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Study of an old Man's Profile - Galleria degli Uffizi - Firenze
The Spirit of Collaboration: Social Work / the Church / Older Adults Torna agli editoriali

Terry Tirrito

College of Social Work, University of South Carolina, Columbia, South Carolina, United States

Even to your old age and gray hairs, I am he who will sustain you.
I have made you and I will carry you:
I will sustain you and I will rescue you.
Isaih 46:4 (IBS)

Introduction
The church has not kept its promise to older persons as stated in this scripture passage. The church has abandoned its historical role of community care for its members. Societies are experiencing a gap in services for persons of all ages. If devolution evolution proceeds, states will be freer to devise and implement welfare and health programs for poor people, but they will have up to 20 percent less federal support to do so (Sherman-Videka, L. & Viaggiani, 1996). National, state, and local agencies are not adequately providing social supportive services to persons of all ages and especially not to caregivers of older adults with Alzheimer's disease. Thus, religious organizations should fill the gap. The roles of religious leaders and religious organizations in community involvement have changed over the decades and must be reexamined if we are to meet the needs of today's older population.

Interorganizational community collaboration is not new. Bailey & McNalley Koney (1996) suggest that many earlier collaborative efforts were voluntary partnerships, whereas more recent collaborations are being mandated (p.604). In this paper organized religions (churches, synagogues, and other religious associations) are referred to as the church. The population of older adults is increasing worldwide. The church can fill the gap for social services that public agencies are not offering especially to older adults.

The Importance of Religion in Late Life
For centuries famous works of art depicted the importance of religion in life"s transitions. One of these famous works is Thomas Cole's paintings Journey of Life, in which an angel leads man in his travels through each of life's stages, from birth to youth, middle age, and old age (Cole, 1992) The importance of religious organizations to Americans is indicated by the numbers of Americans listed as members of religious bodies:
Jews (includes Orthodox, Conservative, and Reform =5,981,000
Old Catholic, Polish National Catholic, and American = 950,000
Roman Catholic = 58,568,000
Protestant (includes latter-day Saints, and Jehovah's Witnesses) = 86,684,000
Eastern = 3,976,000
Buddhist = 19,000,000
(Statistical Abstracts,2000)

A Gallup poll reported that 71 percent of Americans claim to be members of a church or synagogue and 41 percent report having attended church seven days prior to the survey (Cnaan, 1997). How long we live, when and how we die seem to be within the realms of science, medicine, and law more than religion. However religion is still important in the lives of most Americans generally and plays a major role in the lives of older persons (Taylor, 1993). Gerontological studies find that religioous affiliation is positively correlated to life satisfaction in older adults (Tobin, 1985). According to Tobin, Ellor & Anderson- Ray (1986) in Enabling the Elderly: Religious Institutions within the Community Service System:

1. Three out of four of persons more than 60 years old report that religion is important in their lives.
2. Four out of five of persons more than 65 years old attend church or synagogue regularly.
3. Evidence suggests that people maintain their religious beliefs throughout their lives and that the current cohort of older adults have been religious throughout their lives and continue to be so as they age.

In religious gerontology spirituality is defined as the state of being spiritual or relating to the nature of a non tangible spirit, and religiosity is defined as membership or attendance in a religious organization ( Tobin et al. 1986). Spirituality may be more important to older adults than to younger people (Hooyman & Kiyak, 1993). The National Interfaith Coalition on Aging defines spiritual well-being or spirituality as the "affirmation of life in a relationship, with God, self, community and environment that nourish and celebrates wholeness" (Tobin et al. 1986, p. 371). They equate well-being with the wholeness of life and with physical, psychological and social good health. The spiritual well-being of the person cannot be separated fully from physical or psychological well-being. Assessment of spirituality is considered essential to the health of individuals by nursing professionals (Hungelmann, Kenkel-Rossi,Klassen, Stollenwerk, 1996). Spirituality and religious activity are positively correlated with the health of older persons in several studies (Koenig, Smiley & Gonzales, 1988). After age 60, religious beliefs/spirituality tends to increase but it is not clear from the research if this is an aging effect or a cohort effect. Religious activities are positively associated with morale and among some individuals ages 75 years and over, religion was second only to health in its relationship to morale (Koenig et al. 1988). Older adults are happier who have a belief in some spiritual being or a connection to some church /synagogue activity. Only recently religious affiliation of older adults is recognized as an influential force that can be positively used to enhance their well-being (Hungelmann, Kenkel-Rossi, Klasser, Stollenwerk, 1996
Church and synagogue attendance is lowest among those in their 30's, peaks in the late 50's and early 60's (60% of this age group attends religious services), and slowly declines in the late 60's and the 70's. Older adults exceed any other age group in attendance, with more than 50% attending religious services. People over age 65 years are the most likely to be affiliated with church groups or fraternal associations (Koenig, George, & Seigler, 1988).

