory) organizations just outside of Buffalo, New York, individuals flock to its campus each year for healing — be it mental, physical or spiritual. The organizations he founded include OLV Charities, a fundraising arm, and OLV Human Services, children and family programs that serve more than 12,000 individuals annually. He also spearheaded the construction of OLV National Shrine & Basilica, which draws 280,000 visitors each year and serves as home to a thriving parish community. Fr. Baker — called the region’s “most influential citizen of the 20th century”1 — was named a “Servant of God” by the Vatican in 1987, the first step toward canonization, more than 50 years after his death. This historic process took yet another leap forward in 2011, when, on January 14, Pope Benedict XVI named him Venerable Nelson Baker.
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Courtesy Our Lady of Victory Basilica
F
r. Nelson Baker was an ordinary man who did extraordinary things. His 60 years in the priesthood were spent sheltering the homeless, feeding the hungry, caring for the sick and giving hope to the destitute.
Fr. Nelson Baker
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Although he came to the priesthood later in life than many men, his deep faith, a gift for fundraising, and a desire to respond to the vulnerable and those in need still inspires Catholics in the modern day.
WHO WAS FR. BAKER?
Nelson Baker was born on Feb. 16, 1842, in Buffalo to Lewis and Caroline Baker. Baptized a Lutheran like his father, Nelson’s early faith took a new direction when he was nine years old. Influenced by his deeply Catholic mother, he chose to be rebaptized into her faith — a quiet but defining decision that would guide much of his life to come.2 After graduating from high school, Nelson joined his father and brothers in running the family store. He was bright, outgoing and sharp with numbers — the kind of person who seemed to find opportunities wherever he looked. When the Civil War broke out, Nelson answered the call to serve, enlisting in the summer of 1863 at the age of 21. After returning home from the war, he slipped back into his familiar role at the store. Before long, opportunity knocked again. A friend, Joe Meyer, approached him with a proposal to open a feed and grain business that could tap into Buffalo’s booming economy. Nelson agreed, and together they launched Meyer & Baker — a venture that quickly grew into a thriving success. During those years, Nelson gave freely of his time, money and food to a nearby orphanage. He often said he felt God had blessed him and his family so generously that he was compelled to give something back. From time to time, the idea of becoming a priest crossed his mind. Still, he brushed it aside. He was getting older, and without the proper schooling, the thought seemed unrealistic. Yet, deep down, the calling never fully left him. One afternoon, fate stepped in. Nelson spotted two boys struggling to carry a heavy sack along the road. He stopped his wagon to offer them a ride and asked where they were headed. “Limestone Hill — St. Joseph’s Orphanage,” they told him. Nelson knew the place and its administrator, Fr. Thomas Hines, well. After dropping the boys off, he stopped in to say hello. Their conversation took an unexpected turn — by the time Nelson left, Fr. Hines had promised to recommend him to the bishop for admission to the diocesan
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seminary. In 1869, Nelson took a steamer trip through the Great Lakes, using the quiet moments along the journey to pray and reflect on his future. By the time he returned home, his decision was made. The first person he told was his mother, who, as it turned out, had secretly been praying for this very outcome. That same year, on Sept. 2, Nelson closed one chapter of his life and began another. Though nearly a decade older than most of his classmates at Our Lady of the Angels Seminary in Niagara Falls, Nelson fit in easily. He quickly became a respected leader and excelled in his studies. But in November 1871, his path nearly ended — he fell gravely ill and was given last rites. Against all odds, he pulled through. After nearly a year of recovery, Nelson regained his strength and was soon accepted into the major seminary, more determined than ever to serve.
A STIR IN HIS HEART
In early 1874, Nelson came across an announcement for a pilgrimage to some of Europe’s great Catholic shrines. The idea sparked something in him. After getting permission from the seminary rector, he set off that May, eager to see the places that had inspired so many before him. One of the stops along the way was the Basilica of Notre-Dame des Victoires in Paris. During Mass there, Nelson felt something stir deeply in his heart — a moment of grace he would never forget. It was on that trip that he made a quiet but life-changing decision: to dedicate his ministry to promoting devotion to Our Lady of Victory. The title, also known as Our Lady of the Rosary, honors the Blessed Virgin Mary and traces its origins back to the Battle of Lepanto in 1571. When Nelson returned home in July 1874, he resumed his studies with renewed purpose. After years of perseverance, prayer and preparation, he reached the milestone he had long dreamed of. On March 19, 1876 — at what many called the “advanced age” of 34 — Nelson Baker was ordained a priest at St. Joseph’s Cathedral in Buffalo.
HIS MISSION
Fr. Baker was more than a little surprised by his first assignment. Freshly ordained, he was named assistant superintendent of the institutions at Limestone Hill under Fr. Hines — the man who had encouraged him to enter the seminary. The
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Courtesy Our Lady of Victory Basilica
Those who lived in the orphanage run by Fr. Nelson Baker were known as Father Baker’s Boys. Here, in 1890, some of them have been organized into a band that used to play in the Buffalo region.
bishop believed Fr. Baker’s sharp business sense would be an asset. When he arrived in 1876, however, he was met with a harsh reality. St. John’s Protectory and St. Joseph’s Boys’ Orphan Asylum were buried under a combined debt of $27,000 — and by 1881, that figure had ballooned to more than $60,000. Convinced the situation was hopeless, Fr. Baker asked to be reassigned. He spent a year serving a parish in Corning, New York, before the bishop called him back to Limestone Hill — this time as Fr. Hines’ successor. It would be his home for the rest of his life. Despite the overwhelming financial challenges, Fr. Baker returned with determination and faith. Almost immediately, creditors came knocking, demanding payment. Hoping to buy some time, he offered partial payments — all except one refused. Undeterred, Fr. Baker climbed into his buggy, drove to the bank, and withdrew every cent he had to his name to settle the debts. Around that same time, inspiration struck. He
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founded the Association of Our Lady of Victory, a bold new fundraising idea built on personal connection. Fr. Baker wrote letters to postmasters across the country, asking for the names of charitable Catholic women in their communities. Then he reached out to those women directly, sharing the story of the children in his care and inviting them to join his mission for just 25 cents a year. The response was overwhelming. The Association of Our Lady of Victory became a nationwide success. Within a few years, Fr. Baker not only erased the crushing debt but also expanded the facilities — adding a larger chapel and additions to the protectory and orphanage. His blend of faith, ingenuity and persistence had turned a desperate situation into the foundation of something extraordinary.
AN ANSWERED PRAYER
One evening, as Fr. Baker sat in his office worrying over the ever-growing heating bills for his institutions, an idea came to him: What if they could find
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Catholic Health in Western New York Channels Fr. Baker’s Caring Legacy JUSTIN ROWAN, BCC Chaplain for Catholic Health–Buffalo
he bright spirit of Buffalo, New York’s, “Padre of the Poor” still animates works of mercy long after his time on earth. Venerable Nelson Baker founded Our Lady of Victory Hospital in 1919 for maternity care, but widened its scope to the general public the following year. It served the people of South Buffalo and Lackawanna for seven decades before closing in 1999. Catholic Health, a regional health care system, then studied the contemporary needs of area residents to discern next steps. In 2008, Catholic Health relaunched the facility to include a comprehensive array of eldercare services. The former hospital now houses Mercy Nursing Facility (an 84-bed nursing home), laboratory services and apartments for seniors on limited incomes. In 2009, it became home to the Living Independently for Elders program, or LIFE, the system’s version of PACE, the Program of All-Inclusive Care for the Elderly. LIFE has since expanded to two additional sites in Buffalo, at Villa Maria College and D’Youville University. Father Baker Manor, a 160bed skilled nursing facility in the suburb of Orchard Park, is named in his honor. Part of Catholic Health’s Home and Community-Based Care, ground was broken on March 19, 1993 — chosen to commemorate
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Courtesy of Catholic Health
T
Father Baker Manor in Orchard Park, New York, provides residents with treatment, including occupational, physical and speech therapy. Pictured, left to right, are Krista Hitzel, MS, OTR/L, Carlos Darby, DPT, and Jennifer Dellapenta, SLP. Catholic Health’s skilled nursing center is named in memory of the priest known for his good works in the area. Baker’s ordination on the same date in 1876 — and the facility opened the following year. Offering both subacute rehab and long-term care, the system takes pride in the quality of care there and at its sister facilities in the region, Mercy Nursing Facility, McAuley Residence and St. Catherine Labouré Health Center. Though the era of infant homes and orphanages is long past, OLV Human Services, the present form of the ministry Fr. Baker founded, continues to serve those in need through mental and behavioral health services, foster care, special education, dental care and an outpatient clinic. OLV Charities,
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the descendant of Fr. Baker’s fundraising arm, supports these programs, as well as Our Lady of Victory National Shrine & Basilica, a summer camp and St. Gianna Pregnancy Outreach Center. OLV Charities is further involved in the ongoing cause for the canonization of Fr. Baker and the promotion of devotion to Mary as Our Lady of Victory. May that same Lady, in whom Fr. Baker trusted so much, obtain for him the crown of sainthood! JUSTIN ROWAN is a boardcertified member of the National Association of Catholic Chaplains and an Oblate of St. Benedict.
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natural gas right on the property? It sounded farfetched, but he’d faced long odds before. True to form, he turned to prayer. Whenever a major decision loomed, Fr. Baker would spend the night in quiet reflection before a small statue of Our Lady of Victory, the same one he had brought home years earlier from France. A drilling crew was contacted, and the foreman went to Fr. Baker at St. Patrick’s Church to ask where they should begin. What happened next left everyone stunned. A grand procession emerged from the church — parishioners carried candles and prayed the rosary while they followed him into an open field. When they reached a spot that felt right, Fr. Baker stopped, sprinkled the ground with holy water, buried a small statue of Our Lady, and simply said, “Drill here.” His faith was rewarded. At an astonishing depth of about 1,100 feet, the drillers struck gas — and the “Victoria Well,” as it came to be known, roared to life in 1891. The well produced enough natural gas to heat all of Fr. Baker’s buildings and even provide warmth for about 50 local families. Incredibly, the well is still producing to this day — a lasting testament to Fr. Baker’s faith, vision and remarkable trust in divine providence.
