Chapter 9 – Profile of the Care Facility Population

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Beyond the need for more intense medical care and generally advanced age, it is important not to oversimplify or stereotype the kind of person you will find living in a care facility: they are as diverse as the general population.


In each type of facility, you will find residents with varying degrees of illness and dementia. Depending on the purpose of the care facility, there will be a higher or lower proportion of individuals with serious health problems, but we stress that you will meet people just like you in all of them. (We should note that “adult family homes” often house three or four retarded individuals who are given the greatest degree possible of self-sufficiency in a “home” environment.) In every case, although they may be in wheel chairs or rolling recliners, and though they may be very worn and look very tired, and though they may be very sick or confused, each resident in a care facility has desires and feelings just like you – if anything, they may be even a little more sensitive and hungry for friendship than you are! Pay attention to them and get to know them – they are very human.

Disclaimer: Christian Concourse Ministries, Inc. provides this information solely as a general reference for your convenience. This material may not apply to your physical or emotional situation and it is not intended to provide guidelines for diagnosis or treatment. If you have questions about a specific health condition please consult a professional medical provider.

Physical Illness

All of us get sick, so we all can identify with the negative feelings of being ill. As you interact with residents in care facilities you will encounter numberless types of physical sicknesses. Obviously, we cannot list them all, but, there are some special diseases we will mention here due to their unique relationship with the aging process.

This material taken from the web site of the National Institute on Aging, U. S. Department of Health and Human Services (

Alcohol Abuse

Anyone at any age can have a drinking problem. Alcohol slows down brain activity. Because alcohol affects alertness, judgment, coordination, and reaction time – drinking increases the risk of falls and accidents. Some research has shown that it takes less alcohol to affect older people than younger ones. Over time, heavy drinking permanently damages the brain and central nervous system, as well as the liver, heart, kidneys, and stomach. Alcohol’s effects can make some medical problems hard to diagnose. For example, alcohol causes changes in the heart and blood vessels that can dull pain that might be a warning sign of a heart attack. It also can cause forgetfulness and confusion, which are symptoms of Alzheimer’s disease.


Arthritis causes pain and loss of movement. It can affect joints in any part of the body. Arthritis is usually chronic, meaning it can occur over a long period of time. The more serious forms can cause swelling, warmth, redness, and pain. The three most common kinds of arthritis in older people are osteoarthritis, rheumatoid arthritis, and gout. Treatments for arthritis work to reduce pain and swelling, keep joints moving safely, and avoid further damage to joints. Treatments include medicines, special exercise, use of heat or cold, weight control, and surgery.


Constipation is a symptom, not a disease. It is defined as having fewer bowel movements than usual, with a long or hard passing of stools. Older people are more likely than younger people to have constipation. But experts agree that older people often worry too much about having a bowel movement every day. There is no right number of daily or weekly bowel movements. “Regularity” may mean bowel movements twice a day for some people or just twice a week for others. Doctors do not always know what causes this problem. Eating a poor diet, drinking too little, or misusing laxatives can be causes. Some medicines can lead to constipation. These include some antidepressants, antacids containing aluminum or calcium, antihistamines, diuretics, and antiparkinsonism drugs.

High Blood Pressure

You may be surprised if your doctor says you have high blood pressure (HBP) because it does not cause symptoms and you can have it even though you feel fine. But HBP is a serious condition that can lead to stroke, heart disease, kidney failure, and other health problems. The good news is that there are simple ways to control it. If you have mild HBP, your doctor may suggest that you lose weight and keep it off, eat less salt, cut down on alcohol, and get more exercise. You may bring your blood pressure down simply by following this advice. Even if medicine is needed, these daily habits may help it work better. Some people think that when their blood pressure comes down, they no longer need treatment. If your doctor has prescribed medicine, you may have to take it for the rest of your life. Later on, though, you may be able to take less of it.

Hyperthermia: A Hot Weather Hazard

Warm weather and outdoor activity generally go hand in hand. However, it is important for older people to take action to avoid the severe health problems often caused by hot weather. “Hyperthermia” is the general name given to a variety of heat-related illnesses. The two most common forms of hyperthermia are heat exhaustion and heat stroke. Of the two, heat stroke is especially dangerous and requires immediate medical attention. Heat-related illnesses can become serious if preventative steps are not taken. Many people die of heat stroke each year; most are over 50 years of age. With good, sound judgment and knowledge of preventive measures the summer can remain safe and enjoyable for everyone.

Osteoporosis: The Bone Thinner

Osteoporosis is a disease that thins and weakens bones to the point where they break easily– especially bones in the hip, spine, and wrist. Osteoporosis is called the “silent disease” because you may not notice any symptoms. People can lose bone over many years but not know they have osteoporosis until a bone breaks. About 25 million Americans have osteoporosis– 80 percent are women. Osteoporosis is preventable. A diet that is rich in calcium and vitamin D and a lifestyle that includes regular weight-bearing exercise are the best ways to prevent osteoporosis.

Prostate Problems

Found in men, the prostate is a small organ about the size of a walnut. It lies below the bladder (where urine is stored) and surrounds the urethra (the tube that carries urine from the bladder). Prostate problems are common in men 50 and older. Most can be treated successfully. A urologist (a specialist in diseases of the urinary system) is the kind of doctor most qualified to diagnose and treat many prostate problems.


Thanks to new tests that help predict stroke, treatments that help control high blood pressure, and good health habits that many Americans are practicing, the death rate from stroke is down as much as 50 percent since 1970. Still, stroke is the third leading cause of death in the United States and the leading cause of disability among adults.

A stroke is a sudden partial loss of brain function usually caused by a clot that stops the flow of blood to an area of the brain. Without oxygen and important nutrients, the affected brain cells are either damaged or die within a few minutes.

