BY: KATHLEEN McGOWAN, MSW, and TERRANCE P. McGUIRE, EdD
Ms. McGowan is executive director of Catholic Charities, Diocese
of Joliet, IL; Dr. McGuire is principal of McGuire Associates and a consultant
to both the Catholic Health Association and Catholic Charities USA. Together,
as husband and wife, they have dedicated 58 years to these ministries.
Catholic health care and social services in the United
States trace their roots back to the religious order of the Ursuline sisters,
who arrived in the New World in 1727 to provide food, clothing, shelter, health
care, compassion, and the love of Christ to those suffering. The call to provide
such service, however, traces back to a much earlier time. Old Testament passages
refer to the responsibility of the community to care for the anawimthe widows,
orphans, and strangers in their midst. Jesus exemplified this call to service
in his life, teachings, and miracles. He healed the sick, cared for those who
were the outcasts, and gave power to the powerless. With this as a legacy, those
ministering in health care and social services in the Church are truly following
the call of Jesus. By providing care to the sick, ministering to the elderly
in nursing homes, offering counseling, assisting refugees, dealing with broken
families, or extending compassionate care to those recovering from the ravages
of substance abuse, our ministries are modeled to emulate Jesus' life.
From these historical and scriptural roots, sophisticated health
and human services systems that serve people of all faiths and diverse backgrounds
have grown and flourished. At this moment in time, in commemoration of 275 years
of Catholic social services and health care in the United States, it is appropriate
that we take a look at these respective organizations, exploring their relationships
to the Church, sources of funding, organizational life, national organizations,
and the issues that they face today.
Relationship to the Church
While Catholic Charities and Catholic health care organizations
provide ministries within the Church, their relationships to the Church differ.
In most cases, Catholic Charities agencies are diocesan entities, with the chief
executive officer or executive director reporting directly, or through a diocesan
official, to the bishop. Sometimes this diocesan relationship includes monetary
assistance from diocesan collections. At the same time, most Catholic Charities
agencies are separately incorporated non-profit organizations. In contrast,
Catholic hospitals and long-term care facilities have more of an arm's length
relationship to the local diocese. Although they also are separately incorporated
non-profit organizations, few health care systems are diocesan entities. They
are connected more closely to the religious order that founded them.
Because of the complexity of issues facing Catholic health care
today, health systems and local ordinaries are seeking closer relationships
to better meet health and pastoral needs. The United States Conference of Catholic
Bishops (USCCB) has urged Catholic hospitals, Catholic long-term care organizations,
and Catholic social service agencies to collaborate in their service to the
poor and to the local communities in which they serve. This effort, called New
Covenant, has resulted in numerous initiatives around the nation in various
dioceses. The Catholic Health Association (CHA) and Catholic Charities USA have
organized a New Covenant Committee comprised of members from long-term care
facilities, social service agencies, and hospitals and health care systems to
help formulate the principles upon which the ministries can come together to
serve the community's unmet needs.
Some specific examples of these initiatives include the National
Catholic Collaborative Refugee Initiative, which has brought together Catholic
Charities USA, CHA, and the USCCB's Office of Migrant and Refugee Services.
Other examples of New Covenant collaborations are local initiatives such as
clinics, adult day centers, parish nursing programs, pastoral counseling centers,
shelters, and subsidized senior housing initiatives.
Sources of Funding
Catholic Charities agencies have a wide array of funding sources,
including private donations, grants, and diocesan allocations. Agencies also
contract with local, state, and federal government to provide social services.
In recent years, Catholic Charities has been criticized by those who see accepting
government monies as anathema to the agencies' independence and Catholic identity.
Catholic Charities leaders counter these criticisms with the belief that there
is a legitimate place for the private and public sector to come together in
serving the citizens of this country. Social programs need the support and funding
afforded by government sources to continue to serve the needs of the overwhelming
number of indigent and disenfranchised. The Bush administration has supported
this position by establishing the Office of Faith-Based Initiatives. Unfortunately,
however, Catholic Charities agencies have experienced cuts in government funding.