A GROWING CAMPUS
A GREAT AMERICAN SHRINE
In 1916, tragedy struck Fr. Baker’s growing “City of Charity.” A fire tore through St. Patrick’s Church, destroying its spire and badly damaging the sanctuary. The loss was painful for the entire community, but for Fr. Baker, it became the spark for something extraordinary. After modest repairs kept the church usable for a few years, Fr. Baker celebrated the final Mass at St. Patrick’s on May 7, 1921. Soon after, the old structure was taken down to make way for a new
Courtesy of Catholic Health
Around the turn of the 20th century, Fr. Baker came across a heartbreaking story in the local news. Workers dredging a nearby section of the Erie Canal had uncovered the tiny remains of infants and small children. Reports suggested that unwed mothers — terrified of judgment and rejection from their families and community — felt they had nowhere else to turn. The discovery
horrified Fr. Baker. He knew immediately he had to do something. His answer was the creation of the OLV Infant Home, a place of safety and compassion for unwed mothers and their babies. Everyone was welcomed — no questions asked. It was a radical act of mercy for its time, and not everyone approved. Many in the community argued that these women should “pay for their immorality.” Fr. Baker, however, refused to be swayed by such cruelty. His focus remained on love, dignity and forgiveness. When the infant home opened in 1908, it quickly became one of his favorite places on the campus. Each night, before turning in, Fr. Baker would stop by, quietly blessing the babies as they slept. The ministry continued to expand in the years that followed. In 1919, a maternity hospital and nursing school were added to meet the growing need. More than a century later, those same buildings have found new purpose, redeveloped into a “senior neighborhood” that continues to serve the community in the spirit of care and compassion that Fr. Baker began.
Father Baker Manor in Orchard Park, New York
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Courtesy Our Lady of Victory Basilica
The National Shrine of Our Lady of Victory was consecrated in 1926 and built in a late French Renaissance Revival style designed by Emile Uhlrich. At the time it was built, the Vatican praised it as “one of the greatest” churches in the U.S. It continues to attract visitors from around the globe.
and far grander vision: a magnificent shrine dedicated to the Blessed Mother he had long served so faithfully called Our Lady of Victory. He enlisted the talents of architect Emile Uhlrich and local contractor Edward Jordan, and together with more than 20 other firms, they began to bring his dream to life. To fund the effort, Fr. Baker turned once again to his beloved Association of Our Lady of Victory. True to form, its members responded generously, ensuring that the project moved forward. In August of 1921, a crowd gathered at the corner of Ridge Road and South Park Avenue in Lackawanna to witness the blessing of the shrine’s cornerstone. The moment was steeped in emotion — “Father Baker Boys,” religious sisters and brothers, friends, neighbors and community members all joined Fr. Baker and Bishop William Turner in prayer and celebration. Four years later, just in time for Christmas Mass in 1925, construction of the awe-inspiring shrine was complete. The following May, it was formally consecrated and named a minor basil-
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ica — only the second in the United States at that time. Later that year, on October 3, 1926, Pope Pius XI officially elevated it to the dignity of a basilica. Even the Cardinal Secretary of State at the Vatican took note, declaring that “among the churches of America, the Sanctuary of Our Lady of Victory is, for many reasons, to be counted as one of the greatest.”3
PUBLIC MOURNS THE DEATH OF BELOVED PRIEST
By the summer of 1936, age had finally caught up with Fr. Baker. His health declined rapidly, and on July 29, at the age of 94, he slipped into a coma. That morning, surrounded by those who loved him, Fr. Baker took his final breath while being blessed by Rev. Joseph Burke, one of the many orphans he had raised, who would later become the bishop of Buffalo. The response to his passing was unlike anything Western New York had ever seen. Media accounts described waves of mourners streaming to Lackawanna to pay their respects. More than half a million people braved the summer heat to
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honor the man who had given so much of himself to others. Crowds lined the streets five and six people deep as his funeral procession passed, and the basilica he had built was filled to overflowing for his funeral Mass. Decades later, Fr. Baker’s legacy continues to inspire. Those devoted to his cause for canonization remain in close contact with the Vatican and believe it’s only a matter of time before he will be recognized as a saint.
HIS LEGACY LIVES TODAY
was laid and to carry Fr. Baker’s vision into the next century. The celebration’s theme, All Are Welcome, invites people from near and far to revisit, or discover for the first time, the beauty, history and spiritual heart of the shrine. Events include special Masses, concerts, speaker series and more. The gatherings are meant to engage the community, deepen devotion and renew commitment to Fr. Baker’s legacy of charity and faith. For more information on Fr. Baker’s life and legacy, go to www.olvbasilica.org or www.fatherbaker.org.
Nelson Baker was many things — an astute businessman, a Civil War veteran, a dreamer and a builder. But above all, he was a man of deep compassion and unwavering faith. Fr. Baker left a profound legacy in Catholic health care by providing compassionate medical care to the poor and vulnerable. Individuals in the Catholic medical field can emulate his visionary leadership as he served as a model of Catholic charity and service throughout his life. Today, his work continues to inspire Catholic health ministries committed to dignity, healing and service to those in need. In 2021, OLV National Shrine & Basilica embarked on a five-year Centennial Celebration (2021–26) to honor 100 years since its cornerstone
MSGR. DAVID G. LiPUMA is pastor and rector for Our Lady of Victory National Shrine & Basilica in Lackawanna, New York. NOTES 1. Jeff Z. Klein, “Heritage Moments: Father Baker’s Miracle at Our Lady of Victory,” Buffalo Toronto Public Media, April 9, 2018, https://www.btpm.org/heritagemoments/2018-04-09/heritage-moments-fatherbakers-miracle-at-our-lady-of-victory. 2. “The Father Baker Story,” OLV National Shrine & Basilica, https://www.olvbasilica.org/the-father-baker-story. 3. Richard Gribble, CSC, Father of the Fatherless: The Authorized Biography of Father Nelson Baker (Paulist Press, 2011).
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Menopause:
Navigating from Symptoms to Solutions TRICIA STEELE Contributor to Health Progress
M
enopause has entered the chat. The subject of a recent Oprah Winfrey special, outspoken celebrity confessions, and the focus of institutional and startup investors clamoring for a piece of this more than $15 billion market, menopause is finally being noticed for the hidden phenomenon it is.1 Consider that every day in the U.S. alone, approximately 6,000 women become menopausal. That translates to about 1.3 million women annually crossing this biological threshold.2 However, to think of menopause as a moment is misleading. Given a life expectancy of 81, women can spend more than a third of their lives in a menopause-related state.3 The term itself refers to the day that marks one year from the last menstrual cycle, but the transition can involve 10-15 years of physiological changes on either side of that day, thanks to wavering estrogen production by the ovaries.4 A woman experiencing perimenopause in her 40s could live the second half of her life with fundamentally different physiology compared to her first. While often still siloed as a gynecological specialty, there are few body systems beyond the reach of estrogen or the cascade of hormonal changes that follow its decline. The almond-sized hypothalamus gland at the base of the brain stem requires estrogen to play a coordinating role not only in body temperature but also heart rate, hunger, thirst, sleep and a dozen other autonomic processes. Estrogen receptors play active roles in the brain, heart, lungs, bones, muscles, adipose
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tissue and even within immune system signaling pathways.5 Put simply, there is no way to discuss or treat age-related conditions without understanding the menopause transition. But further statistics paint a troubling picture of subject matter neglect, even within the specialty most closely connected. A recent survey of gynecological residents found that while nearly all strongly agreed that they should have access to a standardized menopause curriculum, only about a third reported receiving this during their residency.6 Even the foundational biological research is lacking. A research review in Nature Aging found that while 70% of the top age-related diseases in women are influenced by the systemic effects of declining estrogen, preclinical studies modeling those conditions make up less than 1% of published aging biology research.7 Gaps in medical research, understanding and education lead to gaps in care. The result is predictable: More than 50% of women aged 50 to 64
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report that no provider discussed with them what to expect during the menopause transition.8 These realities contribute to high costs: Menopause-related symptoms affect women in the workplace, resulting in the U.S. in an estimated $1.8 billion in lost work time per year and $26.6 billion annually when combined with medical expenses, according to recent research published by the Mayo Clinic.9 When we consider the downstream health consequences, the true cost of inadequate menopause care becomes exponentially higher. This is not a niche issue affecting a small subset of patients, nor is menopause a condition that can be fully supported by only one specialty. To understand why menopause care demands a comprehensive, system-based approach, we must first dig deeper into the remarkable reach of estrogen throughout the human body and the realities of its decline.
LONG-TERM HEALTH IMPACTS
Increased Cardiovascular Risk Prior to menopause, women enjoy relative protection from cardiovascular disease compared to age-matched men. This advantage evaporates in the postmenopausal period. Estrogen exerts protective effects on the vascular lining, promotes favorable cholesterol makeup, reduces oxidative stress, and regulates inflammatory responses.10 With estrogen’s decline, women experience accelerated arterial stiffening and increased abdominal fat — both of which contribute to heightened cardiovascular risk.11 Women experiencing premature menopause (before age 40) or early menopause (between ages 40-45) due to the necessity of surgical procedures or medical treatments face even higher risks of cardiovascular disease than their natural menopause-matched peers, but might be overlooked for cardiovascular screening due to their younger age.
Accelerated Bone Loss The skeleton represents another major estrogen target. Estrogen inhibits osteoclast (bone-resorption) activity and supports osteoblast (bonebuilding) function. In its absence, this balance shifts dramatically toward bone resorption, or the breaking down of bone. Attributing bone loss simply to older age does not accurately represent the data: Women lose up to 20% of their bone density in the first five to seven years following menopause (regardless of age or cause), with the most rapid loss occurring in the immediate aftermath. This accelerated bone loss translates directly into fracture risk later. According to the Bone Health and Osteoporosis Foundation, half of all women over age 50 will experience an osteoporosis-related fracture in their lifetime; in fact, a woman’s likelihood of a hip fracture is equal to the combined risk of breast cancer, uterine cancer and ovarian cancer.12 While all fractures can lead to other medical conditions and difficulties, hip fractures carry significant morbidity and mortality, loss of independence and financial burden.13 Despite this, the Journal of Women’s Health reports that up to 91% of women over 65 years old with a previous low trauma fracture are not screened for osteoporosis.14 Beyond bones, estrogen influences muscle mass and strength, connective tissue integrity and joint health. The increase in musculoskeletal pain, joint stiffness and conditions like frozen shoulder during the menopausal transition reflects estrogen’s broader role in maintaining musculoskeletal strength and flexibility.15 Neurological and Cognitive Deficits Estrogen influences neurotransmitter systems, promotes neuroplasticity and exerts neuroprotective effects. Its decline removes these advantages and can lead to atrophy and degeneration.