While cell damage can be repaired and the lost function regained, the death of brain cells is permanent. Most strokes are caused by a blood clot or narrowing of a blood vessel (artery) leading to the brain. Other strokes are caused by a hemorrhage (bleeding) from an artery.

A stroke was once viewed as a single damaging attack, but we now know it develops over many years. The risk factors or conditions that may lead to stroke include high blood pressure, smoking, heart disease, and diabetes. The risk of stroke increases with age and is higher in African Americans and Hispanics than in whites.

Mental Illness

Here we list some of the mental diseases that attack care facility residents. Of course, the most well-know is Alzheimer’s. Following this basic description of Alzheimer’s is a list of other dementing illnesses. For more information on how to interface with a resident suffering with some form of dementia, please refer to our material under “Mental Impairment – Dementia” in the section entitled “How to Volunteer in a Local Care Facility.”

Alzheimer’s Disease

Adapted from material compiled by Marci Stocks ( on her website, Elderly Place (

Below, are listed the Stages of Alzheimer’s Disease. Some reading material may break down AD into 3 stages, while others break it into 4 stages. Both philosophies are correct. Please keep in mind that someone may progress at a slower rate while someone else may progress quite rapidly.

Stage 1

The first stage consists of the 2-4 years leading up to and including the actual diagnosis of Alzheimer’s Disease. Typical characteristics of Stage 1 are:

Recent Memory Loss (or short-term memory loss) begins to affect job performances

Confusion in natural environment – gets lost in a known environment

Mood and personality changes

Poor judgment; makes bad decisions

Daily tasks such as cleaning, dressing takes longer

Trouble handling money and/or paying bills

Losing items such as keys, purse, wallet in unusual places

Your loved one doesn’t seem interested in life anymore

Stage 2

The second stage is approximately 2-10 years after diagnosis. This is the longest stage characterized by:

Memory loss increases

Confusion on a regular basis

Problems recognizing family and/or friends

Repeats statements over and over

Difficult speaking and organizing thoughts- cannot get the words out

Makes up stories; may feel paranoid

Reading and writing problems

May be suspicious, irritable, teary/sad


Major or constant weight loss or gain

Stage 3

The third stage is also known as the “Terminal Stage.” This stage lasts approximately 1-3 years and the following symptoms are increasingly evident:

Cannot recognize family/friends

Weight loss while eating good, well balanced meals

Cannot communicate with words

Bowel/bladder movement problems

May have seizures

Difficulty swallowing

Little ambition for self care

Alzheimer-like Diseases

There are several dementing diseases that are often confused with Alzheimer’s Disease. Here we have listed just a few along with some key similarities of that to Alzheimer’s Disease. Please keep in mind that we have only picked “key” similarities. They are not defined thoroughly.

Multi-infarct Dementia (MID)

MID is a breakdown of mental capabilities caused by multiple strokes (infarcts) in the brain.

Symptoms include:

Impaired Thinking

Personality Changes

Changes in Judgment

Memory Impairment

Pick’s Disease (PD)

PD is characterized by personality disturbances and behavioral changes. It is a rare progressive disease that affects certain areas of the brain. Symptoms include:

Speech Impediments

Repetition of Words

Confusion of Surroundings

Changes in Behavior or Personality

Huntington’s Disease (HD)

HD is an inherited degenerative brain disorder. Symptoms include:

Irregular involuntary movements of the limbs or facial muscles

Personality Changes

Memory Disturbances

Speech Impediments (i.e. slurring of words)

Parkinson’s Disease (PD)

PD attacks certain nerve cells, causing difficulties in walking, balancing, and speaking. Symptoms include:


Walking Difficulties

Balance Difficulties

Speech Impediments

Diffuse Lewy Body Disease

This particular disease is a combination of the symptoms of Alzheimer’s Disease and Parkinson’s Disease. It is often mistaken for Alzheimer’s Disease. Symptoms include:

Gradual Memory Loss

Mood or Behavior Changes

Walking Difficulties

Balancing Difficulties


Most people who need long-term care are elderly, but this is not always the case. There are many residents in nursing homes and assisted living homes who are in their thirties and forties, some even in their twenties. In fact, one facility in Norfolk, Virginia, Lake Taylor, has a children’s department. Adult family homes often house individuals in their twenties or thirties. Retirement communities, on the other hand, are almost entirely populated with senior citizens, since they cater to those old enough to have retired from their occupation or profession.

According to the most recent data published by the American Health Care Association, among the residents of nursing homes in 1999, 10% are under 65; 12% are between 65 and 74; 32% are between 75 and 84; and 46% are 85 and older.

The Changes That Come With Age

As the human body ages it experiences certain predictable changes. But these changes are not restricted solely to the physical person. The intangible parts of us go through changes also. By being aware of these changes, as Christian volunteers, our ministry to elders can be more effective, more appropriate and more relevant to their specific needs. In the following paragraphs we note several of these changes. Some are the result of a disease and should not be considered as part of the “normal” aging process.

Note: This material on the changes associated with aging is taken from a presentation given to a national meeting of the Christian Fellowship of Care Center Ministries in March, 2004, by Paul Falkowski, Executive Director of Desert Ministries, Inc. in Omaha, Nebraska. You can email him at: .

Changes in the Senses

[Schieber, F. (1992). Aging and the Senses. In: Handbook of Mental Health and Aging. Second Ed. Academic Press. 10, 251-306.]

Vision – Light entering the eye becomes scattered (astigmatism).

Less light gets in the eye due to reduction of the diameter of the pupil (senile miosis).

The lens has trouble focusing on near objects (presbyopia).

The rods and cones of the retina deteriorate causing loss of night vision, onset of tunnel vision and eventual blindness (retinitis pigmentosa).

Loss of contrast sensitivity making it difficult to recognize faces and objects.

Color sensitivity decreases significantly after the age of 70, especially the recognition of blues, greens and violets.