Catholic health care accepts government funds in the form of
Medicaid and Medicare reimbursement. However, with increased regulation of health
care and decreased payment for medical services, Catholic institutions have
faced funding crises. The Balanced Budget Act of 1997 presented grave implications
for health care funding. In response, CHA and the U.S. bishops' conference advocated
strongly for the health systems, decrying the potential lack of services that
would result from funding cuts. While the deep cuts have been somewhat averted,
concern still exists state by state over budget cuts to hospitals and long-term
care facilities. During these changing times, both CHA and Catholic Charities
USA have set into force their advocacy arms to counter the decrease in services
to people that these situations create.
Organizational Life
Catholic health care organizations have taken seriously the planned
approach to promoting their mission and values. This is accomplished through
orientation programs that focus on the heritage of the sponsoring institute
and its vision for the future. Additionally, services such as pastoral care,
community service benefit, organizational ethics, employee education, leadership
development, and others have, in recent years, come under the umbrella term
of "mission integration." Mission integration serves to promote the specific
Catholic beliefs to the patients and residents through the quality care that
is compassionately delivered and by promoting the organization's culture in
a practical, daily manner. The employees are also seen as a key constituency
ýn proclaiming the organization's mission. Attention is paid to maintaining
respect and support of one another in their daily work. Further, sensitivity
to the community is provided so that the appropriate health-related services
are promoted as the components of wellness in society.
In like manner, the Catholic Charities agencies operate with
mission, vision, and values ever-present. Commitment to the agency's mission,
the respectful and compassionate way clients and staff are treated, and involvement
in the community have traditionally been part of the operation of Catholic Charities
organizations. The emergence of specific mission effectiveness positions or
roles is a more recent phenomenon within Catholic Charities, and assessing the
agency's mission and Catholic identity has recently become a more conscious
and communicated part of Catholic Charities organizations.
A key component to the ministry of CHA and Catholic Charities
has been the emergence of lay leadership in the roles formerly held locally
by religious and clergy. If one traces the history of the emergence of lay leadership
in Catholic Charities, a clear correlation exists to the Church's development
since Vatican II. As we have seen more lay leaders come into ministry positions
in the Church, we have also seen lay men and, more recently, lay women leaders
as the chief executive officers in the Catholic Charities movement. Many of
those involved in this social service ministry have roots in religious institutes
or seminaries. Lay health care leaders have emerged with the decline in religious
vocations. Principles of business and finance have dictated leadership decision-making
because of the demands of this highly complex and regulated professional delivery
system. For both ministries, executive leadership mentoring and programs that
imbue lay leaders with the why and how of being Catholic are critical to the
promulgation of these ministries into the future.
National Organizations
The national organizations of Catholic health care and Catholic
Charities maintain similar governance structures in that constituents are members
of the boards of trustees and episcopal liaisons to the USCCB are appointed.
In Catholic Charities USA, prominent community members are solicited for board
participation along with professional Catholic Charities administrators and
executive directors. CHA primarily recruits board members from the health care
and long-term care industry. Presently, the leaders of the respective organizations
are clergymen who bring extensive Church involvement, knowledge and understanding
of public policy, applied ethical practice, and strong analytical skills to
their national role in these public ministries of the Church. Both organizations
have had a history of clergy leadership, with CHA recently hiring Fr. Michael
D. Place, STD, in the role formerly held by a lay man for many years.
Both Catholic Charities USA and CHA see their member constituents
as primary. They exist to serve the members and are focused on including organizational
executive directors and leaders in their various boards, committees, and work
groups. They convene their members annually through a national meeting. Special
interest groups or sections have been established to meet the specific needs
of the membership. Catholic health care includes ethics/mission, advocacy, finance,
and legal committees, among others. Catholic Charities USA has membership sections
that included diocesan directors, administration/management, aging, housing,
parish social ministry, and others that members feel are critical to their work
in the field. Both organizations use these groups to advocate for change in
order to deal with the systemic problems facing our society, to share best practices,
to network, and to develop new service models. Training for members is critical,
and regional meetings provide opportunities to network and to receive advocacy
and specific educational material.
