MIT.CAL cooperative CCRC Research

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In the United States there are over two thousand Continuing Care Retirement Communities (CCRCs). These communities, also known as Life Plan Communities, offer a variety of long-term care options, allowing residents to access higher-level care as their physical and medical needs increase. The communities typically include Independent Living, Assisted Living, Skilled Nursing Care and Memory Care (America‘s Best Continuing Care Retirement Communities 2024: Methodology, 2024).

In most CCRCs residents are from 65 to 95 years in age with the average being around 80 to 83 years of age (Howley, 2024). Residents can buy-in to the life plan community while they are still able to live independently and then move to the next level of care when needed with no additional or at a known cost. Florida has 70 CCRCs with more than 31,000 residents (Marselas, 2023), and currently in Polk County, Florida, where I live, there are two CCRCs with about 650 residents.

Yet, as the residents of CCRCs’ lives progress and they need more physical care, they become more limited in their ability to access and be part of traditional worship experiences. Along with the limited ability to continue in their past traditional religious experiences, their spiritual needs increase as they face the loss of control of life, experiencing family dysfunction, guilt, loneness, fear of death and dying, and grief, among others. Because I am a resident of a CCRC, I wish to serve my community by first understanding our needs and then helping religious leaders in my area by providing them with an awareness of the community’s religious needs.

Currently this researcher believes there is a gap in our understanding of the religious needs of CCRC residents. The gap comes because some equate religious needs and spirituality (Koenig, et al., 2000) as the same concept. All people face the spirituality of life whether they admit or understand the idea. It is a personal quest. On the other hand, are there religious needs of some people based on their past religious traditions? Because 68% of the American population identify with a Christian religion (Gallup, 2024), this project will examine the residents’ needs through the lens of Christianity.

Further, this project will focus on the shepherding of residents of CCRCs who identify themselves as Christians. Shepherding includes “leading, nurturing, comforting, teaching, challenging, and/or protecting God’s people” (Kairos, 2020). William H. Willimon in his book Worship as Pastoral Care, (1979), mentions four functions of pastoral care: healing, sustaining, guiding, and reconciling, noting later that worship is a major yet neglected aspect of pastoral care. Often pastors and CCRC management believe that it is enough to have worship services on CCRC campuses, but as seen through the Kairos shepherding definition, there is much more needed. To that end I hope to find from CCRC residents what they believe is missing from their religious lives.

To gain an understanding of what the religious needs are, CCRC residents in Polk County, Florida will be surveyed using a pen and paper survey (not all residents have electronic access). This survey will be based on religious/spiritual surveys already being used by other researchers. Once the data is analyzed and interpreted by the researcher, it will be provided to local pastors and CCRC management through group and personal presentations. It is also hoped that pastors and church leaders will use this information to evaluate their ministry to older persons and those not able to attend traditional worship services.

In the days the Scriptures were written, people continued in their ‘work of life’ until the day of their death; there was no retirement mentioned in scriptures. Even the discussion of the Levites in Numbers 8:24-26 was about the repurposing of some duties of the Levites, not retirement as we know it in today’s world. Throughout the Scriptures, while age may be mentioned, there is no fixed age when a person reaches the prime of their life. Frank Stagg, in his book The Bible Speaks on Aging, (1981), notes that a person’s wisdom, character, competence, and maturity are not functions of calendar age, but on most occasions can be attributed to the ‘fear of the Lord.’ Stagg continues that any theology of age and aging needs to consider ‘all people die’ (Exodus 1:6) and ‘God lives on’ (Exodus 3:6 & 16).

In the New Testament Jesus’ ministry focused on the disadvantaged as He told his followers, “When the Son of Man comes in His glory… as a shepherd divides his sheep from the goats. And He will set the sheep on His right hand, but the goats on the left. Then the King will say to those on His right hand, ‘Come, you blessed of My Father, inherit the kingdom prepared for you from the foundation of the world: for I was hungry and you gave Me food; I was thirsty and you gave Me drink; I was a stranger and you took Me in;  I was naked and you clothed Me; I was sick and you visited Me; I was in prison and you came to Me.’ Then the righteous will answer Him, saying, ‘Lord, when did we see You hungry and feed You, or thirsty and give You drink? When did we see You a stranger and take You in, or naked and clothe You? Or when did we see You sick, or in prison, and come to You?’ And the King will answer and say to them, ‘Assuredly, I say to you, inasmuch as you did it to one of the least of these My brethren, you did it to Me’ (Matthew 25:31-40, NKJV).