To compensate for some of these eye limitations here are some suggestions you might consider:

Be sure there is adequate lighting.

Avoid high gloss surfaces and printed materials that give off a glare.

Use bold, large, plain san serif fonts for text in printed materials.

Example: This is readable text.

(Arial Unicode MS, bold, 18 pt.)

(For more guidelines on this refer to The American Printing House for the Blind —

Avoid quick movements when speaking.

Do not use presentation materials that have fine visual details.

Be aware that the older we get the more difficult it is to see blues, greens and violets.

[Owsley, C. & Sloane, M. (1990). Vision in Aging. In: Nebes, Robert D. (ED); Corkin, S. (Ed); Handbook of Neuropsychology, New York, NY, US: Elsevier Science. Vol. 4. pp. 229-249.]

Hearing – Structures in the middle ear become calcified.

Auditory canal blocked with increased secretion of ear wax.

Auditory nerve cells and inner ear structures show decline with age.

Sound localization decreases with age – the ability to tell where a sound came from.

Elderly have difficulty hearing higher frequencies (e.g.: consonants, d, k, p, s, t, etc.).

Men are more likely to have hearing loss than women.

We list here some considerations for the volunteer concerning the hearing of seniors:

Some believe that hearing loss can lead to clinical depression!

Rooms with a lot of echo or speakers with a lot of reverberation added will hinder

elders’ hearing.

Background noise – chatter, machinery, ice machines, air conditioners, etc. – will hinder speech recognition.

Adjust recorded and live music to emphasize higher frequency sounds.

The faster you talk, the less likely the elderly will get your message.

Speaking louder will not help if you are talking too fast.

Speak clearly, slowly and distinctly.

Taste – Interacts with smell: loss of taste may be closely tied to loss of smell. There is disagreement among researchers as to whether the number of tastebuds declines with age. Taste sensitivity may be more associated with tobacco use and medications, especially treatments for hypertension.

Smell – There is a rapid decline of the olfactory process with age. Institutionalized elderly tested poorly for the sense of smell compared to non-institutionalized.

Note: Try experimenting with recipes to bring out “the flavor” of a food to offset this loss of smell and taste. Consult a dietitian.

Touch – The skin becomes less elastic with age. The ability to tell what an object is just by touch alone declines with age. Sensitivity to pain and temperature generally does not change with age. The importance of touch remains into old age, even though there is a decline in the structure of the skin and nerve pathways.

Changes in Memory

[Conway, A., Engle, R. (1994). Working Memory and Retrieval: A Resource-Dependent Inhibition Model. In: Journal of Experimental Psychology: General. 123, 4, pp. 354-373.]

There is some decline in memory but, overall, it is normally not significant. Generally, younger people test better for memory, but this may be due to slower processing time than of memory itself. We repeat: severe memory loss is not normative with aging. We encourage you to stimulate the memory of your senior friends through memorization of Bible passages, hymns, poetry, etc. See Section 11, Games and Activities.

The enemies of memory include:

The natural tendency to accept the erroneous, self-fulfilling stereotype of “I’m old, therefore, I’m forgetful.”

Some diseases listed previously under “Mental Illness” affect our memory.

Poor diet, lack of exercise, lack of mental stimulation and depression adversely affect our memory.

Changes in Personality

[Helson, R., & Stewart, A., (1994). Personality Change in Adulthood. In: Can Personality Change? Heatherton, T., & Weinberger, J., (Eds.) American Psychology Association, pp. 201-225. Also, see: Costa, P & McCrae, R., (2000), Revised NEO Personality Inventory.]

In some ways, our personality remains the same as we age and in other ways our personality changes. If we are cranky when we are young, without an unusual change of heart, we will probably be cranky when we grow old. Some researchers, therefore, identify traits that do not change after the age of 30 (e.g.: anxiety, anger, depression, assertiveness, positive emotions, openness, actions, agreeableness, trust, modesty, order, self-discipline, etc.). On the other hand, other parts of our personality probably change with time: our values, creativity, relationships and self-image. At any length, it is important to remember that we are not rigidly locked into our ways. We can change.

Changes in Intelligence

[Cavanaugh, J. (2002). Intelligence. In: Adult Development and Aging. Fourth Ed., Wadsworth Publishing Co., 8, pp. 253-296.]

There are two types of intelligence:

Fluid – the ability to think on your feet, allowing you to draw inferences and respond.

Crystallized – knowledge acquired across your life time, your library of experiences and education.

The effects of aging are minimal on intelligence, but there is a correlation between intelligence in later life and certain factors. “Loss” of intelligence is slowed by the following:

Complexity of career.

Lengthy marriage to a well-educated and intelligent spouse.

Exposure to stimulating environments.

Flexible attitudes at mid-life.

Self-motivated individuals protecting themselves from “worthlessness.”

These factors press us as volunteers ministering to the elderly to be sensitive to the level of a person’s education. We should keep in mind the potential of the elderly to be a valuable resource for mentoring, teaching, etc. It is important to remember that the elderly are intelligent. They can learn new skills. This fact holds valuable implications for the programs and the events we seek to involve them in.

Changes in Wisdom

[Baltes, P., Smith, J., Staudinger, U., & Sowarka, D. (1990). Wisdom: One Facet of Successful Aging? In: Late Life Potential. Perlmutter, M., (Ed.) pp. 64-69.]

Wisdom is defined as: the culmination of all life experiences and intelligence giving the ability to make “good judgments and good advice about difficult but uncertain matters of life.” This faculty that we call “wisdom” increases with age. As Paul Falkowski says, the “hardware” may be breaking down, but the “software” can compensate for those limitations. “In the task of reviewing one’s life, the elderly show a greater understanding of life’s uncertainties than younger adults” (Baltes, et al. 1990). Obviously, not all old people are wise, but a careful observation should show a disproportionately large number of elderly among the wise. The implications of this fact are important: We should involve older people in mentoring at-risk youth and other difficult family situations; we should tap their experience in the work place; and we should include the enrichment of relationships with older people in our personal lives!


