The Mission Field We Don’t Think About

“The doctors told me I got the cancer,” Margaret whispered in her thick, rural Pennsylvanian accent during prayer time. She was a longtime attendee of the nursing-home church service I helped lead; I’d had the privilege of walking alongside her these past few years. I prayed with her weekly while proclaiming God’s Word to the 25 residents. Even as her weight dropped and her mobility deteriorated, Margaret’s steely-eyed attentiveness to my preaching remained unwavering.

A few weeks ago, as I unpacked my guitar and unfurled the bulletins for the service, a resident entered the room and casually informed me Margaret had died. Over the several years I’d known Margaret, I’d never seen anyone visit her. It’s likely her death will remain largely unnoticed, without a funeral or obituary. There’s also a good chance no one besides me prayed with her, placed a hand on her shoulder to comfort her, or preached to her the hope of Christ as her earthly life slowly waned.

What I provided Margaret was little more than a few brief prayers and a simple sermon each week. She deserved much more. But at least she could gather weekly with other Christians in worship, if only for an hour or two. The tragedy is many nursing home residents in America have far fewer opportunities in their waning years to pray with other believers and hear the Word of God.

Dying Alone

It’s been 23 years since sociologist Robert Putnam chronicled America’s declining relational networks in his book Bowling Alone. As the first “bowling alone” generation now enters nursing homes and assisted-care facilities, they do so with fewer loved ones to support them and fewer churches to close the gap. They’re dying alone, and few Christians are doing anything about it.

When I discuss the need for Christians to minister in care facilities, most people are unaware of how bad the situation is. Many picture large facilities with clean, private rooms and resident chaplains paid to provide pastoral care. Such facilities are outliers. Average nursing homes have 109 beds and suffer periodic staffing shortages. They have no chaplains or pastoral staff. Many facilities I’ve ministered in look more like prisons than homes, with the stench of urine permeating every floor. They rely exclusively on volunteers, with overworked nurses required to find and coordinate them. Many facilities have no Christian activities unless churches visit.

A recent report from the National Imperative to Improve Nursing Home Quality chronicles the dire conditions. There are “huge gaps in the quality of care.” The list of ailments seems ripped from the pages of an Upton Sinclair novel. The Centers for Medicare and Medicaid Services—responsible for sanctioning and monitoring nursing homes—reported a staggering range of deficiencies: 45 percent of homes were deficient in infection control, 42 percent in food sanitation, 34 percent in quality of care, and 20 percent in treating residents with dignity. Such conditions contribute to increased rates of poor health outcomes, such as loneliness and suicide.

In America, 21 percent of all deaths occur in nursing homes and long-term care facilities. Thousands each year are consigned to live out their last years in isolating, impoverished, and sometimes dangerous environments. One would think such data would spark a litany of newspaper exposés and Senate hearings. But despite the issues being well documented for decades, little has changed. They remain largely invisible to the public—just as Margaret’s death remains largely invisible outside the walls of her facility.

Thousands each year are consigned to live out their last years in isolating, impoverished, and sometimes dangerous living environments.

How did we reach this point? How did we as a society grow numb to the millions of Americans we place in cramped, hospital-like “homes” to end their days with no assurance they’ll receive any care beyond essential medical services? How have churches accepted that millions of Americans—including many brothers and sisters in Christ—spend their dying days far from their churches and with few opportunities to pray and hear Scripture preached?

Acute Problems

The history of the modern nursing home and related facilities is complex; their existence stems from a legion of philosophical, social, economic, and political factors. Two are particularly important for Christians, for they’re issues the church too often reflects rather than combats.

1. Problem of Value

Our society tends to equate productivity with worth. According to theologian Thomas Reynolds, our culture defines personhood according to “the ability to produce and purchase.” Conversely, those who can’t make money have little worth. Such persons are, at best, sidelined from society—and at worst, dispensed of entirely. This is clear in how our society treats the unborn, those with Down syndrome, and the infirm elderly.

Our society tends to equate productivity with worth.

While consistent in opposing abortion and assisted suicide, many American Christians still fall into the trap of equating productivity with worth. In my experience in church planting, I’ve seen a fixation on reaching “the next generation” of leaders and culture shapers. New church plants often target young professionals migrating to large cities, which isn’t wrong—but energy isn’t expended to reach those on the margins.

2. Problem of Relationships

Americans have fewer friendships than in decades past. Putnam’s Bowling Alone cites loss of membership in a variety of organizations, from fraternal clubs to bowling leagues. Declining family bonds have continued to multiply relational woes. Fewer Americans are getting married or having kids. This relational decline has been so coupled with drastic increases in loneliness and depression that the surgeon general recently declared a “loneliness epidemic.”