When we consider the downstream health consequences, the true cost of inadequate menopause care becomes exponentially higher. This is not a niche issue affecting a small subset of patients, nor is menopause a condition that can be fully supported by only one specialty. 52
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The neurological manifestations of menopause extend well beyond the infamous hot flashes and night sweats experienced by up to 80% of women. During a hot flash, blood vessels rapidly dilate, dropping the blood pressure while quickly bringing blood to the face, chest, back, stomach and legs. Body temperature rapidly rises, and measurable sweat is produced in episodes that can last 10 minutes or more and recur dozens of times a day.16 These autonomic disruptions can significantly impair sleep, creating a cascade of mood and cognitive decline. Dr. Rhonda Voskuhl, professor of neurology at UCLA and founding faculty neurologist of UCLA Health’s Comprehensive Menopause Program, studies the impact of estrogen and sex-based genetics on the brain alongside treating patients in the multispecialty clinic. Separate from vasomotor symptoms, she said, large areas of the brain express abundant estrogen receptors, particularly in regions important for memory, focus and processing speed. “Brain fog occurs in 70% of healthy women as they go through menopause,” said Voskuhl, specifically causing challenges with verbal memory and concentration. “It’s not global IQ , they’re still smart,” said Voskuhl. “They’re still able to do complex decision-making, but they have these domain specific problems.” Voskuhl lamented that often her patients are at the height of their careers, may have more time for themselves and then find themselves struggling to retrieve words or respond as quickly, often undermining confidence. A woman deserves to understand how this experience may be related to her estrogen levels, said Voskuhl, and how she might address it to live the life she desires. Genitourinary Decline Unlike vasomotor symptoms, which often improve with time, genitourinary syndrome of menopause tends to worsen progressively without treatment, said Dr. Harmony Schroeder, a gynecologist who focuses on menopause care at PeaceHealth in Washington state. The vulvovaginal lining, bladder and urethra are especially sensitive to estrogen. Without it, these tissues atrophy: The lining thins and loses elasticity and lubrication, and vaginal pH changes, becoming more susceptible to infection and contributing to the increase of urinary tract infections (UTIs), which sometimes require hospitalization. Schroeder said that symptoms such as vaginal
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dryness, dyspareunia (painful intercourse), urinary urgency and frequency, and recurrent UTIs significantly impact both sexual function and quality of life for many postmenopausal women. Metabolic and Body Composition Changes Schroeder said that many women are surprised during the menopausal transition by other unexplained body changes. The characteristic redistribution of body fat from a gynoid (peripheral or “pear-shaped”) to an android (central or “apple-shaped”) pattern often happens even with no weight gain. The “menopot” (as Schroeder’s patients call it) occurs independently of aging and is directly related to estrogen deficiency. Without any increase of net calories, women often gain an average of 5-7 pounds during the menopausal transition. More concerning than weight gain itself is the accompanying metabolic dysregulation. Insulin sensitivity decreases, glucose metabolism becomes less efficient, and the risk of type 2 diabetes increases, even when a woman’s weight stays relatively stable. These metabolic changes, combined with the adverse cardiovascular and bone health effects already described, create a perfect storm for accelerating chronic disease development in the postmenopausal years.17 Thinning Skin and Gums As if these internal changes were not enough, menopause changes the appearance and health of the skin and teeth. With less estrogen, skin ages faster as collagen falls by almost one-third in the first five years after menopause. As a result, the skin thins and becomes stretchier, easier to break or tear and takes longer to heal.18 Oral health deteriorates as the outer layer of the gums undergo atrophic changes alongside bone loss affecting the jaw and teeth. Postmenopausal women have an increased risk of periodontal disease, dry mouth and altered taste perception. These seemingly marginal concerns can significantly impact self-esteem and quality of life, contribute to loss of teeth and increase in infection, yet they’re rarely addressed in clinical menopause discussions or patient education. Earlier detection of periodontal disease or jawbone loss gives more options for successful intervention.19
TREATMENT OPTIONS EXPAND
From head to toe, women are undergoing shifts to their very sense of identity and personality as
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they experience autonomic, metabolic, mood, neurological, vascular and physical changes they have little control over, even as they access other medical advancements that keep them living longer. How can health care providers be better equipped with the knowledge and tools to support patients through this decades-long period? Hormone therapy remains the most effective way to eliminate or reduce vasomotor symptoms and genitourinary syndrome, as well as relieve the many other possible effects of estrogen loss. Yet its use has plummeted. In 2002, clinical trials conducted on the use of hormone replacement medications, known as the Women’s Health Initiative (WHI), were stopped prematurely due to an observed increase in the rate of breast cancer detection in the test group. The interpretation of the WHI findings and the ensuing media coverage created misunderstanding that persists today, leaving countless women with symptoms that medical professionals now say are often treatable.20 Twenty years of subsequent analysis and additional trials have provided crucial context. The WHI trials studied primarily older women (average age 63) without differentiating time since menopause. Hormone supplementation was initiated for most participants many years after menopause. Additionally, subjects within the study used a specific, now outdated regimen (conjugated equine estrogens containing additional forms of estrogen not found in the human body) that was taken orally. Medical research now indicates that timing, dose and delivery mechanism matter profoundly. Detailed analysis of both the WHI trials and subsequent research suggests that hormonal treatment initiated within 10 years of menopause, or before age 60, provides cardiovascular and neuroprotective benefits, while initiation in older women (or further from menopause) may have increased risk. Impact on all-cause, cardiovascular or cancer mortality rates remained neutral when WHI participants were followed for 13 years. The biggest concern related to the use of hormone replacement — breast cancer — remains nuanced. The difference in absolute number of cases within the WHI test group was calculated at “one per 1,000 women per year,” but “with no increased risk of breast cancer mortality.”21 Metaanalysis of 58 studies shows that risk varies based on the estrogen formulation and combination
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with progesterone. Lastly, in several early studies, “lack of assessment of the effect of underlying breast cancer risk on attributable risk” was “a major limitation.”22 Contemporary hormonal treatment has evolved significantly, with a much wider array of formulations, delivery methods, dosages and more nuanced risk and benefit guidelines. FDA-approved hormone replacement therapy is recommended as first-line treatment for the relief of certain symptoms and risks of menopause by both American College of Obstetricians & Gynecologists (ACOG) and The Menopause Society (formerly The North American Menopause Society).23 Current recommendations favor bioidentical hormone formulations, such as estradiol, and transdermal delivery systems. These patches or creams (in various frequencies and doses) deliver estrogen through the skin into the bloodstream, which avoids metabolism through the liver, lowers the effective dose needed and reduces side effects. Current approved treatments also include varied progestogen options for patients with a uterus.24 Recent recommendations emphasize that all women be evaluated and treated based on their individual risks and treatment goals, especially those with personal or strong family history of estrogen-receptor positive cancer or other specific risks. Physicians caring for patients in this stage of life use research-based guidelines, analysis of risks, lab tests, coordination with other specialists, and patient reporting to prescribe and manage treatment. “When needed, I even use an FDA-approved medication for testosterone,” said PeaceHealth’s Schroeder. “Because there is not an approved dose for women yet, I [prescribe] a tenth of the male dose.” She regularly lab tests and tracks symptoms to titrate treatment up or down. For women whose symptoms are primarily genitourinary, low-dose vaginal estrogen provides highly effective local therapy with minimal systemic absorption. In addition to preventing skin tearing and tissue atrophy, vaginal estrogen prevents recurrent UTIs by restoring a healthy vaginal microbiome and improving urinary tract health.25 “The data is so clear that the vaginal estrogen does not come with the same risks,” agreed Schroeder. To place the highest warnings on this product, she said, is “almost antimedicine.” The FDA now agrees. Following years of advocacy by providers and associations like ACOG
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Overall, women and providers should “start paying more attention in the 40s to physiological changes. Menopausal medicine is so complex and can be a frustration for a lot of women, so I’m excited that there’s more research and tools.” — DR. HARMONY SCHROEDER
and The Menopause Society, a comprehensive review of the scientific literature prompted an expert panel and public comment period this past summer. In November, the FDA announced the removal of all black box warnings on low-dose vaginal estrogen as well as most systemic hormone replacement therapy products.26 For those requiring or preferring nonhormonal treatments, the pipeline has expanded considerably in recent years. Many FDA-approved medications can be used off-label to relieve menopause symptoms including specific antidepressants, certain treatments for overactive bladder and high blood pressure, and others. Multiple new nonhormonal medications have been recently approved for the specific treatment of hot flashes, and there are a variety of treatments on the horizon.27 UCLA’s Voskuhl, for example, is studying other forms of estrogen, including estriol, to gauge its impact on cognitive and neurological symptoms. Overall, women and providers should “start paying more attention in the 40s to physiological changes,” advised Schroeder. “Menopausal medicine is so complex and can be a frustration for a lot of women, so I’m excited that there’s more research and tools.”
TIME IS NOW FOR CULTURAL CHANGE
The bottom line is that a woman experiencing any of the wide range of consequences resulting from natural, surgical or chemical menopause could present anywhere in the health care system — emergency, primary, cardiology, endocrinology, rheumatology or many other specialties. She requires education, support and access to treatment options from an informed clinician. In many health care systems, providing this kind of care may mean creating new kinds of primary care models or encouraging continuing education for a broader range of clinicians. Perhaps most fundamentally, women’s care
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seems primed for a cultural change. Menopause is not an inevitable decline requiring resignation or just a gynecological condition, but rather a significant biophysiological shift, deserving competent, compassionate and comprehensive health care. TRICIA STEELE is a freelance science writer and health care consultant. After a career as a technology entrepreneur, she recently completed her master’s degree in science writing from Johns Hopkins University. NOTES 1. Heather Landi, “Menopause Care Is Still a Largely Untapped Market. Here’s Why Investors and Startups Should Dive In,” Fierce Healthcare, June 28, 2023, https://www.fiercehealthcare.com/health-tech/ menopause-care-market-remains-largely-untappedheres-why-investors-and-startups-should. 2. Jennifer Whiteley et al., “The Impact of Menopausal Symptoms on Quality of Life, Productivity, and Economic Outcomes,” Journal of Women’s Health 22, no. 11 (2013): 983–90, https://doi.org/10.1089/jwh.2012.3719. 3. Ricki Pollycove, Frederick Naftolin, and James A. Simon, “The Evolutionary Origin and Significance of Menopause,” Menopause 18, no. 3 (2011): 336–42, https://doi.org/10.1097/gme.0b013e3181ed957a. 4. Dr. Michael R. Soules et al., “Executive Summary: Stages of Reproductive Aging Workshop (STRAW) Park City, Utah, July, 2001,” Menopause 8, no. 6 (2001): 402–407, https://doi.org/10.1097/00042192200111000-00004. 5. Peng Chen, Bo Li, and Ling Ou-Yang, “Role of Estrogen Receptors in Health and Disease,” Frontiers in Endocrinology 13 (2022): https://doi.org/10.3389/ fendo.2022.839005. 6. Dr. Jennifer Allen et al., “Needs Assessment of Menopause Education in United States Obstetrics and Gynecology Residency Training Programs,” Menopause 30, no. 10 (2023): https://doi.org/10.1097/gme. 0000000000002234.