By any casual observation, the population of care facilities is substantially more female than male. But, it should be stressed that, contrary to popular stereotypes, we see a large number of men in every facility. According to studies published by the American Health Care Association, about 33% of nursing home residents are male, and 67% are female. This is important to remember as you formulate the types of activities you help with in the facility. Men like to do “men” things. Consider sports interests, workshop skills and masculine hobbies as you look for ways to relate to elderly men. And, of course, accommodate the ladies with appropriate activities that would spark memories of their former favorite pastime.

Race and Culture

The racial and cultural diversity of care facilities usually reflects that of the community around it. As a volunteer, you will probably have the opportunity to minister to individuals from all the races and many cultural backgrounds. It has been our experience that some of our most rewarding relationships in care facilities have been with residents of a different race from ours.

Color and cultural differences among the people who live in nursing homes should not be a factor in our availability or our attitude as volunteers. You may disagree about many things, you may have differing preferences on any number of issues with a care facility resident, but your job is to show them the love of Jesus. Accepting them as someone He loves and died for does not compromise your convictions. In fact, this is the perfect environment to practice our Master’s teaching to love our neighbor as we would love ourselves. Be tolerant and try to understand someone who is different from you — “Do unto others as you would have them do unto you.”

The January 18th, 1999 selection from Our Daily Bread is a wonderful exhortation on the bigotry that is inclined to rear its awful head in all of us. We have copied it here for your reflection.

“Sin of the Skin”

Do not hold the faith of our Lord Jesus Christ, the Lord of glory, with partiality. James 2:1

Most people hate to be accused of racism. But racial bias is all too prevalent. Even Christians have had a long history of ethnic prejudice. In the first century, Jewish believers were reluctant to accept their Gentile brothers. A few centuries later, Gentile believers were reluctant to accept their Jewish brothers. In recent years, racial discrimination has been a dominant issue.

Prejudice can run so deep that it sometimes takes a tragedy to make a person see how wrong it is to discriminate on the basis of physical differences. Several years ago I read about a bigoted truck driver who had no use for African-Americans. But one early morning, his tanker truck flipped over and burst into flames. A week later, he was lying in a hospital bed and looking into the face of a black man who had saved his life. He learned that the man had used his own coat and bare hands to smother the flames that had turned the trucker into a human torch. He wept as he thanked the man for his act of unselfish heroism.

We shouldn’t need a tragedy to open our eyes. We need only look to Calvary. There our Lord gave His life for people of every language, race, and nation. The universal scope of His sacrifice shows His love for every human being.

Have mercy on us, Lord, if we have fanned the fire of prejudice that You died to put out. –MRD II

Join hands, then, brothers of the faith,

What e’er your race may be;

Who serves my Father as a son

Is surely kin to me. – Oxenham

Prejudice is a lazy man’s substitute for thinking.

Read Ephesians 2:11-22

Our Daily Bread, Copyright © 1998 by RBC Ministries, Grand Rapids, MI. Reprinted by permission.


The Spirituality of Seniors

Humans, universally, have a spiritual nature which demands fulfilment. This desire for spiritual fulfilment is often heightened in advanced years. What matters most in the later stage of our existence on earth is one’s sense of what life is about, coming to terms with who one is on the inside. (Lifespan Development, Holt, Rinehart and Winston, 1983. Jeffrey Turner. P.451)

Thus, when considering the health of our seniors, we should include their “spiritual well-being.” Those who care for the elderly are focused on relieving their declining physical conditions. Often, the mental and emotional problems that are associated with aging are easily monitored and treated with drugs. But there is also a great need to address the spiritual health of care facility residents. As in the physical body, the spiritual body needs food and nurture to grow and remain strong. Indicators of the spiritual well-being of any individual, young or old, cannot be observed directly with the five senses. Rather, we study the spirit’s indicators, the reflections of it in people’s meanings, ultimate concerns, and faith orientations. All of these spiritual indicators in turn give rise to and influence thoughts, beliefs, and actions. It is in this essence of our being, this core of who we are, that we seek “spiritual well-being” regardless of our physical and mental condition. (Spiritual Well-being Defined by Rev. J. W. Ellor. From the website of The San Francisco Ministry to Nursing Homes,


Approaching the later years of life, we begin to see, with growing certainty, the unavoidable reality of death. Again, this fact naturally presses us to seek the internal fulfilment of spiritual well-being. Christians have often found just such a blossoming fulfilment in God through faith in the person and work of Jesus Christ as He is revealed in Holy Scriptures. Accepting this God-given gift of faith in Christ brings us His sovereign promise of joyful life beyond the grave. We find substance in our faith through the presence of His Holy Spirit in our hearts. And we find vital encouragement for our faith in the faith we see in the lives of fellow believers around us. This is the testimony of the writer of this handbook. And, this is the Gospel that elderly Christians love to share and love to hear again and again because it is more and more the reality of their experience.

This faith, so very priceless to Christian residents, is fed through Bible reading, prayer and discussion of faith issues. Our faith is strengthened when we are reminded of the power and the faithfulness of God. Our faith is strengthened by sharing and listening to others share their faith and hope in Jesus Christ. The Old, Old Story really never gets old – our faith is strengthened each time someone rehearses the Gospel of Jesus Christ with us.

Therefore, as Christian volunteers who conduct and facilitate such religious activities in care facilities, we must keep in mind the importance of our task. We are a vital resource to the facility for addressing this important dimension of the health of their residents.

To achieve this goal best, we must perform our service in a way that demonstrates our respect for the residents as human beings, as fellow creations of God. We must use wisdom so as not to offend and frustrate residents who do not share our enthusiasm for our faith. We are there as invited guests. Our audience is not captive. If they ask us to leave and not come back, we will be obliged to do so.

