"We don't advocate that people have to live forever. We're very blunt about this. They're free to die with dignity, which is something that is so pressing out there in the world."

So says Servants of Mary Sister Maritza Arce, who has been caring for elderly women and helping many pass from life to eternity for almost 18 years at Mary Health of the Sick --- a skilled nursing facility in Newbury Park.

Born in Puerto Rico, she met the Sisters, Servants of Mary --- an order founded in mid-19th century Spain to care for the sick and dying in their homes --- when her family moved to the Bronx in New York City, and entered the community at 19. After graduating from nursing school in Kansas City, Kansas, she came to the Conejo Valley convalescent hospital, working her way up from floor nurse to supervisor to director of nursing. After a two-year sabbatical, she returned to Mary Health of the Sick in 2001 as executive director.

"We're very comfortable with having the patients die here," the 46-year-old woman religious says. "None of the staff members shy away from it, because the sisters have taught them that it's OK to die. We rely on the teachings of Dr. Elisabeth Kübler-Ross and her stages of the dying process. But a lot of people come here, and they know that this is their last stage before they go to heaven. So it makes it easier for us, actually.

"Now the families are another story," she admits through a small smile. "We have to do a lot of spiritual counseling with them because they're not ready to let their mother or grandmother go --- no matter how old she is, no matter how much she's suffering. Your ego gets in the way, and you become selfish. So we have to work with them a lot."

Many times the residents at Mary Health of the Sick want permission from their children to die, according to Sister Maritza. And when they get it, the elderly often succumb peacefully.

But not always.

Last prayers and hymns

"I've witnessed that how you live is how you're going to die," she reports. "If you have been a very cantankerous and belligerent person all your life, you're going to go out with a fight. I've seen that so much. And if you lived with guilt, something that you didn't deal with when you were younger, that's going to be reflected when you're dying.

"A lot of the time, our patients can't verbalize their problem, but by their behavior you can tell. They're very uncomfortable, calling out constantly. There's an anguish that no medicine will take away."

After a moment, she finishes her thought: "And if they're a peaceful patient, I often ask the family, 'This lady was peaceful and quiet most of her life, right?' And 90 percent of the time they'll tell me, 'Yes.'"

Some dying individuals want to be left alone, while others beg the nursing staff not to leave them. But Sister Maritza says they try to be there at the moment of death. Usually, they pray with the person --- the Rosary and songs of the Blessed Mother for Catholics, Protestant prayers and hymns for other Christian denominations. A priest, minister or rabbi is often summoned, too.

Helping the frail elderly die with dignity, however, is just part of Mary Health of the Sick's ministry. The other crucial component focuses on holistic care for the living.

The 61-bed, 24-hour skilled nursing facility has offered long-term assistance to older adults since 1964, after Cardinal James Francis McIntrye had asked the Sisters, Servants of Mary, who were the first hospice volunteers in Europe, to open a convalescent hospital for older women.

Since then, more than 1,000 residents of all faiths have been cared for by the sisters --- trained RNs (Registered Nurses) and LVNs (Licensed Vocational Nurses) who own and operate the convalescent center with paid professional staff. Today, 13 of the 14 sisters who live in a convent on the grounds still provide hands-on care to residents.

Sitting on eight acres of landscaped grounds, the 36,000-plus-square-foot complex of single-story, sandy brick-and-stucco buildings includes a chapel with many stained glass windows, circular garden with koi ponds, mini-waterfalls and some 300 rose bushes, two large dinning/recreation rooms, a thrift shop selling clothes, furniture and antiques, and even a beauty shop.

Exercise and craft classes, pet visits, afternoon teas, variety shows plus the ever-popular bingo and card games keep residents busy. And that doesn't include special events like the Red Hat Society, where residents don bright red hats and purple boas for ice cream socials, a harvest moon ball complete with a queen and her court, and a Halloween parade.

Rejoicing at 'real' life

"What do I like about it?" asks Elizabeth Scott, who's been a resident at Mary Health of the Sick for nearly 2 1/2 years. "They treat us like humans. You have to adjust to it, like any place you've never been to before and you're all alone. But I've made a lot of friends here."

The 83-year-old Buffalo, N.Y., native enjoys dressing up with the Red Hats and reminiscing about old times. She also likes the flower-arranging workshops as well as playing bingo and cards.

"I was re-Catholized when I came here," she says, before chuckling. "I love the sisters. They come around and ask how you are. They really talk to you. The nuns are here day and night. Some of them work all the time, it seems to me."

Sister Claudia Rodriguez, an LVN, says she likes working with the frail elderly at Mary Health of the Sick. She describes her vocation as a special calling --- a mission.

"One of my joys is we are like the Blessed Mother at the foot of the cross," she explains. "Maybe a resident cannot respond because she is declining. So you are just there. Another joy is when they thank you. That's really God telling you through the resident things."

The challenge is watching so many new friends die. Being a nurse doesn't lessen her feelings as a human being. She confesses that sometimes it breaks her heart.

"But at the same time, it's a rejoicing because I know that this is not the end," Sister Claudia says. "This is the beginning of their real life.

"Also, it's beautiful because you're giving importance to these people even though they are old," she adds. "You are saying, 'Here you are very valued because you are a human being, and you are a daughter of God.'"