Msgr. Charles Fahey has worked in the university classroom, boardrooms and the halls of Congress. No matter the venue, he has delivered the same message: The needs of the frail elderly are medical, economic and social. Frailty in old age, according to Msgr. Fahey, has consequences for individuals, families and society at large.
Msgr. Fahey has challenged health care providers and public policy makers to respond with solutions that the elderly themselves support. He has advanced a patient-centric approach that underpins the support services and home health services that enable many frail elderly to remain at home throughout their lives, or, at the very least, to delay nursing home placement.
"That will be his legacy — creating a vision of long-term care that is not institutional," said Kathryn Ruscitto, president and chief executive of St. Joseph Hospital Health Center in Syracuse, N.Y. "He took us down the path of thinking about home care, thinking about (the) independence," of individuals who are aged and medically compromised.
For his contributions to health care and public policy, Msgr. Fahey is a recipient of CHA's 2012 Lifetime Achievement Award.
Road to the White House
Msgr. Fahey did not set out to become an expert on the elderly. In a personal note on his website, he recalls the time in 1961 when that path opened to him. The bishop of Syracuse unexpectedly transferred the young priest from a parish to Catholic Charities in Syracuse, where he went to work for Msgr. Daniel Lawler. Msgr. Lawler was a delegate to the first White House Conference on Aging, an event held that year by the John F. Kennedy White House. Msgr. Fahey credits that symposium with putting aging on the nation's radar during an era of tumultuous social change. In 1965, the Lyndon B. Johnson administration would alter the nation's social service and safety net for seniors with the passage of Medicare and Medicaid.
The late Msgr. Lawler encouraged Msgr. Fahey to concentrate his graduate studies in aging at the National Catholic School of Social Service at the Catholic University in Washington. Msgr. Fahey said that experience prepared him for program development roles in the Syracuse diocese and it introduced him to the Commission on Aging of the National Conference of Catholic Charities, the National Council on Aging and the American Association of Homes and Services for the Aging.
As assistant director and later director of Catholic Charities in the Diocese of Syracuse, Msgr. Fahey helped open five diocesan nursing homes and create the Christopher Community, a nonprofit organization affiliated with Catholic Charities that developed specialized housing for the elderly and disabled. He was a charter member of the Federal Council on Aging and served during the administrations of Presidents Richard Nixon, Gerald Ford and Jimmy Carter. He chaired that group as well as the National Council on Aging, the American Society on Aging, the American Association of Homes and Services for the Aging and Catholic Charities USA. He served on the National Commission for Quality in Long Term Care and helped lead the White House Conferences on Aging in 1971, 1981 and 1995. Msgr. Fahey represented the Holy See at the 1982 World Assembly on Aging; he was the U.S. delegate to the United Nations Second World Assembly on Aging in 2002. He's served on the CHA board and the boards of numerous health systems and charities. Today, he is active on the boards of the National Council on Aging and ArchCare, the Continuing Care Community of the Archdiocese of New York. He also is a program officer of the Milbank Memorial Fund, an organization involved in national and international health policy.
A field, not an industry
Throughout his career, Msgr. Fahey has provided insight into the suffering associated with poverty, powerlessness and insecurities associated with old age. When liberal and conservative politicians have sought his advice, Msgr. Fahey framed aging issues in the context of social justice and the public good.
"He has the capacity we all need to look forward and see the kind of care we want to offer to be successful," said Mark Kator, president and chief executive of Isabella Geriatric Center in New York City, where Msgr. Fahey served as a board member. "He has taught me about aging, the need for sound public policy, and above all, what is right. In this last regard, Msgr. Fahey has caused me, and I suspect many others, to use an ethical screen first when it comes to making decisions, or helping others do so. He is a legend in our field, and it is always Chuck who reminds us that we work in a field, not an industry."
Msgr. Fahey has tried to impart that ethic to generations of students as Marie Ward Doty Professor of Aging Studies (now emeritus) at Fordham University in New York City, where he founded the Third Age Center in 1979. Msgr. Fahey coined the term "third age" to refer to the period after the normal period of reproduction when cellular renewal and repair cannot keep up with its degradation.
According to Msgr. Fahey, it is a time in which one's spirituality becomes more significant, heightening the responsibility of all who minister in this area. Social and economic changes occur too during the third age. People retire and spend down their savings, sometimes outliving their financial resources. Significant others and friends may die. Adult children may move away, leaving an elder with a limited personal support system. When men and women grow older, progressive, intermittent frailty may become more debilitating ultimately leading to death. The trajectory can be taxing physically and financially as dependence on medical and support services increases.
Msgr. Fahey holds that society must ask whether individuals who live to old, old age can be expected to have accumulated enough wealth in their working years to pay for years of increasing dependency on medical care and other services.
Health care providers, according to Msgr. Fahey, should guard against becoming desensitized to needs of the elderly lest their relationship with elderly patients become more transactional than personal and they come to define these fragile patients by their physical infirmities.
The onus of caring for the individual's needs is not on the medical system alone. Msgr. Fahey says that as a society, the U.S. needs to respond with better medical care, housing and palliative and hospice services that recognize a person is more than the sum of his or her ailments.
Ruscitto, the head of St. Joseph Hospital Health Center, met Msgr. Fahey 35 years ago just after she graduated from college. He became her friend and mentor. Because of Msgr. Fahey's influence, she thinks about the difference between transactional and relational medicine daily.
"I've learned so much from him about advocating for frail elders, for having a vision," said Ruscitto. "He forces people in systems to reflect on their behavior and intent," she said. "Over the years, he has said, 'Wait a minute, is this really what frail elders want?'"
At 79, Msgr. Fahey possesses a wicked golf swing and quick wit. Still, he is no stranger to "intermittent frailty." His own experiences with the health care system reinforce his belief that health care providers can do better by their elderly patients.
"Rarely have I interacted with a doctor in a way that I would describe as totally human," said Msgr. Fahey. "Doctors are, by and large, technicians; and they don't take the time" to connect with patients.
After working in the field of aging all his life, Msgr. Fahey is still learning what it means to grow old. While it's axiomatic that wisdom comes with age, Msgr. Fahey maintains that wisdom takes work. "Wisdom is a gift of the Holy Spirit, and it's a discipline. It isn't intuitive. But the more real life experiences you've had, the more you've prayed, the more you've studied, the wiser you can be in terms of making practical judgments in difficult situations. I would hope that I am continuing to learn," he said.