Special Report: Give And Go

March 1, 2005       Matthew Sinclair      

Call it supporting a good cause, hedging one’s bets or cramming for the final exam, Americans tend to prefer donating to faith-based health care or long term care.

That’s among the results of a recent national telephone survey which found that two-fifths of 1,080 consumers polled indicated the faith-based aspect of a health care or long term care facility would positively influence their decision to donate to the group.

The three questions asked during a telephone survey, conducted in early January by Opinion Research for The NonProfit Times and its sister publication Contemporary Long Term Care, all related to faith-based organizations. More specifically, the questions asked about housing choices, charitable contributions and worship space design preferences.

These points were also among the study’s findings:

  • 22 percent of respondents indicated they were much more likely to donate if a facility was faith-based;
  • Another 18 percent said they were somewhat more likely;
  • 59 percent of respondents indicated that a health care or long term care facility’s reputation as being faith-based had at least some influence on their decision to use its services;
  • 15 percent indicated it had a great deal of influence on their decision;
  • 28 percent indicated it had no influence at all on their decision;
  • 29 percent of respondents said that they would prefer a facility had a room that could serve multiple denominations’ spiritual needs;
  • 60 percent indicated it wouldn’t matter;

The survey showed 22 percent of respondents indicated they were much more likely to donate to a faith-based group, and another 18 percent were somewhat more likely.

Those findings far outpaced the 10 percent who indicated they were much more likely to donate if such an organization was not faith-based. Another 11 percent of respondents answered that they wouldn’t donate to either type of organization.

James Towey, assistant to the president and director of the White House Office of Faith-Based and Community Initiatives, said the survey confirmed that Americans hold faith-based organizations in high regard. “(They have) excellent reputations in their communities,” he said, “and that’s why people will give money to them.”

He added, “It also shows that there’s only a small group of Americans who have a bias against them, and it’s really a fringe voice.” The fringe he pointed to were the 10 percent who said they were much more likely to give to a group that was non-faith-based.

Heartening to Towey was the consistent support across age groups. “I was very heartened to see a lot of young professionals, those in the 25-34 age range supported … and placed their confidence in health care and long term care providers (that are) faith-based.”

He acknowledged, however, that he wasn’t sure what to make of the finding that 15 percent of those 65 and older who responded indicated they wouldn’t give to either a faith-based or non-faith-based organization.

Towey was not surprised that the area with the least support was the northeast. “It’s been my experience, after three years in this job, that a lot of the voice that argues for a strict separation of church and state seems to come from Maine and Connecticut,” he said. Towey noted that the Blaine Amendments of the late 19th century, which blocked Catholic schools from receiving state aid, were initiated by a Maine congressman, James Blaine when he was Speaker of the House of Representatives.

Looking at those surveyed who indicated it didn’t matter whether a group was faith-based or not, Towey said that it confirmed the value of the faith-based office’s message. “(Americans) are interested in whether (an organization) is effective or not, not whether it’s religious.”

Janet L. Ramsey, associate professor of congregational care leadership at Luther Seminary in St. Paul, Minn., said that, with regard to donations, the most interesting group were the people in the middle ground. The largest segment (29 percent) indicated equal likelihood to donate to faith-based or non faith-based. In other words, it didn’t matter.

“For many people, it isn’t a factor either way and they’re looking for other things,” Ramsey said.

The likelihood of not donating to either rose with age, with 15 percent of respondents aged 65 and older an unwillingness to donate to either type of group. That age range also made up the largest segment of respondents who said they didn’t know how to answer the question.

While 15 percent indicated that an organization’s reputation as faith-based would greatly influence their choice for care, 22 percent of the respondents were much more likely to donate to the groups. “(It may be) the trust factor,” Ramsey speculated, adding that faith-based groups might be viewed as more likely to use the money well or ethically.”

“The bottom line for donations is a good cause,” said Sr. Joan Lewis, O Carm., director of pastoral care at Teresian House in Albany, N.Y. “If they’re faith-based or not faith-based, I don’t think it always goes into the equation.”

Looking at the age data, the same percentage of those aged 18-24 indicated they were much more likely to donate to a faith-based health care or long term care group as those who were aged 65-plus. (There was a smaller base of the young segment, however.)

Audrey S. Weiner, MPH, DSW, is the president and chief executive officer of the Jewish Home and Hospital LifeCare System, which has three campuses in the New York metropolitan area. She expressed little surprise that the survey found people were more likely to donate to a faith-based healthcare or long term care facility than not donate.

She said such findings pointed out three sets of issues. “(First, the belief) that the organization will use the money in a better way — that’s the general perception. Second is (the perception) that this is a higher quality facility, so the monies that I’m donating will have a bigger meaning. (And third) there are people who are very pleased to be donating to an organization where indeed their money is going to enhance religious and spiritual life.”