As we have stated, the intangible qualities of faith, religion, prayer, church and spirituality are interwoven into the fabric of physical, emotional and social well-being. And scientists are documenting that these intangible qualities predictably produce tangible results.

Research shows that religious affiliation and frequent attendance at services are associated with lower death rates, though many experts attribute this partly to the strong social network and healthy behaviors encouraged by religious communities. (Ladies Home Journal; Dec 01, 1997; Frishman, Ronny; Bussani, Tracy)

Jeff Levin, Ph. D., senior research fellow at the privately funded National Institute for Healthcare Research has discovered scores of medical studies on the effects of religion on health. Most of these scientific studies support the concept that religious interaction and prayer has a positive physical influence on adherents.

Some highlights from these studies:

–A 1995 study at Dartmouth-Hitchcock Medical Center: one of the best predictors of survival among 232 heart-surgery patients was the degree to which the patients said they drew comfort and strength from religious faith. Those who did not had more than three times the death rate of those who did.

–A survey of 30 years of research on blood pressure showed that churchgoers have lower blood pressure than non-churchgoers–5 mm lower, according to Larson, even when adjusted to account for smoking and other risk factors.

–Other studies have shown that men and women who attend church regularly have half the risk of dying from coronary-artery disease as those who rarely go to church. Again, smoking and socioeconomic factors were taken into account.

–A 1996 National Institute on Aging study of 4,000 elderly living at home in North Carolina found that those who attend religious services are less depressed and physically healthier than those who don’t attend or who worship at home.

–In a study of 30 female patients recovering from hip fractures those who regarded God as a source of strength and comfort and who attended religious services were able to walk farther upon discharge and had lower rates of depression than those who had little faith.

–Numerous studies have found lower rates of depression and anxiety-related illness among the religiously committed. Non-church-goers have been found to have a suicide rate four times higher than church regulars.

(Time; Jun 24, 1996; “Faith and Healing,” CLAUDIA WALLIS)

The Christian Attitude

Our point in quoting the above studies is to underline the empirical observations by secular scientists – that there is a connection to physical and psychological well-being and the exercise of one’s faith. As Christians, though, we must be careful in what we are promoting when we say “prayer and religion works.” We do not, in this handbook, advocate the notion that prayer invokes some impersonal “force” which unalterably solves all our problems and woes like some magic potion. Rather, consider the following five passages of scripture:

Go to now, ye that say, Today or tomorrow we will go into such a city, and continue there a year, and buy and sell, and get gain: [14] Whereas ye know not what shall be on the morrow. For what is your life? It is even a vapour, that appeareth for a little time, and then vanisheth away. [15] For that ye ought to say, If the Lord will, we shall live, and do this, or that. [16] But now ye rejoice in your boastings: all such rejoicing is evil. James 4:13-16

And this is the confidence that we have in him, that, if we ask any thing according to his will, he heareth us… 1 John 5:14

Thy kingdom come. Thy will be done in earth, as it is in heaven. Matthew 6:10

And he went a little farther, and fell on his face, and prayed, saying, O my Father, if it be possible, let this cup pass from me: nevertheless not as I will, but as thou wilt. Matthew 26:39

He went away again the second time, and prayed, saying, O my Father, if this cup may not pass away from me, except I drink it, thy will be done. Matthew 26:42

Christian prayer should be seen as illustrated by the act of a humble child innocently asking their father for something. The loving, generous father knows if granting the request is in the best interest of all concerned. We should pray for our specific needs and for those whose needs have touched our hearts…by all means! But we must do so humbly, readily acknowledging the answer of God to be a function of not just His almighty power, but also of His will and His all-knowing wisdom.

God answers prayer! We are admonished by His written Word to pray; even to pray boldly. But we come to Him as His children in simple faith, not with demanding arrogance as though we were His boss.

Oh, so many of those we minister to in care centers know well the blessing in submissive prayer. It is so much more than making God do what we want Him to do…it is walking in sweet communion with our Lord in the Garden of our heart. There we learn that He, indeed, knows best…that no matter what our circumstances, He will not forsake us or forget about us. In this fellowship with our Creator we find the spiritual sustenance that affects our whole being, the effect of prayer that scientists are trying to catalog and define. To those who know Jesus Christ, fellowship with Him in prayer is vital. To those who do not know Him, prayer can become for them the bridge to that sweet relationship.

The Residents’ Spiritual Needs

We strongly urge Christian volunteers and staff members to consider these proven facts and the timeless experience of all Christians through the ages: make a commitment in your heart to seek to accommodate the real spiritual needs of the nursing home residents that you strive to serve!

Remind them of the faithfulness of Jesus Christ.

Encourage them in their faith in Him.

Tell them the “Old, Old Story” over and over again!

Pray with them.

Religious Orientations

Definition of Religion

Religion could be best defined as man’s attempt to achieve the highest possible good by adjusting his life to the strongest and best power in the universe. This power is usually called God. Most religions are organized systems of beliefs based on traditions and teachings. Religion seeks to discover values and to attract men to them through worship and discipline. Religion has been one of the most powerful forces in history. There has never been a people that did not have some form of religion. (The World Book Encyclopedia, 1977, excerpts from “Religion”)

Major Religions of the World

Ranked by Number of Adherents

Last modified 16 August 2001.(Sizes shown are approximate estimates, and are here mainly for the purpose of ordering the groups, not providing a definitive number. This list is sociological/statistical in perspective.)