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7. Gabrielle Gilmer et al., “Female Aging: When Translational Models Don’t Translate,” Nature Aging 3, no. 12 (2023): 1500–1508, https://doi.org/10.1038/ s43587-023-00509-8. 8. Ivette Gomez, Brittni Frederiksen, and Alina Salganicoff, “Women’s Experiences with Preventive and Health Care Services: Findings from the 2024 KFF Women’s Health Survey,” KFF, March 12, 2025, https://www.kff. org/womens-health-policy/womens-experiences-withpreventive-and-health-care-services-findings-from-the2024-kff-womens-health-survey/. 9. Jay Furst, “Mayo Clinic Study Puts Price Tag on Cost of Menopause Symptoms for Women in the Workplace,” Mayo Clinic, April 26, 2023, https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-study-puts-price-tagon-cost-of-menopause-symptoms-for-women-in-theworkplace/. 10. Du Xiang et al., “Protective Effects of Estrogen on Cardiovascular Disease Mediated by Oxidative Stress,” Oxidative Medicine and Cellular Longevity 2021, no. 1 (2021): https://doi.org/10.1155/2021/5523516. 11. Chen, Li, and Ou-Yang, “Role of Estrogen Receptors in Health and Disease.” 12. “What Women Need to Know,” Bone Health & Osteoporosis Foundation, https://www.bonehealthand osteoporosis.org/preventing-fractures/general-facts/ what-women-need-to-know/. 13. Mansoor U. Keen, Maxim J. Barnett, and Catherine Anastasopoulou, “Osteoporosis in Females,” StatPearls, June 29, 2025, https://www.ncbi.nlm.nih.gov/books/ NBK559156/. 14. Carolyn McPhee, Irene O. Aninye, and Lindsey Horan, “Recommendations for Improving Women’s Bone Health Throughout the Lifespan,” Journal of Women’s Health 31, no. 12 (2022): https://doi.org/10.1089/jwh.2022.0361. 15. Nkechinyere Chidi-Ogbolu and Keith Baar, “Effect of Estrogen on Musculoskeletal Performance and Injury Risk,” Frontiers in Physiology 9 (2019): https://doi.org/ 10.3389/fphys.2018.01834. 16. Nancy E. Avis, Sybil L. Crawford, and Robin Green, “Vasomotor Symptoms Across the Menopause Transition: Differences Among Women,” Obstetrics and Gynecology Clinics of North America 45, no. 4 (2018): 629–40, https://doi.org/10.1016/ j.ogc.2018.07.005. 17. Sarah M. Temkin et al., “Chronic Conditions in Women: The Development of a National Institutes of Health Framework,” BMC Women’s Health 23, no. 162 (2023): https://doi.org/10.1186/s12905-023-02319-x.
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18. Glenda Hall and Tania J. Phillips, “Estrogen and Skin: The Effects of Estrogen, Menopause, and Hormone Replacement Therapy on the Skin,” Journal of the American Academy of Dermatology 53, no. 4 (2005): 555–68, https://doi.org/10.1016/j.jaad.2004.08.039. 19. Maria Clarinda A. Buencamino, Leena Palomo, and Holly L. Thacker, “How Menopause Affects Oral Health, and What We Can Do About It,” Cleveland Clinic Journal of Medicine 76, no. 8 (2009): 467–75, https://doi.org/10.3949/ccjm.76a.08095. 20. Valerie A. Flores, Lubna Pal, and JoAnn E. Manson, “Hormone Therapy in Menopause: Concepts, Controversies, and Approach to Treatment,” Endocrine Reviews 42, no. 6 (2021): 720–52, https://doi.org/10.1210/endrev/ bnab011. 21. Avrum Bluming, Howard Hodis, and Robert Langer, “‘Tis but a Scratch: A Critical Review of the Women’s Health Initiative Evidence Associating Menopausal Hormone Therapy with the Risk of Breast Cancer,” Menopause 30, no. 12 (2023): https://doi.org/10.1097/ GME.0000000000002267. 22. Flores, Pal, and Manson, “Hormone Therapy in Menopause: Concepts, Controversies, and Approach to Treatment.” 23. “The 2022 Hormone Therapy Position Statement of the North American Menopause Society,” Menopause 29, no. 7 (2022): 767–94, https://doi.org/10.1097/ GME.0000000000002028; Lisa Hauk, “ACOG Releases Clinical Guidelines on Management of Menopausal Symptoms,” American Academy of Family Physicians, September 1, 2014, https://www.aafp.org/pubs/afp/ issues/2014/0901/p338.html. 24. Dr. David D. Rahn et al., “Vaginal Estrogen for Genitourinary Syndrome of Menopause: A Systematic Review,” Obstetrics & Gynecology 124, no. 6 (2014): 1147–56, https://doi.org/10.1097/aog.0000000000000526. 25. Rahn et al., “Vaginal Estrogen for Genitourinary Syndrome of Menopause.” 26. “HHS Advances Women’s Health, Removes Misleading FDA Warnings on Hormone Replacement Therapy,” U.S. Food & Drug Administration, November 10, 2025, https://www.fda.gov/news-events/pressannouncements/hhs-advances-womens-healthremoves-misleading-fda-warnings-hormonereplacement-therapy. 27. Carolyn Crandall, Jaya M. Mehta, and JoAnn Manson, “Management of Menopausal Symptoms: A Review,” JAMA 329, no. 5 (2023): 405-420, https://doi.org/10.1001/jama.2022.24140.
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MISSION
EXPLORATION OF THE SOUL IS EVER-PRESENT IN THE MINISTRY’S CHANGING SEASONS
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ike many of you, the events of the recent season have left me feeling powerless. Angst over recent policies persists, as some legislators attempt to oppress health care coverage for those most in need. We find ourselves asking, “How might I be an effective agent for change?” The divisiveness feels hopeless, where societal fear of the “other” looms as acceptable. As we look for God’s unity amid the animosity, we ask, “How am I to be a bringer of peace?” But beneath powerlessness and hopelessness, soul questions lie dormant until their proper time. There are fundamental questions one must attend to on the spiritual journey: Who am I? Who is God? What does God love? What is mine to do? For those who seek to live a spiritual life, the questions sprout whether we seek them or not. If JILL FISK we can look beyond life’s turbulence and give the questions the attention they deserve, they can be catalysts for flourishing and move us deeper into who we are most called to be. “Soul” is that which gives us life, that which sustains and nourishes us. Our soul is the totality of who we are — body, mind and spirit. It works in cooperation to help make sense of the world around us and activate us for the sake of our own healing and the world’s flourishing. In whatever Catholic health leadership role we have, we share a responsibility to tend to the institutional soul as much as we do our own. The flourishing of our ministry’s mission, vision and values depends on it. One author even describes the soul as an “agent of the divine spark in the institution. The soul is the authentic and truest self of the institution; the source of its divine calling, character and destiny; the protector of institutional integrity.”1 For those of us called to be ambassadors of the healing ministry, making sense of God in our institutional work is crucial. It can help us endure the difficulties of leadership and allow us to be organi-
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zational collaborators of human flourishing. Like our own souls, each return to these questions will bring us renewal, and along the way, shape and reshape the institutional soul: Who am I? Who is God? What does God love? What is mine to do? What institutional wisdom might be gained in exploring these questions of soul? There are a few lessons that have arisen for me as I consider the institutional soul.
WHO AM I, AND WHO IS GOD?
Christian tradition understands God as sovereign, where relationships with the Creator, community and creation are primal (Exodus 20:2-17). All life must return to the source in and through God, as the societal and economic principles of the Hebrew scriptures instruct (Leviticus 19:9-10, 18; Deuteronomy 6:4-5). This is how the community was and is designed to operate. From the biblical perspective, life flows rightly in returning to love of God, love of neighbor and love of creation. Though the daily grind has a way of slowly and silently disconnecting us from who and whose we are, Torah’s teaching, in the first five books of the Old Testament, continually redirects God’s people to return to the basics: God, others and the land. Returning is itself a holy posture, for it produces a humility that might not otherwise be achieved. Daily living has a way of keeping us in the space of returning, for we cannot will, manage or control it all. We cannot satisfy the hunger and thirst of our souls that come from our role
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as co-laborers. The work is wearisome; fatigue is legitimate, and we are not machines. Modernity places self-sufficiency on the path to self-actualization: If I can think it, I can do it; if I can do it, I can master it; and if I can master it, I can possess it. But in returning to who and whose we are, and what we ought to love, humility, not possession, is the treasure. This is not a narrative that makes news feeds or strategic plans, but it is a necessary framework for Christian leaders and organizations to maintain focus.
WHAT DOES GOD LOVE?
To know what God loves, one simply has to pay attention to where the good is happening. There’s a holiness found in the childhood game of I Spy, where one player locates a secret object within the room and gives a clue to the other players, who are on the lookout to be the first to discover the secret object. Many Catholic health ministries practice a similar version in “sacred encounters”2 or through “sacred moments”3 initiatives, where goodness, compassionate care and the Divine hide within the care setting. Focusing on these moments is healing for eyewitnesses. Telling others about it is healing for the community. But there’s a special joy in being close enough to the action to behold it.
managed to keep up with her on the extensive walking tour of St. Joseph’s University Medical Center. But at the intersection of the community ministries, she stopped us, right in front of the flagship hospital: “If we’re not in the community, meeting people right where they are, then there’s no need for us [the ministry].” Sr. Demarest is a holy difference-maker, a sacred moment wherever she goes. Sr. Demarest’s love for those most in need of care is fierce. Her ministry is good news, and it exemplifies what God loves. The message of the Gospel, literally meaning “good news,” is that the kingdom Jesus proclaimed is accessible to all (John 14:6), belonging can be found (Mark 10:1316) and souls can find rest (Matthew 11:28-30). Good news must be lived and proclaimed. For ministries whose aim is the Gospel, we must activate holy beholding and be unrelentless in our call to embody and proclaim community as access, belonging and rest. This is what God loves.
WHAT IS MINE TO DO?