Data from the National Survey of Black Americans indicate a high degree of religious commitment among older black adults (Taylor, 1993). For African American older adults, the church provides social services, counseling, and transportation as adjuncts to the religious activities. Older black adults have a higher probability of being religiously affiliated, of having attended religious services as an adult, and of being a church member than their white counterparts (Taylor, 1993). Social and political functions have been attributed to the church in the African American community. Some writers suggest that during slavery the church functioned as an agency of social control (Smith, 1993). During the civil rights era the African American church served as an arena for political functions, and today, African American churches function as social service agencies in some communities. Mexican American older adults were found to be more religious than white older adults as measured by church attendance, self-rated religiousness, and private prayer.


In spite of the noted involvement of ethnic and white older adults in their churches, the church offers little adult ministries in many congregations. Tirrito and Euster (1994) asked older adults what services their churches provided for them. The responses were as follows: home visiting for the shut-ins or sick, bingo, group healing services, support groups, senior adult choirs, trips, and even a senior prom. A small number reported having formal social service programs such as adult day care or group support programs. However, an unexpected finding was that more than 40% of congregations did not have any special programs for their older adults (Tirrito & Euster, 1994). It is in this context that it is important to examine how churches and public agencies can collaborate to develop models for social service delivery.

Religious Leaders and Religious organizations: Past and Current Roles
The roles of religious organizations and their impact upon the lives of people have changed. In America, the role of religion changed from community involvement to one of spiritual guidance Historically, religious organizations served many community functions, such as helping the poor; housing the sick, the old, and the disabled; providing food; and providing shelter to families. Charity and almsgiving can be traced to references in the Bible. The Book of Genesis frequently offers reference to hospitality ( Hastings, 1910). In the Book of Proverbs, the poor are regarded as oppressed, ill treated, and the relief of the needy is an act of merit bringing down upon the performer the praise of God and the favor or man ( Hastings, 1910). The influence of churches upon governing rulers during the Middle Ages contributed to persecutions of innocent victims in the name of religion and the separation of church and state became a powerful focus. In the 15th and 16th century, colonization created countries that demanded freedom of religion and freedom from persecution due to religious affiliation. The role of the religious organization changed dramatically after the Reformation period when the separation of church and state became a focal issue between governments and churches. During the Reformation period the church become less important as a community and the secular state became the primary source of authority over people's lives (Peterson, 1993). The separation of church and state was a major issue in Colonial America. Americans insisted on a government that was free from specific religious ties and continue in this tradition through the 20th century. It is in this context that churches abandoned many of their traditional community functions. In the 20th century social services previously provided by religious organizations became the responsibilities of governments especially after the passage of the Social Security Act of 1935.

Older Adults Expectations from Their Religious Organizations
A study by Tirrito & Spencer-Amado, (1996) found that older adults expected and desired social services from their religious organizations. A sample (n=106) randomly drawn from a population of 5000 found that older adults would use social services if provided by their churches. The study found that older persons identified many services that they desired from their faith organizations such as: support groups, meals, transportation, nursing services, availability of social workers, help with medicines, housing, help with housing repairs, friendly visitors, companions, legal advice, family support groups, recreational activities, volunteer work, help to find paid work, educational programs, intergenerational programs, help with abusive family members, help with family members with mental illness, or developmental disabilities, or alcoholism and help with elderly parents.