As people age, their bodies begin to show the results of the fall of humankind with diminished physical and psychological abilities. As their lives diminish, they become part of the ‘least of these’ needing a shepherd who will care for them to the end. The Psalmist wrote, “He makes me to lie down in green pastures; He leads me beside the still waters (Psalms 23:2 NKJV), and many have done that by moving to CCRCs. Even in those green pastures many older people still experience the problems of loneliness, loss of a sense of meaning, how handle retirement, fear of death and dying, grief, and other spiritual and mental health needs. Many people living in CCRCs have the same request that Paul made to Timothy, as Stagg (1981) writes, “If we could hear them, many are making the same plea, not necessarily from jail but from the loneliness of wherever they are, the old home, nursing home, or wherever: “Do your best to come!””

Aging is part of human existence, and for many people during the last third of their lives, they are considered an ‘older person’ (Administration for Community Living, 2024). As gerontologist James Davies, Ed.D. (2008) believes, the Bible has three themes when it comes to aging: Divine Tribute, Definite Testing, and Distinct Triumph. Davies begins by looking at the distant past, a world where infant mortality was high, war and strife abounded and famine was always near, achieving old age was to be celebrated. As Moses was putting various laws together for the children of Israel, the Lord instructed him to add a law of Divine Tribute, “Stand up in the presence of the aged, show respect for the elderly and revere your God. I am the Lord” (Leviticus 19:32 NIV). 

Moses again recognized the life of the older person as he wrote, “All our days pass away under your wrath; we finish our years with a moan. Our days may come to seventy years, or eighty, if our strength endures; yet the best of them are but trouble and sorrow, for they quickly pass, and we fly away” (Psalms 90:9-10 NIV). Moses understood the Definite Testing of older people after leading the Israelites for more than 40 years. Ecclesiastes 12:1-7 lists several losses older people experience, to include loss of sight, hearing, and confidence, among others, as the end of their life comes near. 

And as the end of life nears, there is Distinct Triumph for the child of God. The apostle Paul writes: Therefore, we do not lose heart. Though outwardly we are wasting away, yet inwardly we are being renewed day by day. For our light and momentary troubles are achieving for us an eternal glory that far outweighs them all. So, we fix our eyes not on what is seen, but on what is unseen, since what is seen is temporary, but what is unseen is eternal (2 Corinthians 4:16-18 NIV).

Even in academic literature we see the importance of religion and spirituality in the lives of older people. In a review of the Rowe and Kahn’s Model of Successful Aging, researchers found that participation in religious activities such as being present at worship services, having others pray and praying for others, along with visits from religious leaders improved an individual’s ability to deal with physical illness, and that higher levels of religious commitment could impact depression recovery (Crowther et al., 2002). 

The concept of retirement for the masses is not a Biblical/Theological construct. National retirement (leaving a job and ceasing to work) is a modern-day concept that finds roots in Germany in the late 19th Century and followed in the United States in 1935 (Social Security Administration, n.d.). Pensions have been part of the retirement strategy of some people as limited military pensions were available as far back as 1781, in this country and expanded through all levels of government by the early 1900s (Short, 2002). During the early and mid-20th century many companies provided pensions which became a major source for retirement for many people. With more people having the opportunity to retire with pensions and social security, older people began looking for age-restricted communities in the last half of the 20th century. 

In 1960, “Del E. Webb pioneered the active adult concept with the idea that retirees should be able to live in a self-sustaining community with access to every amenity and necessity they could want or need” (Rocha, 2016). As more older people considered age restricted communities, there was a corresponding growth in CCRCs (Nelson, 2008). Many were started as not-for-profit corporations by religious organizations, but in the recent past the shift has been to a for-profit model where the focus on religion is lost. These communities, unless developed by a religious organization, did not have churches within the boundaries, forcing older people to leave their community to attend church. 