Equally essential to leadership is the ability to discern what fundamental action the organization must take to fulfill its vision. What steadfastness must be channeled, and what principles must be maintained, even if the fruits of the end goal will never be seen by the current leadership? “If we’re not in the community, meeting Lofty goals require ordinary people right where they are, then faithfulness. A colleague recently reminded me of this truth there’s no need for us [the ministry].” in a moment of my own goal loftiness. In their gentle way, — SR. FRAN DEMAREST, SC they suggested some timeless Quarterly, I have the privilege of seeing the words might release me from the burden of lugaction on the ground with members, as my CHA ging around spectacularism.4 The familiar words colleague Dennis Gonzales, senior director of of the prayer written for the memorial mass on the mission innovation and integration, and I round. anniversary of the martyrdom of St. Archbishop We meet with leadership teams, hear from local Oscar Romero of San Salvador, El Salvador, were mission and spiritual care leaders, and visit with the words my striving soul needed.5 co-workers in local facilities. On a recent trip to St. Joseph’s Health in Pat“We plant seeds that one day will grow.” erson, New Jersey, we met Sr. Fran Demarest, SC. In her 80s and officially retired as a system health “We cannot do everything … . It enables us to care administrator and social worker, she is still do something and to do it very well. It may be working in the health system’s community-based incomplete, but it is a beginning, a step along ministries. Her vision, energy and commitment to the way, an opportunity for the Lord’s grace to serve people right where they are is a wonder to enter and do the rest.” witness. Affectionately known as Sr. Fran, we barely “We are the workers, not master builders … .”
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Most visions are achieved not by doing something amazing, but by just doing something. Faithful acts over a long period of time can yield extraordinary results. Organizations that commit to tending to soul questions are more likely to flourish. Contemplative inquiry can blaze a trajectory of thriving, urging the divine spark to stay lit in the institution’s soul. Returning to the most fundamental inquiries can sustain the abundance needed to bring Jesus’ healing ministry to life for years to come. JILL FISK, MATM, is director, mission services, for the Catholic Health Association, St. Louis. NOTES 1. Susan Beaumont, How To Lead When You Don’t Know Where You’re Going: Leading in a Liminal Season (Rowman & Littlefield Publishers, 2019), 9.
2. Dale Singer, “Catholic Health Invites Staff to Document Sacred Encounters,” Catholic Health World, April 2, 2025, https://www.chausa.org/news-and-publications/ publications/catholic-health-world/archives/april/ catholic-health-invites-staff-to-document-sacredencounters. 3. Jennifer Swenson, “Mercy Employees Talk the Importance of Compassionate Care,” Biz 417, September 2022, https://www.biz417.com/advice/ culture/mercy-employees-importance-ofcompassionate-care. 4. The late spiritual writer Henri Nouwen, in his classic book In the Name of Jesus: Reflections on Christian Leadership, proposes three temptations every Christian leader faces: the power to be relevant, powerful and spectacular. 5. “In Memory of Bishop Oscar Romero (1917 – 1980),” Catholic Health Association of the United States, https://www.chausa.org/docs/default-source/prayers/ in-memory-of-bishop-oscar-romero.pdf.
CATHOLIC HEALTH ASSOCIATION WEBINAR
IRS Form 990, Schedule H An overview and update on current tax exemption issues JOIN US ON FEB. 18 1 – 2:30 P.M. ET
CHAUSA.ORG/EVENTS
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ETHICS
THE ROAD TO REVISION:
UPDATED ERDs SET GUIDELINES FOR CATHOLIC CARE
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he Ethical and Religious Directives for Catholic Health Care Services (ERDs) outline the moral and theological principles guiding Catholic hospitals and health systems in fulfilling their mission of healing. They articulate the Church’s deep convictions about human dignity, the common good and faithful stewardship within the modern practice of medicine. As science and social questions evolve, so too must the guidance that supports the Catholic health ministry.
The United States Conference of Catholic Bishops (USCCB) has completed the latest revision of the ERDs, marking the seventh edition of the document. Understanding what the NATHANIEL ERDs are, how they have been BLANTON revised, and what themes are HIBNER emerging in the current version is essential for all those serving in Catholic health care.
nicians and patients. 4. Issues in Care for the Beginning of Life: Offers moral guidance for fertility, conception, pregnancy and reproductive technologies. 5. Issues in Care for the Seriously Ill and Dying: Focuses on end-of-life care, pain management and respect for human dignity in dying. 6. Collaborative Arrangements with Other Health Care Organizations and Providers: Outlines principles for partnerships and mergers to ensure Catholic identity is preserved.
WHAT ARE THE ERDs?
The ERDs are not a rule book; rather, they serve as a moral and spiritual compass. They must be read in dialogue with the Church’s broader body of ethical reflection developed over centuries. Their intent is not to provide every answer, but to orient Catholic health care toward moral coherence, compassion and the healing mission of Christ.
The ERDs express how the Catholic Church understands health care as a ministry of the Church, rooted in the life and mission of Jesus Christ. They connect Catholic moral theology with clinical and organizational realities, helping health systems uphold both ethical integrity and clinical excellence. The document’s structure has remained consistent for decades. It opens with a general introduction that explains its purpose and theological grounding, followed by six main parts, each addressing a particular area of health care practice: 1. The Social Responsibility of Catholic Health Care Services: Articulates the Church’s call to promote the common good, serve the poor and ensure just stewardship of resources. 2. The Pastoral and Spiritual Responsibility of Catholic Health Care: Emphasizes holistic care that attends to spiritual needs. 3. The Professional–Patient Relationship: Explores ethical decision-making, informed consent, and the moral responsibilities shared by cli-
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A BRIEF HISTORY OF THE ERDs
The directives have evolved alongside modern medicine and the institutional growth of Catholic hospitals in the United States.1 1921: First written as a short set of ethical norms for Catholic hospitals. 1947–1949: Early drafts started, and the first Ethical and Religious Directives for Catholic Hospitals appeared in The Linacre Quarterly, then in a CHA brochure. 1956: The first official revision appeared. 1960s–1971: Authorship shifted from CHA to the U.S. bishops, who published the Second Edition in 1971.
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1994–1995: The Third Edition established the modern format used today. 2001: The Fourth Edition incorporated Vatican guidance on sterilization. 2009: The Fifth Edition revised directives on medically administered nutrition and hydration. 2018: The Sixth Edition addressed issues surrounding institutional partnerships and Catholic identity. Each edition has reflected both moral teachings of the Church and medical advancements to address new questions in ethics, medicine and health care delivery.
WHY WERE THE ERDs REVISED AGAIN?
Revisions occur when new developments in medicine or Church teaching require clarification or guidance. The latest revision, begun by the U.S. bishops in June 2023,2 was prompted largely by new moral questions about gender identity, transitioning procedures and technological manipulation of the human body. In March 2023, the USCCB’s Committee on Doctrine released a theological note titled “Doctrinal Note on the Moral Limits to Technological Manipulation of the Human Body.” That note, together with related Vatican statements, underscored the need to revisit the ERDs to address emerging issues related to gender. Although these questions served as the catalyst, the bishops’ review has extended more broadly to other parts of the text.
HOW THE REVISION PROCESS WORKS
The USCCB Committee on Doctrine leads the process. A team of bishops and staff draft proposed changes and seek consultation from experts in theology, medicine, law, ethics and health care operations. Organizations such as CHA are included as commentators, offering input on language, practical implications and clarity for those who will implement the ERDs at the system and clinical levels. After a final draft is complete, the entire body of U.S. bishops votes to approve it, which they did this past November. The process is deliberative and careful, often taking several years. Most revisions take between two and four years from authorization to publica-
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tion. This time it took 2 1/2 years.
CHA’S ROLE AND PRIORITIES
CHA participated in the revision process as both a collaborator and a commentator, seeking to ensure that the final document balances fidelity to Church teaching with clarity for practitioners. CHA’s main priorities include: 1. Focusing on principles and virtues, not procedures. The ERDs should orient Catholic health care around enduring moral truths, not attempt to regulate every specific clinical scenario. 2. Emphasizing obligations and mission over prohibitions. Rather than only listing what cannot be done, the ERDs should emphasize what Catholic health care is called to do. 3. Using clear, pastoral language. The document should speak in accessible terms to clinicians, administrators and ethicists who use it in real time. 4. Avoiding unnecessary conflict with civil law. The directives should articulate Catholic moral teaching without positioning Catholic institutions in legal jeopardy. CHA ethicists, members and scholars provided detailed written commentary throughout the drafting process to ensure the final directives met these goals as much as possible, and we saw a positive impact on the drafts due to our thoughtful input. Several dozen member experts provided their insight into the draft texts. Many did so virtually, and several graciously came together in Denver and St. Louis to have a rigorous dialogue about CHA’s official response. I am particularly grateful for the help of these members, as they met the time constraints of the process with diligence and excellence.
THE REVISION’S BROADER SIGNIFICANCE
This revision process offers more than updated language; it’s a moment for the Church to reflect on what it means to practice Catholic health care in a rapidly changing moral and scientific landscape. Catholic health ministries today navigate questions that could not have been imagined when the first set of medical ethical norms were written in 1921. The ERDs serve as a unifying moral framework. The changes to the text address areas critical
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GET IT DELIVERED Health Progress and Catholic Health World CONTACT THE SERVICE CENTER AT SERVICECENTER@ CHAUSA.ORG
to the mission of the health care ministry, including defending human dignity; attention to people experiencing gender dysphoria; commitment to hospice and palliative care for the seriously ill and dying; physicians’ responsibility to transfer care when requested; protection of women and children; and patients’ informed consent, among others. As we live into these revisions, we must remind ourselves that as a ministry of the Church, we are called to act like Jesus to all who seek our care. These revisions must continue to meet that ultimate end as we put them into our daily practice.
LOOKING AHEAD
As the revision has been approved and published, Catholic health leaders are encouraged to remain engaged. We look forward to ongoing dialogue between Catholic health care and the USCCB on how we can best live out these revisions together. Understanding the process helps ministry leaders prepare for how new directives may affect policy development, staff formation and clinical decision-making. CHA will host a variety of educational events to help orient members to the changes in the text. These will include webinars, podcasts, published articles and learning modules. We will keep everyone informed about these
resources and events as they are released. As the conversation continues, Catholic health care leaders, clinicians and ethicists are invited to participate in the spirit of hope. We must ensure that, whatever new technologies or social issues emerge, the heart of the ministry remains the same: to continue the healing mission of Jesus Christ. NATHANIEL BLANTON HIBNER, PhD, is senior director, ethics, for the Catholic Health Association, St. Louis. NOTES 1. Rev. Kevin O’Rourke, OP, Rev. Thomas Kopfensteiner, and Ron Hamel, “A Brief History: A Summary of the Development of the Ethical and Religious Directives for Catholic Health Care Services,” Health Progress 82, no. 6 (November/ December 2001): 18-21, https://www. chausa.org/news-and-publications/ publications/health-progress/archives/ november-december-2001/a-briefhistory. 2. Michael J. O’Loughlin, “Transgender Treatment at Catholic Hospitals: U.S. Bishops Vote to Begin Process That Could Formally Ban It,” America: The Jesuit Review, June 16, 2023, https://www. americamagazine.org/politics-society/ 2023/06/16/usccb-transgender-healthcarecatholic-hospitals-245508/.