1. Christianity: 2 billion – 33%

2. Islam: 1.3 billion – 22%

3. Hinduism: 900 million – 15%

4. Secular/Nonreligious/Agnostic/Atheist: 850 mil.-14%

5. Buddhism: 360 million – 6%

6. Chinese traditional religion: 225 million – 4%

7. primal-indigenous: 190 million – 3%

8. Sikhism: 23 million

9. Yoruba religion: 20 million

10. Juche: 19 million

11. Spiritism: 14 million

12. Judaism: 14 million

13. Baha’i: 6 million

14. Jainism: 4 million

15. Shinto: 4 million

16. Cao Dai: 3 million

17. Tenrikyo: 2.4 million

18. Neo-Paganism: 1 million

19. Unitarian-Universalism: 800 thousand.

20. Scientology: 750 thousand

21. Rastafarianism: 700 thousand

22. Zoroastrianism: 150 thousand

Our thanks to for this information (

Religion in the United States of America

Today the country is overwhelmingly (85%) Christian, but we are no longer simply Catholic, Protestant and Jew. There are more than 200 denominations in this country, and 5 million Muslims, 1 million Hindus, 1 million Buddhists, 275,000 Sikhs, and 133,000 Baha’is. (Gannett News Service, Feb. 1, 1999)

Religion in the State of Virginia

There are more than 3 million practicing Christians in the State. The approximate breakdown of major religious groups in Virginia is as follows:

Baptist – EV (1,200,000)

Methodist – ML (534,000)

Catholic – HC (523,000)

Lutheran – ML (174,000)

Episcopalian/Anglican – HC (149,000)

Presbyterian – ML (130,000)

Pentecostal/Charismatic – EV (145,000)

Jewish (73,000)

Mormon (63,000)

Church of Christ – ML (55,000)

Christian Ch. (Disciples) – ML (42,000)

Brethren – EV (34,000)

Buddhist (28,000)

Orthodox – HC (14,000)

Moslem (14,000)

Nazarene – EV (12,000)

Mennonite – EV (10,000)

Unitarian (6,000)

High Church (HC): 686,000 – 21%. Main Line (ML): 935,000 – 29%. Evangelicals (EV): 1,401,000 – 44%. Other: 184,000 – 6%.

These figures for Virginia do not include unchurched Christians, agnostics, atheists, or very small sects.

Our thanks to for this information (

Denominations – What difference Does it Make?

Noting some of the differences of beliefs in Christianity below, we present you, the Christian volunteer, with the issue of denominationalism among the residents of care facilities. You may notice that these issues are being dealt with in the greater Christian community – outside nursing homes. We want you to be prepared in your heart and mind to face these issues as you minister in facilities because, as we have stated before, the population of a care center reflects that of the community around it. And you may very well be asked pointed denominational questions and presented with charged sectarian circumstances in the course of your ministry. There are an infinite number of ways these issues may surface and we cannot give you all the answers you may need, but we can stimulate your thinking as a Christian ambassador to this field of mission. Remember: every audience in every facility is subject to be interdenominational.

Four of the major questions of religion that Christianity answers

Who is God?

How has He revealed Himself to man?

What is man’s relationship to Him?

What does He want us to do?

The basic answers to these questions are fairly universal throughout the Christian world.

● Who is God? God is the Creator.

● How has God revealed Himself to man? He has revealed Himself 1) in Holy Scripture, 2) in the person of His Son, Jesus Christ and 3) in the presence of His Holy Spirit in the world today.

● What is man’s relationship to God? Our proper relationship to Him is founded on humble, child-like faith, recognizing our need for His divine intervention and fellowship in our life.

● What does He want us to do? He wants us to love Him and love all others around us.

Beyond these basic tenants there are implications of each one that divide Christians.

How did God create us? Was it some form of evolution over millions of years or was it a literal six-day event?

Has God finished revealing Himself to man? Or is mankind still learning and in need of adjusting our record? What does the Christian Bible mean and how do we apply it to our lives? Are other religions valid in God’s eyes?

As humans, are we really born condemned to eternal punishment if it were not for some supernatural intervention or are we basically good inside and able to find our own way if we try?

How do we show our love for God and for our fellow man?

And these basic differences aside, there are a myriad of contentious interpretations and ideas that Christians struggle with:

Are the “gifts of the Spirit” for today? When will Christ return – before, during or after The Tribulation? Can you lose your salvation? Do you have to be baptized to go to heaven? Is it sprinkled or dunked? Should we pay a tithe to the church? Do we meet on Saturday or Sunday? Does the Bible have any mistakes? Can women be ordained? Should we pray to Mary and the Saints? Is it right to have musical instruments in worship services? Is the local church the highest organization or is an overseer of a group of churches the highest authority? What about the Pope? If you are a good person will you go to heaven? Do you have to go to church to be saved? Is sanctification a one-time experience or a process? Is it right to eat out on Sunday?

These questions are still being debated among theologians. You may have strong convictions about the answer to some of them, if not all. We caution you to be careful when you deal with these subjects in the course of your ministry. Emphasize the major themes of our faith, not the divisive points. Major on the major points of Scripture and minor on the minor…and prayerfully ask the Lord to show you the difference. We all need to consider our need for godly wisdom in the discharge of our ministry responsibilities in the nursing home. Please be careful not to put a stumbling block in the path of one of the residents who may not share your view on some point of doctrine.

Remember John 3:16!

For God so loved the world, that he gave his only begotten Son, that whosoever believeth in him should not perish, but have everlasting life.

Remember Mark 12:30-31!

And thou shalt love the Lord thy God with all thy heart, and with all thy soul, and with all thy mind, and with all thy strength: this is the first commandment. And the second is like, namely this, Thou shalt love thy neighbour as thyself. There is none other commandment greater than these.

What about the “other” religions showing up in our neighborhood?

While the idea of a cornucopia of human religiosity is very old, our awareness of its challenge to Christian faith is rather new in the United States. We are in a fundamentally different religious environment from what our grandparents or even our parents encountered. We can no longer think and speak in terms confined to Protestant, Catholic, and Jewish categories. The world we live in has changed. (Christianity Today; Jan 12, 1998; Clendenin, Daniel B.)