By region

The south seemed to put its money where its faith was, with 27 percent of those responding from the area indicating they are much more likely to donate to faith-based groups, which was slightly more than the west (25 percent). The south also posted the largest segment of respondents (21 percent) who were somewhat more likely to donate to faith-based groups, with the west and the north-central following again (both at 18 percent).

Of respondents from the northeast, 40 percent said that it didn’t matter whether the organization was faith-based or not. That response far outpaced the south (23 percent) as well as the west (29 percent) and north-central (31 percent).

For those who responded they wouldn’t donate to either, there was a surprisingly high number of southerners (13 percent), the same percentage as those from the north-central. Those findings outpaced the northeasterners (9 percent) and the westerners (6 percent).

Looking at education levels to the donation question, there was wider variation than exhibited on the choice question. Those who said they were much more likely to donate to a faith-based organization, tended to be without a high school diploma (26 percent), or just a high school education (25 percent).

Only 18 percent of those who graduated college indicated they were much more likely to donate to such an organization.

Those who answered that they were equally likely for faith-based or non faith-based, tended to be college graduates (35 percent). Those without a high school diploma responded at 23 percent, with little variation between those who graduated high school (27 percent) and those who didn’t finish college (26 percent).

Among those who indicated they wouldn’t donate to either, 13 percent were without a high school diploma. Those who graduated college were likely to at least donate; only 7 percent indicated they wouldn’t donate to either.

Ramsey called for more research to be done in this area. “It’s an extremely important topic,” she said. “We have to find out what really works and what doesn’t work. … Why would people give money but not send mother? (The) study is good because it raises questions.”

A place called home

No one doubts the prominence of quality care when a family determines which long term care facility is best for their loved one. For nearly three out of every five people (59 percent), however, a facility’s faith-based connection — either in name or in reputation — has at least some influence on the choice.

The survey found that nearly one-third (32 percent) of the 1,080 respondents indicated the faith-based aspect had either a great deal or a strong influence on the housing decision. Another 27 percent said the facility’s faith-based reputation had at least some influence on their choice of a care provider.

For 28 percent, however, the faith-based aspect had no influence whatsoever on their choice of a facility. In light of the reported importance of faith and moral values on the recent elections, that finding might strike some as surprising.

Sr. Peter Lillian Di Maria, O. Carm., director of the Avila Institute of Gerontology in Germantown, N.Y., said she was most surprised by the survey’s findings citing a lack of influence of an organization’s faith-based reputation. The age breakdown found that 27 percent of respondents older than age 65 were among those who considered faith-based reputation to have no influence. Indeed, 30 percent of respondents aged 55-64 reported that the faith-based aspect had no influence at all.

“I would have thought that (the oldest respondents) would be the lowest,” Sr. Peter said. “I’d hope that people would want to continue their faith, not that they wouldn’t be able to in a non-faith based (facility) … That’s all they’ll be able to hold onto is their faith.”

Ramsey, at Luther Seminary, said the findings did not undermine her belief that “older people tend to be more religious and interested in faith matters. … Gerontologists are still debating whether that’s all related to aging or if it’s (intergenerational).”

The survey’s findings on the housing question might say more about the value of quality care than religion or spirituality. Weiner of the Jewish Home, expressed little surprise regarding the findings of the choice question. “It’s close to where I would have expected it,” she said. “I think that faith-based organizations have always had associated with them a perception of high quality. … For some people it’s difficult to separate the two in thinking where to (decide to live).”

After quality care and medical and nursing, Weiner said, the most influential element in deciding upon a facility tends to be the environment. “Not just the physical environment,” she added, “(but) to what degree it is welcoming.”

When potential residents or their adult children arrive at the facility under consideration, they immediately assess the surroundings, look at the activities calendar, and try to imagine what it would be like to live there. “Would one’s mother or father feel comfortable with (the other residents) and would it make a more normal life while they’re here,” Weiner offered as common questions. “I think it’s in that context of how does it feel, what are the activities, who will visit my mom that goes to the decision around is this life here going to be a life (from which) she’ll have some value and meaning.”

Red vs. blue

The geographic aspects of the question, however, seemed to fit into preconceived notions about the nation. Those who considered the faith-based aspect having a great deal of influence were more likely to come from the south, while those who indicated it had no influence at all tended to come from the northeast.

More specifically, 12 percent of respondents from the northeast indicated that an organization being faith-based made a great deal of influence. In the south the same response came from 19 percent of respondents. The west and the northcentral states of the country posted 14 percent.

