Care of the aging, particularly widows, is one of the earliest tasks of the church and was identified as a marker of “pure and undefiled religion” in the book of James (1:27). Responding to this expectation, the church has faithfully served marginalized seniors for centuries and remains the inspiration for senior ministry today.
The Presbyterian Church has been a leader in ministry to seniors, and the impact of the combined work of Presbyterian-related organizations in the United States is both historic and significant. The sheer size of the Presbyterian footprint in senior care is impressive. Five of the 20 largest nonprofit senior care providers in the United States are Presbyterian-related, and 16 of the top 100 share Presbyterian roots. The geographical reach is also wide, with multifaceted organizations in Pennsylvania, Minnesota, Florida, Ohio, California, New Jersey, North and South Carolina and many other states. Presbyterian Senior Living, headquartered in Dillsburg, Pennsylvania, is part of this family of ministries. How did this remarkable growth occur? What was needed from those involved to make it happen and to sustain it? What were the greatest challenges in the growth of this ministry and what challenges remain today? The Presbyterian Senior Living story provides some insight into these questions.
From acorns into oaks
Like many of our sister organizations in senior services, the Presbyterian Senior Living ministry began small and grew to meet the changing needs of older persons. Bill Swaim, the first executive of Presbyterian Homes, described this phenomenon as “growing from acorns into mighty oaks.” The founders of Presbyterian Homes (now Presbyterian Senior Living) came together because of an unmet need in the days before Social Security, Medicare and other welfare programs. It was a time when being old, single and poor meant that life was very hard. Seeing such hardship inspired the founders to take action to meet this challenge. Ellen Parker, a wealthy Presbyterian woman, turned that dream into reality with the donation of her summer home, a working farm near Carlisle, Pennsylvania.
The first residents of our original location were all widows and single women with no family support. Their average age was in the early 70s.
In the years that followed, other locations were added. The operating concept was simple: small homes for persons with housing needs and limited physical restrictions. The byline on our letterhead was descriptive: “small scattered, homelike homes for the aging.” This would now be described as a “small house” model. Each location provided care for approximately 24 residents in a large homelike building in a residential neighborhood. Most were located in small communities and were within walking distance of the post office and local stores. From one location in a single presbytery, the organization eventually extended its territory to 10 presbyteries in Pennsylvania, Maryland, Delaware and Ohio.
Responding to the call
My personal story is a bit unusual in that I came to Presbyterian Homes through the Presbyterian Church (U.S.A.) mission office in New York. My wife Rhonda and I were originally looking for an opportunity to serve in a medical mission. As nurses, we thought our skills might be needed in Central America or a foreign field. When we received a response to our letter of interest, the mission office expressed an appreciation for our willingness to serve, but informed us that there were no suitable openings for us at the time. Unbeknown to us, someone in the personnel department of the PC(USA) office had been a seminary classmate of Al Schartner, Bill Swaim’s successor as the executive of Presbyterian Homes, and forwarded our information to Presbyterian Homes. We could not figure out how these people in Pennsylvania were able to track us down in Michigan, but they were persistent. Eventually we moved to Lancaster County, Pennsylvania, to serve in their first skilled nursing center. Responding to a call to Central America led to a ministry working with seniors in Central Pennsylvania. Looking back on it, it was a great example of a connectional church in action.
Over the years the needs of seniors changed rapidly. When I joined Presbyterian Senior Living in 1971, we had one skilled nursing location with 17 residents. The remainder of the approximately 350 residents served by Presbyterian Senior Living still resided in small personal care homes. The only exception to that model was Presbyterian Apartments in Harrisburg, a 23-story building with 165 apartments. Starting in the 1970s and 1980s, the expansion of skilled nursing and continuing care retirement communities changed the revenue stream. Middle-income (and sometimes upper-income) seniors were welcomed into the Presbyterian Senior Living family, but philanthropy was still required as charitable care costs were increasing and the ministry continued to grow.
From the 1920s to the 1960s, the overwhelming majority of the budget was supported by philanthropy. I am told that there was even a line in the budget that was labeled “anticipated bequests” (proceeds of estates of people who had not died yet that were needed to balance the budget). Nearly all of the persons served in these ministries needed financial support. We also began with a pledge that no one would ever have to leave Presbyterian Senior Living because they could not pay for the care they needed — a pledge that has endured to the present day. Growth included the affiliation of other groups with histories that predated Presbyterian Senior Living family. The Easton Home (1890), The Long Community (1903), Quincy United Methodist (1903) and the Presbyterian Homes in the Presbytery of Huntingdon (1924) joined their rich histories with Presbyterian Senior Living.
Presbyterian Senior Living’s 90+ year history is also marked by a number of significant achievements beyond the normal service to individual seniors. As a founding member of the national association of not-for-profit senior care providers (LeadingAge) and its state affiliate (LeadingAge PA), Presbyterian Senior Living has contributed significantly to the development of the field of aging services. In the late 1950s and early 1960s, the very first educational programs in long-term care administration were held in Dillsburg. Over 1,100 persons from 45 states and 5 foreign countries came to Pennsylvania to learn about the best ways to serve older adults. For the past 13 years, the monthly publication, Reflections on Leadership, has been a continuation of PSL’s commitment to contribute to a wider leadership audience beyond our own organization.
In more recent years, Presbyterian Senior Living’s growth reflects an increase in number of locations and the range of services needed. Specifically there has been increase in independent living options to include moderate income and market rate rentals, adding approximately 1,100 of these of living units in the past few years. The goal has been to provide a balance of services across the entire economic spectrum. We call this balance the “anybody’s mom” approach — there should be room in the Presbyterian Senior Living family to meet the needs of anyone’s mom, regardless of financial status. This has created a system of affordable housing and services, charitable care in skilled nursing and assisted living, market rate apartments and full service continuing care retirement community campus locations that comprise Presbyterian Senior Living’s 31 locations. Staff has grown to nearly 3,000 persons with a wide range of skills and abilities to meet the increasingly complex needs of seniors.
The road forward
The challenges to sustaining current operations and continuing to grow include:
- Funding the increasing charitable care needs of the persons we serve.
- Securing support services for persons in independent living with limited incomes that will assist them to age in place.
- Engaging and sustaining a competent and compassionate staff to the staff to carry out the mission of the organization every day, in a highly competitive labor market.
- Marshaling public support for housing and services to low-income seniors, a group that is expected to grow exponentially in the near future.
- Finding the next generation of leadership to continue to grow into the future — not just any willing person, but smart, dedicated, compassionate persons who respond to the call to ministry.
- The projected growth in the senior population and the high percentage of older persons within Presbyterian congregations would suggest that Presbyterian-connected senior care organizations will need to lead the way through challenging times.
The story of Presbyterian Senior Living is distinctive, but not entirely unique. Our sister agencies throughout the country, all governed by volunteer board of trustees and directors, continue to serve seniors in the name of the Presbyterian Church. This is a legacy of care and compassion that will endure for generations into the future.
Steve Proctor is CEO of Presbyterian Senior Living in Dillsburg, Pennsylvania.