Spirituality in long-term care
Eleanor Feldman Barbera
Last week, a New York Times article referred to the lack of training to prepare doctors to recognize the spiritual needs of their patients. Hospital physician Robert Klitzman, M.D., emphasized in the Well section article the value of meeting these needs.
Psychology graduate school also avoided focusing on clients' spiritual needs, which were considered to be the province of those with formal religious training. Despite this, I've found that many of the conversations I have with residents can be considered spiritual work.
In the beginning of my LTC career, I quickly recognized that in order to be of service in this environment, I needed to come to a spiritual understanding of how such nice people could be dealing with such difficult illnesses. This led me to the book by Harold S. Kushner, “When Bad Things Happen to Good People.” The gist of the book, as I recall it, was that the question is not so much, “Why me, God?” but, “Why not me?”
That stance allows me to help people come to terms with their experiences and also to recognize very clearly that this could be me, or me down the road a few paces. I am merely assisting others as I hope someone will assist me when it's my turn.
Another spiritual aspect of long-term care is in the day-to-day dealing with the many personalities of the staff members and peers that residents encounter throughout the day, the need to cope with the rules and regulations of an institutional or semi-institutional environment, the necessity of medical appointments and procedures, the frustrations of declining physical abilities and on and on.
In this case, each day the spiritual task is to stay serene in the face of these challenges.
Finding a purpose in life within the LTC setting — when others are doing so much for residents — is another spiritual realm. I counsel residents personally and in my book, “The Savvy Resident's Guide,” to consider that although they might not be able to cook a meal or build a bookshelf, there is still much they can offer the world.
When they say “good morning” to a resident who is largely ignored or encourage a peer to attend an activity, this is important spiritual work. Having a friendly conversation with an aide creates good will that is likely to result in better care for the next resident. Their positive interactions are ripples that affect the community.
Serious illness also brings the opportunity to address important spiritual concerns. This includes discussions about the end of life and about the level of medical intervention they are willing to pursue. It may also involve conversations about their parenting work and how to prepare children and grandchildren for their death, as well as addressing beliefs regarding the existence of an afterlife.
Regardless of whether or not I've been working in a facility with a religious affiliation, I've found residents yearning for recognition of the spiritual aspects of their situation and deeply appreciative of the opportunity to address it.
Sometimes this occurs during formal religious services or in counseling with a psychologist or social worker, and sometimes this happens with an aide while getting personal care — most of the experienced and content staff members I've encountered over the years consider their profession to be not just a job, but a calling.
Eleanor Feldman Barbera, Ph.D., author of The Savvy Resident's Guide, is a 2014 Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is the Gold Medalist in the Blog-How To/Tips/Service category of the 2014 American Society of Business Publication Editors Midwest Regional competition. A speaker and consultant with nearly 20 years of experience as a psychologist in long-term care, she maintains her own award-winning website at MyBetterNursingHome.com.