A Little History of the Christian Church.

In order to provide some background on how Christianity got where it is today, we provide below a brief overview of the history of how the Christian Church developed.

The death of Jesus of Nazareth should have put a quick and quiet end to what had been a minor religious disturbance in the smoldering tinderbox of Roman-occupied Palestine. There was no public outcry when the enigmatic Jewish preacher was executed after he challenged the religious authorities by declaring “the kingdom of God” at hand. His demoralized disciples had simply given up and gone home. Whatever it might have become, this tiny dissident sect of Galilean Jews had been decapitated and seemed destined to be quickly forgotten.

But as the New Testament tells it, the broken faith of Jesus’ disciples was restored as they were confronted by the risen Christ and as the Holy Spirit came upon them during the Jewish festival of Pentecost a few weeks later. Suddenly and dramatically, they began preaching boldly in the streets of Jerusalem that the resurrected Jesus was “both Lord and Christ.”

Within a few years, their message would echo through the cities and villages of Jewish Palestine, touching a chord with many but also creating turmoil within Judaism. After a few decades, the movement would begin to take hold in the commercial and cultural centers of the Greco-Roman “world”. And within a few centuries, what began as a grass-roots movement of Jewish peasants would become a powerful institution and a dominant force in Western culture. (U.S. News & World Report; Apr 20, 1992; Jeffery L. Sheler)

322 A.D. – Constantine Defeats His Last Rival. Seeks a restoration of the ancient glory of the Empire on the basis of Christianity. Persecution of Christians stops in Western Culture and Christianity becomes the main religion of the State. Seat of power moved from Rome to Constantinople. During most of his political career, Constantine seems to have thought that the Unconquered Sun and the Christian God were compatible – perhaps two views of the same Supreme Deity – and that the other gods, although subordinate, were nevertheless real and relatively powerful. Effects of Constantine on Christianity: an end of persecution; development of “official theology;” for selfish reasons, people flocked to what became the imperial church which many considered sinful and apostate; an age of religious “giants” ensued who shaped the church for centuries to come; pomp and circumstance and imperial protocol pushed the congregation into a less active role in worship; bone relics of martyrs and huge church buildings began to dominate Christian devotion and worship; clergy exempted from taxes. (Source: The Story of Christianity, Vol. 1; Harper and Row Publishers, 1984; Justo Gonzalez, pp. 120-126.)

520 A.D. – In the east, under Justinian, the state is seen as the Heaven ordained defender of the Christian faith and the protector of the Holy Catholic and Apostolic Church. In the west, the Pope (“papa”) of Rome has taken this authority. Rome’s religious leaders begin to gain political control. Eastern religious leaders are subservient to the emperor in Constantinople. In coming centuries, debates over theology begin to seriously polarize east and west: they quibbled about one word in the creed; they insisted on different practices for Lent; they disagreed over the type of bread to use in celebrating the Eucharist; they differed over the worship of icons (holy images), seen as windows into the divine by some and as idolatry by others; and of course, the Roman Bishop and the Bishop of Constantinople joust for religious supremacy. (Source: Church History in Plain Language, Word Book, 1982; Bruce L. Shelley, pp. 149-169.)

1054 A.D. – The great division between the Eastern (Constantinople) and Western (Rome) Churches: Representatives of the Roman Pope, Leo IX, excommunicate the Patriarch of Constantinople, Cerularius. Underneath this religious competition – Roman thought placed man in a legal posture with God , man is obliged to meet the demands of a just God, thus penance and purgatory develop whereby man makes restitution to God for sins. Eastern thought is dominated by the great theme of the incarnation of God and the re-creation of man in His image (man carries an “icon” of God within himself); hence, sin is not a legal infringement on God, but a reduction of the divine likeness, a wound in the original image of God. In Rome, the church is a formalized institution overseeing religious transactions between God and men’s souls. In the east, the church is seen as the mystical body of Christ invigorated by the Life of the Holy Spirit restoring man in an atmosphere of love to the likeness of God. Center of Eastern Orthodoxy ultimately moves to Moscow. (Source: Church History In Plain Language, pp. 159 – 169.)

1500-1650 A.D. – The Age of the Reformation. The New World is explored and colonized while Lutherans, Calvinists, and Anabaptists rise and flourish as religious movements in Europe.

Lutheranism: Salvation by faith in Christ alone; the Scriptures, not popes or councils, are the standard for Christian faith and behavior.

Calvinism: “Reformed” Christianity; Predestination – God is the Governor of all things. In his own wisdom, from the remotest eternity, he decreed what he would do, and by his own power, he executes what he has decreed. No one can be a true Christian without aspiring to holiness in this life. No man, whether pope or king, has any claim to absolute power.

Anabaptism: The Christian experience must go beyond inner experience and doctrines; it must involve a daily walk with God, in which Christ’s teachings and example shape a transformed style of life. Pacifists. Love is the Law – mutual aid and redistribution of wealth. All believers are priests and missionaries – very congregationally oriented. Separation of church and state – i.e., the right to join in worship with others of like faith without state support and without state persecution. (Source: Church History In Plain Language, pp. 255 – 281.)

1648-1789 A.D. – The Age of Reason and Revival. Reason takes the place of faith in Western Culture. The Methodist movement and “revivals” grow. (Source: Church History In Plain Language, pp. 327 – 370.)

1789-1914 A.D. – The Age of Progress. French Revolution, collapse of the Old Regime. The Church faces social unrest and the challenge of intellectual doubts (evolution). In the Roman church, the pope’s supremacy and infallibility declared. Modern missions develop. Evangelicalism and Fundamentalism are birthed. (Source: Church History In Plain Language, pp. 371 – 436.)

The Orbits of Current Christianity.