The steep rise of adults without children is particularly alarming since, for a large portion of those in physical and mental decline, their children often become their primary caretakers. They help aging parents navigate complex systems of care facilities and the chaos of Medicare and medications. Without children or strong community relationships, most nursing home residents will spend the last years of their lives with no visitors.

Journalist Paula Span recently wrote about the increase in “kinless” seniors (those over 55 with no living spouse or children). There are close to a million kinless Americans, a number bound to rise with the decline in marriage and birth rates. One senior adult told Span, “My social life consists of doctors and store clerks—that’s a joke, but it’s pretty much true.” In my experience, a large portion of residents have similar, if not even smaller, social networks.

Without children or strong community relationships, most nursing-home residents will spend the last years of their life with no visitors.

Sadly, Christians tend to mirror these trends rather than combat them. At a recent pastors’ gathering, a friend admitted his church revised their definition of a “committed” member to one who attends Sunday worship every six weeks. Other pastors described their inability to offer midweek Bible studies and Christian education courses due to lack of interest. Without frequent opportunities to connect, the church is no longer where Christians establish the kind of meaningful relationships lasting through old age.

In the care facility where I minister, Henry is one of the few residents who doesn’t struggle with isolation. He has a number of daughters in town, and members of his church regularly visit. Each Sunday he’s surrounded by a convoy of grandchildren, pets, pastors, and choir members. But Henry is an extreme outlier. The less Christians invest deeply in church relationships, and the fewer familial ties they cultivate, the fewer people will be with them at the end of their lives.

More and more Americans, Christian and lost alike, are dying alone. They’re expending their final breaths in small, crowded buildings tended by overworked and underpaid nurses. Deprived of care and companionship from loved ones, they lack the presence of someone offering regular assurance of eternity in Jesus. Without significant changes, this will be our fate as well.

Immense Opportunity

But what an opportunity churches have to bridge this care gap. God demands that we honor aging parents and care for orphans and widows require drawing near to nursing homes and assisted-care facilities.

The less Christians invest deeply in church relationships, and the fewer familial ties they cultivate, the fewer people will be with them at the end of their lives.

We must admit, though, that we can’t fix the care epidemic overnight. There’s no magic bullet. Some political policies could help in the short term, such as incentivizing home health care and providing financial assistance to family members who care for aging parents at home. But no political or economic policy will change our culture’s privileging of power and ability as predicates for worth.

Even if quick-fix solutions are beyond our grasp, there are simple ways we can reach out to nursing home residents while proclaiming the resurrected Christ and demonstrating his love. Here are three.

1. Pray

Most Christians I encounter are unaware of the care facilities nearby; fewer still know the depths of isolation experienced by residents. Hearts of mercy are forged by the Holy Spirit in prayer. Concerned Christians should pray for this heart and mercifully discern which facilities near them are in the most need.

2. Engage

Many nursing homes and assisted-care facilities are severely understaffed; they could use volunteers of any sort to help care for residents. In a home near me, volunteers help serve meals and water. There are numerous opportunities. Simply go and engage with residents, talk to them, and bring the aroma of Christ.

3. Proclaim

Start a regular Bible study or church service for residents. Again, most facilities don’t have enough activities for residents, so such programs would likely be received warmly. Just start simply—and discern whether to add more activities from there.

In my community, laypeople, many of them students, run morning prayer services in local nursing homes. These include a handful of hymns, Scripture passages, and a five-minute sermon. It requires comparatively few hours compared to most other church projects, yet the effects cannot be overstated. We’ve seen miraculous healings, spontaneous outpourings of worship, and unexpected conversions to Christ among individuals who were months away from death.

I’ve recently started a new initiative, Heritage Mission, that offers free training, coaching and resources for those interested in starting worship services in care facilities.

If a worship service seems too complicated, I’d encourage Christians to do something, however simple, to proclaim Jesus. Care facilities are places where the harvest is plenty but the harvesters are few.

Care facilities are places where the harvest is plenty, but the harvesters are few.

I recently informed residents I’d be moving to Northern Virginia. It was a hard visit. Barbara, one of my usuals, had died from kidney failure. Sharp and wisecracking, she brought a lot of personality to our services. Barbara had a painful past—she often hinted at addictions and family instability. But she always sprang to life whenever we sang hymns, her raspy voice belting “It is well with my soul” louder than anyone else. I pray that it is well with Barbara’s soul now, and I’m grateful for the opportunity to have been part of her final months.

I’m not sure what will happen to our weekly service. I wish there was a legion of volunteers queued up to take over. I wish a small percentage of the outrage that our society expends on the latest social media controversy or celebrity fiasco could be redirected to the tangible injustices down the street. But, more than that, I wish more people saw the God-given beauty of these residents and could experience a tenth of the joy I’ve had in preaching the gospel to them, praying with them, and weeping alongside them.