According to Gallup, using the averages of several 2023 polls, more than two-thirds of Americans identify with a Christian religion, either Protestant, Catholic or simply "Christian." Fifty years ago, that number was almost 90%. Along with the decline in religious affiliation, there has been a similar decline in church attendance, with less than one-third saying they attended church on a weekly basis (Gallup, 2024). 

Researchers note that in some cases religiosity increases with age (Lechler and Sunde, 2020), yet others found no age pattern in religious attitudes but a decline in religious participation due to health-related limitations (Ainlay et al., 1992). While the Gallup statistics focused on the broad group of Americans, there is a difference between generational cohorts not addressed here. 

With the average age of CCRC residents being around 80 to 83 years (Howley, 2024), many of the established residents come from the Silent Generation, and a growing number of CCRC residents are coming from the Baby Boomer Generation. Each of these cohorts have different views of religion. When the Pew Research Center (2014) asked the question about the importance of religion in one's life, they found 67% of the Silent generation felt it was particularly important, while only 59% of Baby Boomers did. When asked about church attendance, 51% of the Silent generation respondents report attending church at least once a week, while only 38% of Baby Boomers did.

Other researchers, such as Neil Howe and William Strauss, have looked at generations with a broader view. In their seminal work on generations; Generations: The History of America's Future, 1584 to 2069, (1991, Morrow: New York) and Millennials Rising: The Next Great Generation, (2000, Vintage Books: New York) they note that there are religious differences between generations, and generally people are becoming less religious. Neil Howe for his podcast Demography Unplugged with Neil Howe notes, “The share of the U.S. population that identifies as Christian continues to shrink, falling from 77% to 65% over the past decade” (Howe, 2019). More specifically, Pew Research (2019) found that between 2018-2019, 84% of the Silent Generation identified as Christian, 76% of Baby Boomers identified as Christian, 67% of Generation X did, and only 49% of Millennials identified as Christian. As far as attending church, the numbers were similar with 61% of the Silent Generation, 49% of Baby Boomers, 46% of Generation X, and only 35% of Millennials reporting that they went to church more than once a week or at least twice a month (Pew Research, 2019). Because “most seniors first join a continuing care retirement community in their mid-70s” (Crane’s Mill, 2024), the earliest that most Generation X’ers will consider CCRCs will be around 2037, and Millennials around 2053. For that reason, those generations will be out of the scope of this religious needs project.

Recent literature supports people attending church as a way to live longer. In a Harvard study published by the American Medical Association noted that people: “who attend church services more often actually have a better chance of staying alive in the long run. Researchers then noticed that the women who went to church services were thirty-three percent less likely to be in the group of those deceased when compared to those who never attended services. Furthermore, researchers found that the positive effect diminished as the study participants decreased their church attendance” (Lewis, 2018).

A study of middle-aged adults (future CCRC residents) found the same type of results for, “both men and women -- who attend church or other house of worship reduce their risk for mortality by 55 percent” (Vanderbilt University, 2017). Attending church helps people avoid loneliness. It is loneliness and isolation which can cause physical and mental illnesses, yet one of the biggest hinderance of older people attending church is transportation and mobility (Lewis, 2018).

Even when considering the socio/cultural aspect of retirement in CCRCs, religion is still important to some older people. And looking closer at these older people, it is noted that they are divided into generations by age which goes back to the discussion of age in the Biblical/theological section. But no matter where the person retires and lives or at whatever age they find themselves to be, they still need an earthly shepherd who will care for them to the end. 

The purpose of this non-experimental mixed methods study is to determine the perceived religious needs of residents living in CCRCs. Using focus groups, questionnaires, and data analysis, the religious needs of residents will be identified from their perspective and not based upon what they have been told they need by others.

