Spiritual care and freedom

Our duty of care in aged care settings includes monitoring access to vulnerable people. We’ve all experienced that well-meaning do-gooder or evangelist who intrudes on us ‘for our own good’, when actually motivated by some need within themselves.

It follows that to protect the freedoms of those in their care, some aged care managers are wary of those offering spiritual care.

Perhaps that good intention accounts for the forthcoming Commonwealth Aged Care Quality Standards mandate to provide services promoting ‘emotional, spiritual and psychological well-being’ (Standard 4(3)(b)).

Aged care settings have restricted access to spiritual care in part to protect clients’ and residents’ freedoms. But clients and residents need freedom in more ways than one. Every freedom from coercion implies a freedom for flourishing.

An analogy with food provision is helpful. On the one hand, duty of care entails operational considerations around hygiene, timely delivery, range and a variety of medical conditions. But these processes can inadvertently become a locus of control that denies an older person what free citizens take for granted. In addition to the freedom to say no, the freedom also to eat food cooked to our liking and to prefer the familiar or try something new, as the whim takes us.

Proving an experience of life that is both safe and free constantly challenges aged carers. Residential aged care managers navigate ‘food freedom’ within food safety through competent kitchen experts: people who know food and know the residents, and for whom it is their passion to enhance the experience of food. At their best, they break those cultures where food protocols are foregrounded oppressively. Their joy in food educates other staff toward a ‘culinary generosity’ toward residents.

Spirituality is analogous if only because for millennia, it has been compared to food. It is a fundamental need that can nourish and grow us, or starve and poison us. For example Jesus often compared himself to bread, and believed that soul-sustenance is every bit as important as bodily nourishment. If true, then the denial of spiritual care is arguably as abusive as starvation, especially as most people struggle to make sense of their messy lives as their end draws near.

Similarly, managers can only juggle this freedom-within-safety by deploying well-trained, self-aware spiritual carers, whose passion for their craft delivers spiritual care in ways that other staff cannot. Such carers will also educate other staff in what initially seems mystifying. As the end draws near, why do some people need their family while others long to look upon a tree? Why are some actually heart-sickened when a well-meaning staff member speaks of crystals, or divine judgment, or being ‘true to yourself’, or just averts their gaze and says nothing at all? Why do some long for a rite at death, while others want a particular kind of conversation? How may we gently listen—even when we don’t completely understand—then gently invite the person to meet someone who can help?

As the end draws near, the spiritual yearning of some is for the familiar and the known. Others yearn for something they cannot pinpoint and do not yet know. Yet others want simply to be left alone. Good spiritual carers read these hidden, subtle nuances, and interpret them collaboratively to the care team. They know what to do. They ease the burden for everyone offering care, and enhance the freedom of those in our care, right until their end.

Charles Sturt University offers graduate degrees in ageing and pastoral studies through its Canberra-based School of Theology partner, St Mark’s National Theological Centre. The courses are delivered flexibly, online and at low cost. Learners are coached in how to respond to emotional and spiritual care needs of diverse people in later life, whether of traditional faiths or of none.

About the author

Reverend Dr Andrew Cameron is the Director of St Mark’s National Theological Centre, teaching on ethical issues for people in later life and for health-care professionals.