Issues are complimentary for those who work for CHA members in the United States.
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FORMATION
SURVEY: SENIOR LEADERSHIP FORMATION IS FUELED BY REGULAR CADENCE, AMPLE TIME
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enior leadership formation programs have become fixed features of Catholic health ministries in the United States. They have such importance that every ministry has a means of providing them for their senior leadership, and the data indicate the establishment of a shared vision for content, process and programmatic experience. In 2024, CHA requested data from the largest systems related to the operational and programmatic activity of their senior leadership programs. The data collection and subsequent analysis replicated the same process that occurred in 2016. Our partners at DARREN M. the HSM Group compared the data and the practices reported HENSON by members, thereby building a longitudinal perspective on these flagship programs in the ministry. We conducted this in conjunction with the larger national survey of formation activities led by mission and formation leaders.1
PROGRAM LENGTH AND FREQUENCY
Formation’s goodness takes hold over time. Moving through calendar years, seasons, fiscal years and life events together as a cohort — all while making intentional connections to mission and the broader Catholic tradition — has an impact on leaders. Several senior leadership formation programs are slightly shorter than they used to be. In 2024, senior leadership formation programs averaged 17 months in duration. In 2016, the average was 19 months; however, as many as four programs lasted up to 36 months. Today, the proportion saying a program transpires over 7-12 months and 1324 months grew when compared to 2016. There has been a notable jump in programs lasting more than one year and less than two, from 40% to nearly two-thirds. Fewer than one-third of ministries conduct ministry formation for their most senior leaders in less than one year. Currently, just one of
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the surveyed ministries reports a program lasting 24 months. The frequency of sessions has quickened. In 2016, quarterly gatherings were the most popular followed by monthly sessions. In 2024, the data reflect a reversal: Monthly sessions are the most common, followed by quarterly and every-othermonth. One system reports an annual gathering. There is wisdom in these data. Along with the experiences of those who have participated in formation programs, it suggests that quarterly is a minimum meeting cadence for meaningful formation. Adult learning needs regular connections, especially as ministry formation orients and familiarizes leaders with unique vocabulary and a particular worldview. Equipping leaders to faithfully, competently and confidently integrate the Catholic identity of the organization, regardless of their own faith tradition, happens only with a regular cadence of reflection, peer dialogue and discussion on application. The more regular, monthly formation experiences for senior leaders may be attributed to the ease and adaptation of virtual gatherings and capabilities. In 2024, half of the responding programs indicated a blend of in-person and virtual sessions, whereas fewer than 20% reported using this option in 2016. There remains a strong preference for all in-person sessions, with 42% indicating all sessions are held in-person. One system reports all sessions are virtual.
PROGRAM METHODS
Respondents were asked to identify the means of the formation experience. The cohort-retreat model remains the preferred means of formation for senior leaders and now emerges as the
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standard. The majority reported favoring this method in 2016, and the current data validated it. The data reflect a modest use of team-based experiences. They also show usage of pilgrimage, volunteer service and capstone experiences. These activities supplement and integrate content themes explored in formation modules. These data indicate the staying power of the early models of formation, introduced by the founders of Catholic health ministries. Formation entails far more than education or knowledge transfer and engages the whole self and connection to the human heart. Therefore, a retreat setting — or something similar away from the ordinary conference room setting or commercial hotels — provides an environment conducive for creating meaning and enabling the depth of self-reflection that can become transformative. Also, a note about delivery: All major Catholic health systems today report that their own system conducts and oversees the formation programs for senior leaders. This is a testament to the investments and commitments Catholic health ministries have to their Catholic identity and a desire that ministry formation be tailored to that system’s heritage and organizational culture. Eight years ago, 44% reported that a separate group conducted ministry leadership formation, and another 20% reported using some other center. Today, about a quarter (27%) report collaborating with university faculty to augment the formation leadership shouldered by the ministry.
PARTICIPANTS
Individuals currently participating in senior leadership formation programs reflect consistency and a commonality with data reported in 2016. Today, all ministries report participation by leaders in vice president roles (including senior or executive vice presidents, etc.). Participation by individuals in director-level roles, including senior or executive directors, is notably lower in 2024. Some of this shift may be due to the emergence of formation programs designed for mid-level lead-
ers. The data from the formation survey revealed the emergence of mid-level leader formation as a major area of activity for mission and formation leaders.2
CURRICULUM CONTENT
The program content remains relatively stable. Similar to the 2016 figures, programs today focus on vocation and calling, tradition and heritage, mission and values, Catholic social tradition, spirituality and ethics. In 2024, we added discernment as an option, and nearly all systems confirmed this as a content topic. Other content areas consistently reported by most systems in both years include leadership style and holistic care. Suffering and diversity also appeared as topics by half of the surveyed systems. Content related to Church relations dropped by nearly half from 2016 to 2024, from 88% to 46%. Relatedly, there was a slight drop in sponsorship, from 88% to 73%. Catholic social teaching experienced a modest decline from 94% to 82%. This is puzzling, and the ministry should aim for 100% when this study is repeated at a future time. The rationale is that the Catholic social tradition is the very bedrock of the healing ministry. All of our operations stand in service to realizing and giving life to the principles expressed in the social tradition. In other words, Catholic health care is a leading character in Catholic social practice and is precisely the work of the healing ministry. Much of the social tradition presents alternative views to that of the prevailing consumeristic and capitalistic culture. As such, efforts to renew leaders with the ideals and virtues of the social tradition must not tire. The social tradition continues to grow in response to the signs of the times, and thus, we must continue to form, reflect and pray with the richness of the Catholic social tradition. Our healing ministry draws from this social tradition, and related to that is a response to human suffering, both at an individual and at a social level. The recent data from members show that
Much of the social tradition presents alternative views to that of the prevailing consumeristic and capitalistic culture. As such, efforts to renew leaders with the ideals and virtues of the social tradition must not tire.
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just under half of the ministries reflect upon suffering in their programs. Ministries should consider ways to create opportunities to reflect individually and as a group on the experiences and perceptions of suffering. Moreover, our commitments to the poor and vulnerable require a special sensitivity to the suffering of others. Pope Leo XIV’s first major teaching, Dilexi Te, on love for the poor, exhorted the worldwide Catholic community to see and respond to the suffering of the poor and innocent.3 Ministry formation programs are a prime place and opportunity to heed the pontiff’s urging.
KEY OUTCOMES
In the recent study, nearly all systems report incorporating the key outcomes articulated in CHA’s framework for senior leadership formation. This document lays out four indicators that “point to characteristics identified in those who have completed the formation programs.”4 Outcomes recognized in these leaders include: 1) Engages and inspires leaders in their ongoing growth; 2) integrates, articulates and implements the rich tradition of Catholic health care; 3) strengthens and transforms leaders, the organization and community; and 4) grounds leaders in the foundational values of the ministry. Members’ responses reflect ministry-wide adoption of CHA’s work on identifying indicators of the value of formation and mission. In addition to these outcomes, CHA’s recent efforts with members have also identified other qualitative and quantitative indicators of the impact that formation has on both individuals and the organization. Case examples are included in CHA’s new resource, “Demonstrating Formation’s Impact: A Perspective for the Catholic Health Ministry.”5
CONCLUSION
These data give the healing ministry much to celebrate! Senior leadership formation programs, in particular, are gifts from the sisters who founded Catholic health ministries. They insisted that executive leaders experience some programmatic formation. Usually that entailed a group of leaders meeting in-person with facilitators experienced in the Catholic tradition at a retreat center, for a designated period. An intended outcome was to equip and embolden leaders to integrate and apply key aspects of Catholic identity into their
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leadership, operations and strategy with personal and professional integrity, regardless of the leader’s own faith tradition. These data show us we are doing just that, and there’s no question of the enduring importance of formation programs tailored to senior leaders to allow organizations to flourish. They have served as an indispensable engine for Catholic health ministries amid the swirl of changes through the years. We cannot overemphasize that these programs are a beginning, a jumping-off point. The Catholic tradition has always held the view that formation includes an intense initial experience that prepares an individual for a ministry or a way of life, and then the formation continues. The foundational formation programs described in the data summarized here underscore the enduring efficacy and enthusiasm for a unique way of showing up as a leader in health care that expresses itself as a ministry perpetuating Jesus’ healing love. DARREN M. HENSON, PhD, STL, is senior director of ministry formation at the Catholic Health Association, St. Louis. NOTES 1. Darren M. Henson, “Findings From CHA Survey: Formation Reaches Deeper Into Ministries, Increases Demand for New Resources,” Health Progress 106, no. 4 (Fall 2025): https://www.chausa.org/health-progress/ archives/fall-2025/findings-from-cha-survey-formation-reaches-deeper-into-ministries--increasesdemand-for-new-resources. 2. Henson, “Findings From CHA Survey.” 3. Pope Leo XIV, Dilexi Te, The Holy See, October 4, 2025, https://www.vatican.va/content/leo-xiv/en/apost_ exhortations/documents/20251004-dilexi-te.html. See also Valerie Schremp Hahn, “Q and A: CHA’s Darren Henson Explores What Pope Leo’s Dilexi Te Means for Those in Catholic Health Care,” Catholic Health World, October 21, 2025, https://www.chausa.org/newsand-publications/publications/catholic-health-world/ archives/october-2025/q-and-a--chas-darren-hensonexplores-what-pope-leos-dilexi-te-means-for-those-incatholic-health-a. 4. Framework for Senior Leadership Formation (Catholic Health Association, 2011), 19. The enumerated outcomes are not intended to be exhaustive. 5. “Demonstrating Formation’s Impact: A Perspective for the Catholic Health Ministry,” Catholic Health Association, https://www.chausa.org/DemonstratingImpact.