Wilson & Netting (1988) suggested the church as a potential resource for bridging the gap between formal social service agencies and the informal services of churches. Essential public social programs are not being adequately handled by public social service agencies as evidenced by long waiting lists. These include meals on wheels, respite programs, volunteer chore programs, mental health screening, legal and financial planning, retirement planning, and support groups for families and for adult children. Tirrito & Euster(1994) report what one elderly parishioner wrote about her church:

"My church is not fulfilling this need, but I have found some senior centers that are church sponsored and are an alternative for activities and programs for those 55 and older. I believe that churches should recognize and support programs for older adults."

The roles of church leaders have changed from leaders in community affairs to primarily spiritual monitors. Historically, church leaders had teaching and leadership responsibilities in the community. They were not only spiritual leaders but teachers who offered guidance and help in all aspects of life. Ethical issues were debated and decided by spiritual leaders. Life and death decisions were made with religious leaders. Today, the priest is called to administer the last rites at the time of impending death; the minister may visit in times of serious illness; the rabbi may be asked to help with the difficult decision of placing a family member in a nursing home. Religious leaders are no longer involved in making ethical and legal decisions in the community. The professions of medicine and law now have primary responsibility for the policy development regarding life and death issues. Medical personnel (physicians and nurses) make decisions regarding the use of life supports for dying patients, and the courts decide to remove life supports.

Individuals who are facing painful deaths need spiritual comfort but they also need help in dealing with psychosocial issues to make end of life decisions. Helping family members deal with the suicide of a loved one often becomes the religious leader's task. Bullis ( 1996) reports that ministers remain on the front line of mental health care provision (p.156). He cites studies that found that Americans use clergy as their primary source of mental health counseling but that most are ill equipped to provide this service. The spouse faced with a partner with Alzheimer's disease requires support, community assistance, and spiritual comfort. The parent whose adult child has AIDS needs consolation but also needs supportive services and/ or home health care services. The older person whose adult child is abusing or neglecting him or her may confide in the spiritual leader rather than report abuse to police or social agencies. The abused elder may also need legal help and a protective place to live. Religious leaders encounter changes in the mental and physical condition of older adults at early stages but are not gerontologically trained to provide essential information and referral to community service agencies.

Tirrito and Euster ( 1993) examined gerontological training of religious leaders, of whom more than 69% reported that they did not have any training in aging issues although memberships in some churches have from 30% to 80% elderly members. More than 74% of the church leaders (n=57) stated that the proportion of older adults in their churches/synagogues had increased in recent years and yet only 26% (n=22) of clergy were very interested in any gerontological training, 49% (n=41) were somewhat interested, and 25% (n=20) had very little or no interest at all in gerontological training. In a national study sponsored by the Association for Gerontology in Higher Education, Payne and Brewer ( 1989) examined accredited seminaries in the United States to detect the status of gerontology in theological education and found that only recently has gerontological content been taught in schools of theology .

Collaboration and New Opportunities
Collaboration between social agencies and religious organizations can offer new opportunities to meet the needs of persons of all ages especially older adults. Organized religion has concentrated its outreach programs upon youth and families and churches continue to develop youth ministries and are concerned with increasing the number of families and children in their congregations. Recently some churches and synagogues have recognized their responsibility to develop ministries for older members as well. Some community services offered by churches are counseling, adult day care, in-home services, nutrition services, retirement preparation, and transportation. Socialization activities, such as trips or bingo, are no longer adequate to meet the needs of the older adult community especially the needs of an increasing older population. We need more than bingo, games and trips.
Religious leaders and social agencies can share knowledge, work together in advocacy and community planning, collaborate in policy making and ethical decisions, develop joint programs and services, and provide assessments, information and referrals for community members. It is well documented in the literature that many older adults underutilize the services of mental health clinics (Turner, 1992) because public agencies (especially mental health clinics) have a stigma attached to their programs. Older adults are reluctant to use these services even when they are available in communities. Koenig, George, & Schneider (1994) report that low Medicare rates are causing some mental health professionals to turn away elderly patients. How will our society provide mental health services for older adults in the year 2020, when 80 million baby boomers pass age 65? Religious organizations do not have a stigma attached to them. For example, a support group for newly bereaved men is more acceptable if group meetings are sponsored by a church or synagogue than by a local mental health clinic. An older adult who is severely depressed may be reluctant to seek treatment at a local mental health clinic, but may accept treatment from a mental health therapist who is affiliated with his/her church/synagogue. In rural areas transportation is a problem for older adults.