Focus groups of residents currently living in the various CCRC levels will be used to identify a perceived list of religious needs. The identified needs will then be added to questions from currently reliable and validated surveys dealing with Christianity, such as the Spiritual Needs Questionnaire (Büssing et al., 2021), and/or the Spiritual Involvement and Beliefs Scale (Dong et al., 2018). Using a Likert scale to assess the opinions and attitudes of the respondents, a pen and paper questionnaire (not all residents have electronic access) will be created. The Likert scale is chosen because it does not require respondents to simply answer ‘yes’ or ‘no’ but gives them a five-point range of responses. In addition, the Likert scale allows the data obtained to be easily used with Microsoft’s Excel’s statistical functions.

A convenience sample will be used; the research target audience will be the CCRC residents living in Polk County, Florida. Based on information available from GuideStar (2024), a nonprofit data research company, there are approximately 648 residents living in the two CCRCs in Polk County. The first, Carpenter’s Home Estates, Inc. (1001 Carpenter’s Way, Lakeland, Florida 33809), has approximately 368 residents. The second, Florida Presbyterian Homes, Inc. now Westminster Lakeland (16 Lake Hunter Drive, Lakeland, Florida 33803) has approximately 280 residents.

Once an appropriate questionnaire with completion instructions has been created, it will be printed for distribution. On a chosen date, the questionnaires will be placed into the internal mailboxes at the two CCRCs. The number of questionnaires placed into an internal mailbox will be equal to the number of people living in the apartment or unit. Return of the completed questionnaires will be through a central collection box after one week. If necessary, a second collection, after a reminder, could be made at the end of two weeks. Based upon an average survey return rate of 33% (Lindemann, 2021), it is hoped the researcher will get more than two hundred completed surveys back. 

Because the project question is to examine the religious needs through the lens of Christianity, the responses will immediately be divided into two groups. The first group will be responses from individuals who identify themselves as Christian (i.e., a Christian religion, either Protestant or Catholic, or simply "Christian" (Gallup, 2024)). The second group will be of all other respondents who do not identify themselves as a Christian or being part of a Christian religion (i.e., Muslim, Hindu, Buddhist, Jewish or other folk/national religion). While there may be some consistency in the spirituality related questions, it is expected there will be a difference in the religious needs questions.

The first step in the analysis process will be data cleansing or more specifically looking for data collection errors or improperly filled out surveys. Simple corrections may be made by the researcher, but beyond that, the response may be disregarded which will reduce the number (n) of responses to the question. Once data has been cleansed, statistical functions, such as mean, median, minimum, maximum, and variance, will be used to summarize the sample data. These descriptive analytics will be used to create charts and tables to present the findings from the CCRC sample.

The researcher hopes to discover what the religious needs of older people living in CCRCs are, not the religious needs that local churches believe older people have, nor the needs CCRC management may want to present, but the needs of actual CCRC residents. Using mixed methods to study the religious needs, the researcher plans to hear from residents as they present their religious needs through a focus group. Then the created list of religious needs will be considered by a larger group of CCRC residents through a questionnaire. It is believed that the needs survey will demonstrate that there is a lack of religious community involvement and will further show as individuals age they are forgotten by the church. 

The project findings will be shared verbally to pastors and church leaders along with CCRC management: first in Polk County, Florida, and then beyond, if there is community interest. Along with verbal presentations, an in-depth written research report will be prepared for Kairos University. 

The report and its executive summary will be the basis for PowerPoint slide handouts that will be distributed to presentation attendees. To measure learning/knowledge gain, attendees will be given a pre and post assessment of their current understanding of the perceived religious needs of residents living in CCRCs. Finally, a tri-fold brochure will be created to advertise the findings of the study and how to contact the researcher for more information.

Baby Boomer: a term used to describe those who were born from 1946 to 1964. Ten-thousand baby boomers enter the ranks of retirement daily. Baby boomers remain economically and politically influential because of their large numbers and the relative prosperity of the U.S. economy during their working careers. However, many are facing serious financial challenges when they reach retirement age. (Investopedia Team, 2024). 

Christianity: the Christian faith, a religion based on the belief in one God and on the teachings of Jesus Christ, as set forth in the Bible. (Cambridge University Press).