Given the preceding history of the Church, what follows is a general breakdown of the major orbits, or divisions of Christianity today with very brief and general descriptors.

High Church – Orthodox, Roman Catholic, Anglican, Episcopal.





Main Line Denominations – Lutheran, Presbyterian, Christian Church, Methodist, some Baptists.




Evangelicals – Baptists, Brethren, Nazarenes, Pentecostals, Charismatics.

Pastors are strong leader figures.

Authority focused on the local church.

Evangelizing (missions) stressed.

Experience oriented.

What are some of the mutual traits that exist in all the orbits of Christianity?

● Nominalism (“name only” Christians) is in every orbit.

● Fervent (serious-minded, devoted) adherents to the cause and person of Jesus Christ are in every orbit.

● Evangelicals (“soul-winners,” mission oriented) are in every orbit.

● Charismatics (energetic exercise of “gifts of the Spirit”) are in every orbit.

The move toward relational and functional unity in Christianity

I have given them the glory that you gave me, that they may be one as we are one: I in them and you in me. May they be brought to complete unity to let the world know that you sent me and have loved them even as you have loved me. THE PRAYER OF JESUS CHRIST ON THE EVE OF HIS PASSION. John 17: 22-23.

We bless God our Father, and our Lord Jesus Christ, Who gathers together in one the children of God that are scattered abroad. . . . We are divided from one another not only in matters of faith, order, and tradition, but also by pride of nation, class, and race. But Christ has made us one, and He is not divided. In seeking Him we find one another. FIRST ASSEMBLY OF THE WORLD COUNCIL OF CHURCHES – August 22, 1948.

The single, most effective tool for evangelism and affecting our world for Christ is for the Church to show them the supernatural love of God flowing between His children: a love that is centered in the practical, experiential work of Christ in each individual’s heart.

A new commandment I give unto you, That ye love one another; as I have loved you, that ye also love one another. By this shall all men know that ye are my disciples, if ye have love one to another.  John 13:34-35

We have found the population of care facilities in which we minister to be interdenominational, without exception. As a Christian who is given the great honor of ministry in these care centers, you also have the opportunity to experience and model this unity of love among a diverse group of His children. In this ministry God entrusts you with a most wonderful gift. Please, carefully steward this precious, priceless endowment.

Pure Religion – Merging ministry and religion for the residents.

It is most important that we bring “religion” and “ministry” together to meet the actual spiritual needs of the residents. A “religious activity” does not always constitute real “ministry” to spiritual needs. Consider the following two quotes:

If love is eliminated from experiments in prayer, they do not work as well. Love – compassion, empathy, a deep sense of caring – is often connected with a sense of oneness and unity between healer and healee. Prayer, then, often goes beyond the religious ideation and formal rituals with which it is often associated. It can be a state of being rather than a matter of doing – what might be called prayerfulness. (Saturday Evening Post; Nov 21, 1997; Dossey, Larry)

Pure religion and undefiled before God and the Father is this: to visit the fatherless and the widows in their affliction, and to keep oneself spotless from the world. (James 1:27)

With the opportunity of nursing home ministry, God also gives you an awesome responsibility as a nursing home minister: encourage the faith in Christ of the residents as they deal with circumstances and struggles they never thought they would have to face. They deeply need the strength of your love for Jesus to show. They deeply need your faith in the promises of God to show. They deeply need your Christian life to show in your touch, your attitude and your words. Take them the reality of your personal relationship with Christ and trust Him to meet you there!

Accentuating the Central Theme of Christianity – Jesus Christ

In closing this section, we stress again the common ground – the central theme – of Christianity: personal faith in who Jesus Christ is and what He did on our behalf. In all you do, in all you say, in all the time you spend in the course of your functions in the care center, keep the main thing the main thing.

As individuals, when ministering to the residents of a care facility, we certainly cannot possibly be prepared to accommodate each of the denominational and religious groups in their particular doctrines and liturgies, but we should seek to encourage each in their faith in Jesus Christ, a faith which we all share in common. More often than not, this is what the residents want! In “church services” and appropriate opportunities of Christian fellowship, we must seek, as volunteers, to provide activities that focus the residents on Jesus Christ, their faith in Him, and the Word of God, the Bible.

You do not have all the answers to all the questions you will face, but you know who does…and you can point the residents to Him. He knows the way through the wilderness. They are dealing with problems and situations that you can only imagine, at best. Many of the residents have terminal illnesses and they know it. Many of the residents are fighting against the fog of dementia. Many of the residents have no one else alive in their circle of close family and friends…they feel forsaken and alone. Give them Jesus, up close and personal. He has been there! He WILL see them through!

A Prayer for the Vulnerable and Their Caregivers

Our gracious Father, today we seek You on behalf of the millions of people who live in care facilities in our country. We pray for the elderly, the mentally retarded, those who have suffered severe injuries, and those ravaged by diseases like MS, cancer and cerebral palsy, all of them vulnerable and with little or no voice in the conditions of their life.

Father, we pray that You would protect them, that You would make Yourself known to them, and that they would feel Your presence. Would You whisper Your love and devotion to those who are helpless. Remind them that You are the Father of true mercy.

Send believers who know Your mercy to minister to them with caring human hands. Lord, we believe that even if we can’t communicate with them, You can and You do. Father, give us Your heart and Your eyes that we may see them the way You see them. Lord, send volunteers who will make themselves available to serve care facility residents as You direct.

We pray for the believers who work in these places. Manifest Your strength and endurance in them to bear the burden of caring for these people. May they be as wells, continually pouring out Your life-giving water. May the Light which You have put in them be a great blessing to co-workers, residents and family members alike. Instill Your love for the helpless in their hearts.

Jesus, You wept; may we weep too.

We pray all this in Your holy name, Amen.

(Adapted from a prayer by Paul Falkowski, Director, Desert Ministries. )

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