Sharing Knowledge
The diversity of the aging population and the variety of churches and synagogues in various communities demand programs that are unique for each community. Moberg (1991) suggests, "Every church needs to study its own community to determine the specific needs of its older people, and to identify the services that are already available to them, and to discern which are feasible but lacking" (p. 191). A sharing of knowledge about services and programs that are effective is simply a matter of communication between religious leaders, organizations, congregants, and community providers. Religious organizations must again take on community, teaching, and leadership functions.

Advocacy and Planning
How can religious organizations collaborate with government and community agencies to enhance the well-being of today's and tomorrow's older adults? Religious leaders can function as gatekeepers and sources of referral and information. Together they can provide counseling, offer support groups sessions and develop community specific programs. They can be involved in legislation, policy making, advocacy, lobbying, consultation, referral, program planning, and community development. Religious leaders are frequently aware of community issues and can influence leaders and advise planners of the needs of their constituents.

Ethical Decisions and Policy Making
Religious organizations can collaborate with public agencies to find solutions to ethical dilemmas and develop policies to address issues confronting older adults and their families. Clergy of various denominations should be involved in making decisions and passing laws regarding medical ethics: Should assisted suicide be legalized? In an aging society, long life is a blessing for some, for others death is a welcome relief.

Joint Programs and Services
Joint programs, such as family centers, can be developed and resources shared to provide community services for children, teens, and older adults. Some religious organizations are involved in senior centers or day care centers (for example, the Shepherd's Centers in the United States). Some churches, such as in African American communities, offer transportation to doctors' appointments, hot meals, supportive groups for caregivers, and so forth. However, these programs are sporadic and not available in every community. Religious leaders can collaborate with community providers to create programs such as screening for depression by mental health professionals in church/synagogue buildings or education by neighborhood pharmacists regarding drug interactions. Nutrition programs are available in some churches/synagogues but should be offered in all communities.

Assessment, Referral and Information
Religious leaders, frequently, are aware of the psychosocial problems of the members of their congregations. As one minister said, "When I look at my congregation on Sunday, I am sad to look at each face and think about the difficulties each person is dealing with in his/her life" (Private communication, 1996). Alcoholism, drug abuse, elder abuse, caregiving, depression, and mental illness are some of the problems that religious leaders encounter in their congregations. Older adults and their family members often seek counseling from respected members of the clergy prior to consideration of the use of formal services. Although it is not expected that the religious person will take on the role of therapist or psychiatrist, a spiritual leader can recognize warning signs and with the help of social workers refer congregants to appropriate community professionals. For example, it is well known that elderly men are more likely to commit suicide than any other group in the United States, and the rate of suicide increased between 1979 and 1988 ( Kaplan, Adamek, & Johnson, 1994). Religious leaders can play a pivotal role in identifying men who are at risk of suicide and referring these people to community professionals who can help them. Outreach to individuals in the community who are not affiliated with religious organizations can be a major contribution of religious leaders to community public service agencies. These suggestions are not meant to transform churches/synagogues into social service agencies but are a reminder that religious leaders can fulfill a vital community role as referral agents and sources of information.


Conclusions
Churches can provide a pivotal role and fill the gap. First, religious leaders must become aware of the influential roles they can play in the lives of their members, especially the lives of older adults. Religious leaders have an opportunity to bridge the gap in social services if they take leadership roles and become active community practitioners. Second, as Tobin et al.(1986) said, " to become involved in collaborative efforts, the church or synagogue must be willing to support the concept of social ministry" (p.173). Religious organizations must relinquish the notion of their role is solely to meet the spiritual needs of parishioners. Social needs are the domain of the churches.
. As federal policy again begins to shift toward decentralization and the community is given more responsibility to provide services for its citizens, new collaborative models are mandated. The old ways are no longer suitable. We must challenge existing paradigms(Bailey& McNalley Koney, 1996). New challenges require new efforts. The church and its resources (its people ) have been overlooked in the provision of social services. The agenda for the coming decade must include efforts to link social work with the church to contribute to the development of a society in which principles of charity are again incorporated.

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