QC Peter Rozen’s submission to the Royal Commission into Aged Care Quality and Safety is only the latest in a series of bombshells. Quoting a KPMG survey report, Rozen has alerted Commissioners to estimates of unlawful sexual contacts within aged care settings amounting to a national average of some fifty per week, The Australian reported on 22 October.
No doubt this figure includes behaviours enacted by residents with impairments that cause disinhibition. Even so, the fact of it highlights an extremely stretched care infrastructure, worn thin by years of structural neglect, also reflected in COVID-19 deaths and several other systemic failures that multiply under the commission’s gaze.
The commission is likely to promote the utility of in-home care. But institutional care will remain fundamental to aged care for the foreseeable future. For anyone working within these institutions, what the commission is hearing has been obvious for years, just as calls for root-and-branch reform have come and gone.
Clearly, it remains proper to strenuously work toward amended policies, funding streams, carer training and other remediation. Nevertheless, from the perspective of spirituality, something deeper if intangible needs to be addressed.
‘Spirituality’ has become our culture’s catch-all term for those narratives and beliefs that bring meaning and that create value. There are many who know of meaning and value who would not identify as spiritual, of course.
Nevertheless, the interleaving of Western Christian beliefs, and lately those of other belief systems, with systems of care has extensively shaped them for the better. Our intuitions that the elderly are precious; that we should not abandon people to die; that we matter despite our productivity or agility; and even simply that we are all persons –do not arise from a vacuum. They became part of us after centuries of Western spirituality.
Some spiritual traditions regard it as common for evil to insinuate itself into social structures, even if no one individual is obviously evil. A related concept in social psychology is that ‘diffusion of responsibility’ conspires to rob us of our agency, so that in institutional settings we are far more likely to look on and even oversee evils that we would never tolerate in interpersonal or family relationships.
Given this human propensity – all too obviously evident in the overall deterioration of Australian aged care –spiritual care is also essential to the remedies.
Spiritual care does not merely consist in the wellbeing of a client group. The longest-standing examples of institutional spiritual care are found in the ‘chaplaincy’ traditions of Western militaries. The military chaplain does not only assist the wellbeing of the members, although that is of course core-business. He or she stands outside the chain of command, with latitude to act as confidante and advisor to a commander. In this role, they inform, make advocacy to and even challenge commanders, for the good of the service.
The royal commission’s findings suggest that institutional aged care needs such a role, in every aged care setting. The industry needs to re-consider its often standoffish or sceptical attitude to spiritual carers, and its siloing of them to a few bedside visits.
By consciously incorporating spiritual carers into care teams, and by giving these carers access to senior management to be their eyes and ears and sometimes even their loyal opposition –these are clear and easy means by which the shared values of an aged care setting can be affected in favour of older people, at every level in the organisation.
Of course, such privileges given to spiritual carers also demands the expectation that the carer will be adroit in their care of older people; boundaried and respectful in their collaboration with care teams; and cognisant of the manifold organisational, business and compliance demands upon management and governance.
Too often, spiritual carers have been naive and irritating misfits within systems they do not understand. Aged care needs better on this front, too.
Reverend Dr Andrew Cameron is the Director of St Mark’s National Theological Centre. His academic interests are in ethics and theology, and he teaches in the Ageing and Pastoral Studies program with the Charles Sturt University School of Theology. The program equips carers from the bedside to the boardroom, mentoring and challenging people with proven skills in spiritual care to become more effective in institutional settings. For more information, call 6272 6252.