Both CHA and Catholic Charities USA have strong advocacy components.
In the last 10 years, Catholic Charities USA has gained a reputation for being
a primary proponent of public policy, especially concerning the complex societal
changes affecting those in need, such as welfare reform. CHA has also forged
a national reputation of influencing public policy in the health care arena.
Both organizations have a strong impact on lawmaking, policy development, and
social analysis. They maintain close relationships with the local leaders and
have point people within the constituency to assist in influencing political
decision-making at the state and national level. In recent years, the two organizations
have collaborated to lobby for systemic change to serve the poor. The needs
of the uninsured and underinsured, for example, have been major concerns for
both constituencies.
Issues Facing Catholic Charities and Health
Care
A variety of issues face Catholic Charities and Catholic health
care today. Some they share; some are unique to each ministry. Catholic health
care organizations are obliged to follow the Ethical and Religious Directives
for Catholic Health Care Services. These directives guide Catholic health
care organizations in manifesting its Catholic identity, as agreed upon by the
USCCB. In addition to being sponsored by a religious congregation, health care
organizations are designated as Catholic by the local bishop. The ERDs are the
map by which Catholic hospitals and health systems chart their decision-making
on ethical matters in medical treatment, pastoral practice, workplace relationships
and in the administrative arena of mergers and acquisitions. System restructuring
necessitated by such mergers and acquisitions require organizations to balance
the need for comprehensive quality health care services while ensuring that
cost-effectiveness and stewardship of resources sustain the organization's purpose
and mission.
Catholic health care has faced external pressure because of its
Catholic beliefs. Deliberate attacks, aimed at removing Catholic health care
from the arena of service delivery, have been a very real threat to Catholic
health care. Biomedical advancements have caused the church, through CHA and
the USCCB, to speak out on the recent issues of cloning, gene therapy, and stem
cell research.
In Catholic Charities agencies and Catholic health institutions,
the working environment has changed drastically in recent years, and abounding
pluralism exists among the staff. In response, Catholic health care providers
and Catholic Charities agencies have more readily articulated their beliefs
in a clear, consistent, and comprehensive manner, providing staff with the principles
upon which the organization was founded and why it continues to exist today.
The ethics of Catholic health care and social service organizations are the
moral compass for policy decision-making and actions in the workplace. A delicate
balance exists in the workplace to respect an individual's belief system while
maintaining the Catholic identity of its institutions.
While we have presented much about Catholic health
care and Catholic Charities, the discussion wouldn't be complete
without a mention of some of the more humorous differences between
the two networks. We may joke, but there is a kernel of truth,
that the difference between Catholic health care and Catholic
Charities folk is understood by looking at our suits. Catholic
Charities personnel must be able to dance prior to being employed,
while Catholic health care folks, as a contrast, head to the
golf course. Catholic Charities holds its winter meetings in
places like Philadelphia and Chicago, but Catholic health care
folks wouldn't be caught dead in such climates during the months
of December to April. And while the Catholic Charities packet
for board members can be mailed, the Catholic health care packet
must be sent overnight by a moving company!
Humor aside, the work of Catholic health care and Catholic Charities
has been an asset to the social fabric of our country. Working together, we
can become the vision of a society that honors social justice and enhances our
common roots and joint ministry in the Church. The need to remain true to the
health care and social service ministry is a sacred trust in this 21st century.
It beckons us to search out, identify, and frame new ways of addressing our
age-old purpose of caring for those in need. What we have done alone, we must
now do together to remain viable in this ever-changing complex society. If we
are to move forward another 275 years, that must be our prime strategy.
Copyright © 2002 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.