As with other healing orders that have ceded control, the Franciscan Sisters of Mary prepared for their inevitable detachment from SSM with more planning than sentiment.

“We can’t be maudlin about this,” said Sister Mary Jean, 73, who still presides over the company’s board. “I mean, yes, we are a dying breed. We are disappearing from the face of the earth and all of that. That being said, perhaps this is a moment for people to acknowledge the contribution that has been made by women religious throughout our history in the United States.”

The leadership shift has stirred angst in many Catholic hospitals about whether the values imparted by the nuns, concerning the treatment of both patients and employees, can withstand bottom-line forces without their day-to-day vigilance. Although their influence is often described as intangible, the nuns kept their hospitals focused on serving the needy and brought a spiritual reassurance that healing would prevail over profit, authorities on Catholic health care say.

In the case of SSM, that has meant turning away business arrangements with doctors who decline to accept Medicaid. It has meant discounting treatment for the poor and offering charity care to the uninsured, just as the order’s founders did. The St. Louis nuns’ earliest ledgers denoted patients unable to pay as “Our dear Lord’s.”

The near extinction of nuns from American hospitals stems largely from the drastic decline of religious orders that accompanied the women’s movement, the sexual revolution, ethnic assimilation and the Second Vatican Council’s opening of the church to lay leadership.