Continuing Care Retirement Communities (CCRCs): a retirement complex/community that offers a range of services and levels of care. Residents may move first into an independent living unit, a private apartment, or a house on the campus. The CCRC provides social and housing-related services and often also has an assisted living unit and an on-site or affiliated nursing home. If and when residents can no longer live independently in their apartment or home, they move into assisted living or the CCRC's nursing home. (Administration for Community Living, 2020).

Older Person: an older person is defined by the United Nations as a person who is over 60 years of age. In the Unites States an older person is defined as a person who is over 65 years of age; the phrases “older adults” and “older people” refer to the same population. (Administration for Community Living, 2024).

Religion: an organized system of beliefs, practices, rituals and symbols designed (a) to facilitate closeness to the sacred or transcendent (God, higher power, or ultimate truth/reality), and (b) to foster an understanding of one’s relation and responsibility to others in living together in a community (Koenig, et al., 2000).

Shepherding: includes leading, nurturing, comforting, teaching, challenging, and/or protecting God’s people (Kairos, 2020).

Silent (born 1928-1945) / Traditionalist Generation (born 1925-1945): terms used to describe those who lived through the Great Depression and World War II who are generally characterized as cautious conformists who sought stability, worked hard, and thrived by not rocking the boat (Hall, 2023). 

Spirituality: the personal quest for understanding the answers to ultimate questions about life, about meaning, and about relationship to the sacred or transcendent, which may (or may not) lead to or arise from the development of religious rituals and the formation of community (Koenig, et al., 2000).  

                                       Religious/Spiritual Attitudes Survey©

Please Circle a Choice or Fill in the Blank. Attach additional pages if you need to.

Gender:                  Male                   Female              Another Gender Identity

Age:              

If you prefer not to give your age:  

          a. were you born before 1928  

          b. were you born between 1928 – 1945

          c. were you born between 1946 – 1964

          d. were you born after 1964 

Current Marital Status:       Single                Married                Widow/er

For complete survey information contact MIT.CAL Cooperative

Ainlay, S. C., Singleton, R., & Swigert, V. L. (1992). Aging and religious participation: Reconsidering the effects of health. Journal for the Scientific Study of Religion, 31(2), 175–188. https://doi.org/10.2307/1387007

Administration for Community Living. (2024, May).2023 Profile of Older Americans. https://acl.gov/sites/default/files/Profile%20of%20OA/ACL_ProfileOlderAmericans2023_508.pdf

Administration for Community Living. (2020, March 11). Glossary. https://acl.gov/ltc/glossary

America‘s Best Continuing Care Retirement Communities 2024: Methodology. (2024). https://d.newsweek.com/en/file/469060/abccrc-2024-methodology-updated.pdf and https://www.newsweek.com/rankings/americas-best-continuing-care-retirement-communities-2024/florida. 

Büssing, A. (2021). The Spiritual Needs Questionnaire in Research and Clinical Application: a Summary of Findings. Journal of Religion and Health, 60(5). https://doi.org/10.1007/s10943-021-01421-4

Cambridge University Press. (n.d.). Christianity. https://dictionary.cambridge.org/us/dictionary/english/christianity?q=Christianity

Crane’s Mill. (2024, May 20). What Is the Best Age to Move into a Continuing Care Retirement Community? https://www.cranesmill.org/blog/uncategorized/what-is-the-best-age-to-move-into-a-continuing-care-retirement-community/

Crowther, M. R., Parker, M. W., Achenbaum, W. A., Larimore, W. L., & Koenig, H. G. (2002). Rowe and Kahn’s Model of Successful Aging Revisited: Positive Spirituality-The Forgotten Factor. In The Gerontologist (Vol. 42, Issue 5). https://academic.oup.com/gerontologist/article/42/5/613/653590

Davies, J. (2008). A Practical Theology of Aging: Biblical Perspectives for Individuals and the Church. Christian Education Journal: Research on Educational Ministry, 5(2). https://doi.org/10.1177/073989130800500203