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T H I N K I N G G L O B A L LY
EMBRACING GLOBAL UNITY FIRST IN A ‘WHAT’S IN IT FOR ME’ WORLD “In a divided and troubled world, the Holy Spirit teaches us to walk together in unity.” 1 — POPE LEO XIV
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atholic health institutions in every corner of the world serve as beacons of hope, compassion and healing. From urban hospitals to remote rural clinics, the healing ministry continues to respond to the needs of communities with special attention to the most vulnerable. As global health challenges grow more complex and interconnected, the global realities provide us with an opportune time to reexamine our strategy and respond appropriately. The U.S. government has taken a different approach to global health and development under the current administration. This new approach began in January 2025 with the dismantling of the U.S. Agency for International Development (USAID) BRUCE and much of our U.S. foreign development assistance. This COMPTON shift has consequences that are important to us as Americans and as Catholics. According to an analysis published in the medical journal The Lancet, from 2001 to 2021, USAID-funded programs prevented nearly 92 million deaths across 133 countries, including more than 25 million deaths from HIV/AIDS. The researchers went on to estimate that more than 14 million people could die over the next five years because of the dismantling of USAID.2 The ongoing global realities and the U.S. change in strategy have opened the door for other nations to follow with reductions in their health and development funding. More recently, the State Department’s “America First Global Health Strategy” was released in September 2025. A recent editorial in BMJ argued that “The title openly clashes with long-established global health values of multilateralism and international cooperation.”3
BUILDING TRUST, OPENING DOORS
As a result of these ongoing shifts in global health,
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humanitarian aid and development, CHA and our Global Health Advisory Council have had conversations with leaders from around the world, including Catholic health care, bishops’ conferences, dioceses, nongovernmental organizations (NGOs) and academia. The dialogues have reiterated Pope Leo’s assertion from the quote noted earlier that we should “walk together in unity,” and that “America First” doesn’t make sense as a global health strategy for the universal Church. While there are many opportunities for future collaborations, one specifically identified was the need for more conversation, collaboration and coordination among Catholic health leaders and partners worldwide. The power of ongoing dialogue and connection among Catholic health leaders is already bearing fruit. Consider the example of a recent visit facilitated by CHA, where a Tanzanian priest engaged with multiple U.S.-based partners to discuss strategies to continue meeting the needs of his community, despite recent shifts in global health support. Through introductions and support from CHA, he is now exploring partnerships with: Hospital Sisters Mission Outreach for supply chain support. World Telehealth Initiative for physician and nursing assistance. A philanthropist for improvements to water, sanitation and hygiene (WASH) in health care facilities. On the WASH front, a conversation has led to a funder’s promise of a grant commitment to the
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Tanzanian Episcopal Conference (the assembly of Catholic bishops in Tanzania). This funding will launch a circuit rider pilot program, providing human resources and financial support to assess WASH needs and offer formation for staff and communities across a diocesan network of health facilities. Another example stems from conversations involving the same priest and a former regional CEO of a U.S. Catholic health system. This introduction led to a tentative agreement for this former executive to support the Tanzanian Episcopal Conference with an initial site visit, and potentially long-term assistance in project management and assessment of their 400-plus health institutions. More such stories have unfolded from Catholic Relief Services, Catholic Medical Mission Board, Hospital Sisters Mission Outreach and the ministries of Catholic health systems in the U.S. and around the globe that underscore the transformative potential of regular convenings and sustained dialogue. As we engage with these health leaders, we recognize these connections are not isolated. They result from intentional, ongoing conversations that build trust and open doors. We also recognize that the Global South is not merely a recipient of aid, but an important driver of innovation and resilience now and into the future.
A VISION FOR GLOBAL SOLIDARITY
Based on these examples and ongoing conversations, nearly all involved in the global Catholic health ministry agree: The time has come for Catholic health leaders worldwide to unite both intentionally and consistently across borders, cultures and disciplines to sustain and strengthen the global Catholic health mission entrusted to us for more than two millennia. It is time for us to envision a global Catholic forum for health and healing to elevate human dignity and bring unity to our response to the rapidly changing environment. At its heart, we believe we should bring together a forum/collaborative of Catholic health leaders committed to: Global solidarity and collaboration by building relationships across continents to share resources, innovations and best practices. Ethical leadership by representing Catholic values in global health forums and advocating for equitable, person-centered care.
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Capacity strengthening through offering train-
ing, technical assistance and leadership development tailored to diverse contexts. Knowledge exchange and research by promoting evidence-based practices informed by Catholic social teaching. Mission integration and spiritual support by creating space for reflection, spiritual renewal and alignment with the Church’s healing mission. From what we have heard, this should not be merely a professional network, but a community united by a shared commitment to serve the sick, the poor and the marginalized.
WALKING TOGETHER IN UNITY
There is a vibrant tapestry of potential collaborators for this type of community. They include national and regional Catholic health associations, Christian health associations that cooperate with Catholic bishops’ conferences, health ministries of bishops’ conferences, Catholic universities and research centers, Catholic health training institutions, Catholic NGOs and the many partners with whom these organizations cooperate to live out our shared mission. A broad network would reflect the global reach and depth of the Catholic health ministry. By providing space for dialogue and collaboration, we can “walk together in unity” as we harness our collective wisdom and resources to respond to changing realities and share opportunities to address ongoing health challenges.
EMBRACING MISSION THROUGH COLLABORATION
As Catholic health leaders, we are stewards of a rich legacy of compassion, justice and unwavering commitment to every person’s dignity. The current global reality provides a renewed reason to continue building on that legacy together, forging new pathways of solidarity and service. Let us not wait for the next crisis to compel our unity. As the new U.S. global health strategy points out, the challenges before us are too significant for any nation or ministry to face alone. Let us choose collaboration now, inspired by the Gospel and guided by the Spirit. The future of Catholic health ministry depends on our willingness to come together regularly, intentionally and faithfully to continue Christ’s healing work in our world. CHA’s Global Health networking calls have
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shown what is possible when we unite in dialogue and solidarity. While it is not the long-term solution, as a first step, we invite colleagues from the U.S. and worldwide to join these conversations and continue the journey that Jesus began.
TIME IS NOW FOR CONNECTING, COLLABORATING
The world needs our witness more than ever. However, as noted in this column’s title, it shouldn’t be “What’s in it for me?” It should be “What’s in it for us?” As Pope Leo said, let’s “walk together in unity” to heal our divided and troubled world. Reach out to Bruce Compton at bcompton@chausa.org to provide insights or to join the conversation on how Catholic health can further uphold Catholic social teaching in its global health initiatives. BRUCE COMPTON is senior director, global health, for the Catholic Health Association, St. Louis. NOTES 1. Pope Leo XIV, “Homily of the Holy Father Leo XIV,” The Holy See, June 7, 2025, https://www.vatican.va/content/leo-xiv/ en/homilies/2025/documents/20250607veglia-pentecoste.html. 2. Daniella Medeiros Cavalcanti et al., “Evaluating the Impact of Two Decades of USAID Interventions and Projecting the Effects of Defunding on Mortality up to 2030: A Retrospective Impact Evaluation and Forecasting Analysis,” The Lancet 406, no. 10500 (2025): https://doi.org/10.1016/ S0140-6736(25)01186-9. 3. J. Stephen Morrison and Lawrence Gostin, “Promise and Gaps in America First Strategy for Global Health,” BMJ 391 (2025): https://doi.org/10.1136/bmj.r2088.
AI Ethics in Catholic Health A conference sponsored by the Center for Theology and Ethics in Catholic Health and the Institute for the Liberal Arts at Boston College
MARCH 20-21, 2026, AT BOSTON COLLEGE
The “Artificial Intelligence, Authentic Mercy: Navigating AI Ethics in Catholic Health” conference will bring together physicians, nurses, health care administrators, biomedical engineers, technologists, theologians and ethicists to explore the opportunities and challenges presented by AI in Catholic health care settings. The goal is to ethically analyze AI in health care through the lens of Catholic moral teaching and theological ethics. THEOLOGYANDETHICS.ORG/EVENTS
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COMMUNITY BENEFIT
HOW COMMUNITY BENEFIT SERVES AS A LIVING EXPRESSION OF CATHOLIC HEALTH’S MISSION AND COMMITMENT
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hile many in Catholic health care are familiar with our Catholic social teaching and the ways it is embedded in the care that we provide, these Catholic social teachings are also the central tenets of our community benefit programs and activities.
The origin of community benefit dates to the establishment of Catholic health care in the United States, back to the 18th and 19th centuries, when religious women and men — often immigrants themselves — responded to the urgent social and health needs of NANCY their communities, especially for ZUECH LIM those experiencing poverty and marginalization. Over the years, they established hospitals, clinics and social service agencies. Their work was driven by faith and a profound sense of justice. During CHA’s Community Benefit 101: Planning and Reporting Nonprofit Hospital Community Benefit virtual training this past fall, Sr. Teresa Maya, CCVI, senior director of theology and sponsorship at CHA, elevated the mission imperative of community benefit and called on us to remember our “Why”: why our organizations were founded and why as leaders in Catholic and nonprofit health care we are called to serve. Sr. Maya shared that the “Why” of community benefit is based in mercy, with Jesus as healer. His work and actions help others in response to the needs around him. Sr. Maya shared that mercy is the very heart of community benefit.1 From the actions of seeing a need and responding came our community benefit mission to care and commit to our communities. This expression of our mission, which is also based in our Catholic social teaching, came long before the federal policy requirements for tax-exempt hospitals, and is the “Why” of community benefit.
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MERCY AND VALUES IN ACTION
In articulating the mission imperative of community benefit, Sr. Maya shared the vision and commitment of community benefit activities:2 Cherish the dignity of all people by improving access to health care for all individuals, regardless of race, gender, culture or economic status. Promote the common good by addressing social conditions, such as housing, education, employment and the environment. Prioritize people and populations that experience vulnerabilities, ensuring that those most in need receive appropriate care and support. Steward resources responsibly, using them where they are most needed and most effective. Advocate for justice, working to eliminate disparities in health outcomes and access. Care for the whole person, recognizing the complexity of health and designing programs that include prevention, education and holistic services. Work in solidarity with communities, building trust, listening deeply and sharing decisionmaking. These commitments are grounded in Catholic social teaching and are universal among nonprofit health care. These principles are not just aspirational; they are operational and actionable. They are the bedrock that guides the assessment of community health needs, develops responses, implements programs and evaluates their impact. These actions demonstrate a profound commitment to human dignity, the common good and a preferential option for individuals experiencing
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poverty and other vulnerabilities. Community benefit is a living expression of mercy and the values that have guided Catholic health care for centuries.