Among the northeast respondents, 33 percent indicated faith-based had no influence at all on their decision. The west had the lowest percentage (24) stating that it had no influence at all. In the south, 26 percent indicated it had no influence, and 30 percent of respondents in the northcentral region.

Though the numbers might reflect the opinion that people in the south are more likely to be regular service-goers, Weiner offered another possibility. “The northeast is blessed to have many excellent faith-based and other nonprofit organizations involved in health and human services,” she said. “Positive experiences with (non faith-based organizations) may account for the seeming disparity in the numbers.”

Ramsey said the geographic findings mirrored other studies on the issue, but she suggested the question has more facets than just geography. “If I had to put my mother in a badly run faith-based vs. an excellent non faith-based (the decision is simple).”

She added, “We’ve all seen such uneven quality of care … it gets mucky trying to answer these questions.”

Level of education didn’t seem to make much difference within answers. Among those who responded that faith-based made a great deal of influence on their decision, it was nearly as likely to be a person without a high school diploma (17 percent) as with a college degree (15 percent).

Similarly, among those who said faith-based had no influence at all, there was little difference among those with a college degree (31 percent) and those without a high school diploma (29 percent).

A place to worship

The third question asked about design, examining whether people preferred denomination-specific rooms for worship or those that could be used for different denominations. Overwhelmingly, respondents indicated it would not matter (60 percent), with those preferring rooms for multiple denominations taking up most (29 percent) of the remainder. “A room specific to my beliefs” only received 9 percent of the respondents.

“What has been my experience is that people are happy and content when there’s a respect in general for religious life and spirituality,” Weiner said. “Sharing, if it means the space or interfaith programs, isn’t the issue as long as it is (done) with respect.”

To Rabbi Judith Edelstein, director of religious life with the Manhattan division of Jewish Homes, the distinction might come down to people being more concerned with what they receive rather than where they receive it. “A lot of people are more concerned with the substance,” she said. “At this point in their lives, I don’t think the environment is important for them.”

She added, “It is, however, important for those who visit them. Family members ask if there’s a chapel, and I think the staff would like to have a chapel. … It’s a quiet place to go, more than anything else. It’s a place to not talk to anybody, (whereas) residents look forward to a space where there are other people they can see.”

Ramsey had expected more people to express interest in belief-specific settings for service. Ramsey said the response probably says more about ignorance than religious apathy. “I don’t think most people understand how important faith symbols are (for people with) cognitive deficiencies,” she said. “I think it shows we need to educate more about the spirituality of people with Alzheimer’s disease.”

Though respondents were not asked to describe themselves as religious or whether they worshipped within a specific denomination, such an inquiry might have shown interesting distinctions to this question in particular. Even among those interviewed, disparate opinions arose among different denominations.

In America, we tolerate one another’s beliefs,” Sr. Peter said. “I think we probably are … tolerant that if (a room) is the chapel for Catholic mass today (it can be used) for a Baptist service. … I don’t know if it’s the same if you ask people in their 80s and 90s.”

She speculated that the over-65 group might have further shifts with older respondents. Catholics in their 80s, for example, learned the rituals of their religion before the Vatican II changes were made in the 1960s, moving away from a Latin mass and literally turning priests around so their congregation could see them during the consecration. “It does help you have a sense of 15-20 years from now,” she added. “These are things that would spark my interest … As we’re designing and doing feasibility studies, we may need to have conversations about this now.”

“For me as a Catholic,” she added, “I would want to know that the Blessed Sacrament is there, because Eucharist is very important for me.”

Even among Christian beliefs, there are differences that non-practitioners might not notice, akin to the linguistic and cultural differences among people of Spain, Venezuela, and Puerto Rico. “You’re talking about worship, and worship is so completely different for a Baptist or an Episcopalian, or a Catholic,” Ramsey said. “It might seem we’re intolerant, but it’s because we’re so passionate about (our beliefs).”

“Overall my observation is that people who have faith cede some control over their lives to God,” said Rabbi Judith Edelstein, who is director of religious life with the Manhattan division of Jewish Homes. “They go with the flow more readily. … Those people who seem to have a lot of faith that I have observed seem to be adjusting to their circumstances more easily.”

Edelstein runs an ecumenical program that looks at how elders heal emotionally. By the very nature of living a long life, most elders have experienced significant loss.

“It doesn’t mean that they don’t suffer, but it makes them less self-absorbed. It helps them to transcend the situation somewhat.”

The entire staff of a facility was necessary to help elders “fill that emptiness with more sprit,” Edelstein said, not merely the clergy who tend to them. “The residents’ lives would be richer. … It has to be more than the clergy. It has to be a sense that the entire staff is involved. Not that everyone has to go around praying, but they have to make room for it and encourage it.”