Dong, S., Fioramonti, D., Campbell, A., & Ebener, D. (2018). Validation of the Spiritual Involvement and Beliefs Scale in a college student sample. Journal of Spirituality in Mental Health, 20(2), 167–184. 

https://doi.org/10.1080/19349637.2017.1360169 

Gallup. (2024, March 29). How Religious Are Americans? https://news.gallup.com/poll/358364/religious-americans.aspx

Hall, C. (2023, November 21). The Silent Generation Period & Characteristics. https://study.com/academy/lesson/the-silent-generation-definition-characteristics-facts.html

Howe, N. (2019, October 28). The Generational Divide... Fewer Americans Going To Church. https://app.hedgeye.com/insights/78742-the-generational-divide-fewer-americans-going-to-church?type=policy

Howley, E. K. (2024, January 8). When’s the Right Time to Move Into a Continuing Care Retirement Community? https://health.usnews.com/senior-care/articles/whats-the-best-age-to-move-into-a-ccrc

Investopedia Team. (2024, June 8). Baby Boomer: Definition, Age Range, Characteristics, and Impact. Investopedia https://www.investopedia.com/terms/b/baby_boomer.asp

Kairos University. (2020). Doctor of Ministry Handbook 8.0, Appendix C. https://docs.google.com/document/d/1YC6V60KrMgXZoDmt9VgxibD4JQ-d-jeHezrmVY-Np1w/edit?pli=1

Kairos University. (2023). Master Assessment Rubric 10.0. https://drive.google.com/file/d/19AdgqDyzbVeGCUGJXuVolaBU75yvx9PO/view

Koenig, H. G., McCullough, M., & Larson, D. B. (2000). Handbook of religion and health. New York: Oxford University Press.

Lechler, M., & Sunde, U. (2020), Aging, Proximity to Death, and Religiosity. Population and Development Review, 46: 735-755. https://doi.org/10.1111/padr.12358

Lewis, J. (2018, April 2). Spirituality and Seniors: How Church Helps Seniors Live a Longer and Happier Life. https://media.ascensionpress.com/2018/04/02/spirituality-and-seniors-how-going-to-church-helps-them-live-a-longer-and-happier-life/

Lindemann, N. (2021, August 9). What’s the average survey response rate? Pointerpro.https://pointerpro.com/blog/average-survey-response-rate/ 

Marselas, K. (2023, June 29). CCRCs get new lease on life in Florida. Mcknights Long Term Care News. Northbrook IL. https://www.mcknights.com/news/ccrcs-get-new-lease-on-life-in-florida/

Nelson, I. (2008). Continuing Care Retirement Communities, The Columbia Encyclopedia, Sixth Edition. New York: Columbia University Press. www.encyclopedia.com.

Pew Research Center. (2014). Religious Landscape Study: Generational Cohort. https://www.pewresearch.org/religious-landscape-study/database/generational-cohort/

Pew Research Center. (2019). In U.S. Decline in Christianity Continues at Rapid Pace. https://app.hedgeye.com/insights/78742-the-generational-divide-fewer-americans-going-to-church?type=policy

Rocha, M. (2016, December 14). A Brief History of 55+ Communities. 55places.com. https://www.55places.com/blog/a-brief-history-of-55-communities#:~:text=The%20first%20age%2Drestricted%20community,community%2C%20dedicated%20exclusively%20to%20retirees

Short, J. (2002, September 30). “Economic History of Retirement in the United States.” EH.Net Encyclopedia, edited by Robert Whaples. https://eh.net/encyclopedia/economic-history-of-retirement-in-the-united-states/

Social Security Administration. (n.d.). Frequently Asked Questions: Age 65 Retirement. https://www.ssa.gov/history/age65.html 

Stagg, F. (1981). The Bible Speaks on Aging. Broadman: Nashville, TN.

Vanderbilt University. (2017, June 1). "Worship is good for your health, suggests study." Science Daily. www.sciencedaily.com/releases/2017/06/170601125239.htm

Willimon, W. H. (1979). Worship as Pastoral Care. Abington: Nashville, TN.