STORIES OF IMPACT
Across the country, Catholic and other nonprofit health care organizations demonstrate their mission and commitment through community benefit activities and programs.3 They are investing in community health needs assessments, forming TRANSFORMATIVE PRACTICES At the heart of community benefit is a commitment partnerships with public health and communityto the dignity of every person. Catholic and other based organizations,4 and developing innovative nonprofit hospitals are concerned with the health programs that address acute needs and the root of all people in their communities and consider causes of illness. They are also advocating for systhe whole person, including their physical, emo- temic change, recognizing that health is shaped by tional, social and spiritual needs. Understanding policies, institutions and social norms.5 that how well and how long we live is impacted by An example of working in solidarity by resocial factors, including policies and community sponding to identified community health needs is structures, community benefit extends beyond a new health center in Fort Lauderdale, Florida, the walls of hospitals and clinics, seeking out all developed in response to community members in need and working for the common good. Com- wanting more access to health and social servicmunity benefit programs seek to address barriers es. The new health center includes exam rooms, a to health and well-being, and those engaged in the teaching kitchen, a laboratory, a pediatric therapy work advocate for policies and practices that pro- center, office space for community health workmote health equity so all may flourish. ers, and classroom and meeting spaces. The cenThere are four transformative practices that ter’s plans include addressing workforce supare key to community benefit’s success: humility, ports, financial empowerment, support groups solidarity, patience and trust. Sr. Maya described for seniors and domestic violence survivors, and other groups for caregivers and patients with chronic dis“These are practices that take a eases and conditions.6 lifetime, practices that need friends, Another example is the support of respite centers, with a and practices that need faith. … Faith in focus on supporting patients who are experiencing homethe human friend and faith in the human lessness. 7-9 These centers, future and faith that what we do can created through partnerships with other organizations, fill a make a difference.” gap in our communities, pro— SR. TERESA MAYA, CCVI viding a safe and caring place for recovery after discharge. these practices and encouraged us to seek what These examples, along with the numerous is ours to do. In addition to assessing the needs, community benefit programs, demonstrate mercy community benefit involves looking also for what and our commitment to care for our communiis working and can be built upon. It is important to ties. Community benefit programs are the modern acknowledge the need to work in partnership with embodiment of this mission, addressing not only our communities, each other and other organiza- medical needs but also the social determinants of tions. We need to have patience for the programs health that shape lives and communities. and the impact to unfold. We also need to trust each other and be trustworthy for the benefit of CHALLENGES AND OPPORTUNITIES our communities. Community benefit has its challenges and is also a As Sr. Maya said during the session, “These are great opportunity. “Community benefit typically practices that take a lifetime, practices that need falls outside the core business of most health care friends, and practices that need faith. … Faith in delivery organizations,” explained Sr. Maya durthe human friend and faith in the human future ing her presentation, “and moves beyond acute and faith that what we do can make a difference.” and episodic care of individuals who are sick.”
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However, she explained, community benefit is an opportunity. The programs and activities provide a space to “reorient the organization to its core mission and to improve the health of all people in the community.”10 As Catholic and other nonprofit health care organizations move forward, the mission of community benefit remains a guiding light. It calls leaders to be bold, compassionate and innovative. Its mission challenges health care organizations to look beyond their walls and engage with the broader social fabric. And it reminds us that health is not just a personal issue; it is a communal one.
A MISSION TO SERVE, HEAL AND UPLIFT
In a time of rapid change and persistent disparities in how well and how long people live, community benefit offers a hopeful vision for the future. It affirms that every person deserves to be seen, heard and treated with care. It insists that health care must be rooted in justice and love. And it invites us to build a future where all people can flourish. Community benefit is the living expression of Catholic and other nonprofit health care’s mission to serve, heal and uplift. Grounded in mercy, guided by values and focused on the future, it represents their commitment to the health and wellbeing of all. As Sr. Maya shared, “Community benefit reminds us why nonprofit health care exists, where care for all is the reason we were founded.” NANCY ZUECH LIM, MPH, BSN, is director of community health improvement for the Catholic Health Association, Washington, D.C. NOTES 1. Sr. Teresa Maya, “A Mission to Care: A Commitment to Community” (presented at CHA’s Community Benefit 101: Planning and Reporting Nonprofit Hospital Community Benefit virtual conference, October 21, 2025). 2. “A Mission to Care: A Commitment to Community—Community Benefit,” Catholic Health Association, https://www.chausa.org/docs/default-source/ community-benefit/cha_cb_missiontocare_1-sheeter. pdf?sfvrsn=241007b_1. 3. Julie Minda, “CHA and AHA Jointly Release Analysis on Ways Nonprofit Hospitals Benefit Their Communities,” Catholic Health World, April 11, 2025, https://www.
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chausa.org/news-and-publications/publications/ catholic-health-world/archives/april/cha-and-ahajointly-release-analysis-on-ways-nonprofit-hospitalsbenefit-their-communities. 4. Julie Minda, “Pacific Northwest Collaborative Formed to Assess Community Need Explores How Best to Jointly Address That Need,” Catholic Health World, August 12, 2025, https://www.chausa.org/news-andpublications/publications/catholic-health-world/ archives/august-2025/pacific-northwest-collaborativeformed-to-assess-community-need-explores-how-bestto-jointly-address-that-need. 5. “Social Determinants of Health,” Office of Disease Prevention and Health Promotion, https:// odphp.health.gov/healthypeople/priority-areas/ social-determinants-health. 6. Valerie Schremp Hahn, “‘Everybody Deserves the Best’: Holy Cross Family Health Center Opens in Underserved Fort Lauderdale, Florida, Neighborhood,” Catholic Health World, August 26, 2025, https://www.chausa.org/news-and-publications/ publications/catholic-health-world/archives/ august-2025/everybody-deserves-the-best-holy-cross-family-health-center-opens-in-underservedfort-lauderdale--florida--neighborhood. 7. Julie Minda, “Respite Center Provides Solution for Homeless Patients Discharged from Denver-Area Hospitals,” Catholic Health World, January 13, 2025, https:// www.chausa.org/news-and-publications/publications/ catholic-health-world/archives/january-2025/respitecenter-provides-solution-for-homeless-patientsdischarged-from-denver-area-hospitals. 8. Nancy Fowler, “Medical Respite Facility Supported by Sisters of Charity Prepares for Aging Population,” Catholic Health World, December 26, 2024, https:// www.chausa.org/news-and-publications/publications/ catholic-health-world/archives/december-2024/ medical-respite-facility-supported-by-sisters-ofcharity-prepares-for-aging-population. 9. Nancy Fowler, “Oklahoma City Respite Facility Ensures Care for Unhoused Patients After Discharge,” Catholic Health World, January 22, 2024, https://www.chausa. org/news-and-publications/publications/catholichealth-world/archives/january-2024/oklahoma-cityrespite-facility-ensures-care-for-unhoused-patientsafter-discharge. 10. Sr. Maya, “A Mission to Care: A Commitment to Community.”
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SERVICE
Life’s Living Toward Dying A Prayer for Grace as We Age
FR. CHARLES BOUCHARD, OP, STD, SENIOR FELLOW AND CONSULTANT FOR AQUINAS INSTITUTE OF THEOLOGY
INTRODUCTION In 1904, Lucile Randon was born in southern France. After various kinds of work, she entered the Daughters of Charity as Sr. André. She did spiritual and mission work till her retirement in 1979, but even then, she continued to care for her fellow elderly sisters. When she died in 2023, she was just days short of her 119th birthday and was, at that time, the oldest person in the world. If that isn’t a story of graceful aging and longevity, I don’t know what is! The Scriptures are full of stories about aging and longevity. Moses is reputed to have lived to 120, and Methuselah to 969. The Hebrew Scriptures generally see aging as a reward for a virtuous life. Proverbs, for example, says “Gray hair is a crown of glory; it is gained by a life that is just.” (Proverbs 16:31) It also says “For by me your days will be multiplied and the years of your life increased.” (Proverbs 9:11) We often refer to our latter years, when we are relieved of the burden of work and can enjoy our time, as our “golden years.” These are beautiful sentiments, but as I grow older myself, I sometimes have doubts. Old age, after all, is full of challenges, and we don’t always see longevity as a blessing. Age brings diminished physical and mental capabilities, and for some it brings isolation and loss of friendships and family members, leaving us only with our memories. Clare Boothe Luce, writer
and politician, once quipped later in life that she was in her anecdotage, the time of her life when she could remember and share many old stories, but not much else! We tend to associate old age with death, and today we have ways of dealing with death. Euthanasia, assisted suicide and “medical assistance in dying” have become much more common. Clearly, we don’t see longevity as an unalloyed blessing. We are living much longer than previous generations. We may have 15, 20 or even 30 years of life after retirement. What do we do with that time? Can we accept aging (and the prospect of death) with gratitude? Can we claim it as a blessing or is it a burden? Can we, like Sr. André, continue to serve others even as we age? PAUSE, REFLECT AND PRAY I searched Scripture to find passages that were helpful to me in thinking about my own longevity, whatever it might look like. There were two passages I particularly liked, which have inspired me to write this simple prayer: Assume a contemplative, comfortable posture, perhaps with your eyes closed. Take time to let everything drift out of your head. Begin a steady rhythm of soft breathing. Then, review the signs of your own
aging, good and bad. Reflect on past losses, mistakes and misfortunes, but don’t let them take control. Reflect on all you have to be grateful for. Then, slowly read and repeat one of the following passages: “For I know well the plans I have in mind for you — oracle of the Lord — plans for your welfare and not for woe, so as to give you a future of hope.” (Jeremiah 29:11) “We know that all things work for good for those who love God, who are called according to his purpose.” (Romans 8:28) Then, pray: God of life, You have brought me thus far. I thank You for the gifts of the life I am living, for my friends, my vocation and my family. I know Your plan for me includes losses and diminishment, but I ask for the faith to accept them as I bind myself more closely to the suffering of Christ and to that of the many faithful souls who have preceded me. Help me to offer my remaining years as a prayerful gift to You, and to serve others to the extent that I am able. Let me be a sign to others of Your faithfulness and hope. Above all, let me, like Sr. André, be grateful. Amen. NOTE I have borrowed this title from Vigen Guroian’s wonderful reflection on life and death, Life’s Living Toward Dying (Wm. B. Eerdmans Publishing Co., 1996).
“Prayer Service,” a regular department in Health Progress, may be copied without prior permission.
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SUPPORT FOR PALLIATIVE CARE LEADERS CHA is partnering with the Center to Advance Palliative Care (CAPC) for a webinar series that aims to support palliative care leaders by providing high-level training in the following areas: Feb. 2, 2026
Ensuring the financial sustainability of palliative care programs
April 16, 2026
Understanding what matters most to patients and families EXCLUSIVE TO CHA MEMBERS VISIT CHAUSA.ORG/PALLIATIVECARE
Foundations
of Catholic Health Care Leadership JANUARY 29 — MARCH 19, 2026
Foundations Live is an interactive eight-week engaging virtual program with sessions each Thursday from 1–3:30 p.m. ET.
DESIGNED FOR LEADERS LIKE YOU!
The purpose of Foundations Live is to equip new and current leaders with a solid grounding in the Catholic identity of the health ministries they serve. The program helps leaders understand their essential role in advancing the healing mission of Catholic health care and offers opportunities to articulate and integrate the distinctive aspects of Catholic health care across operations, in service to the needs of patients, families, communities and the common good.
Register at chausa.org/foundationslive