The below is a short, edited excerpt from my dissertation on Chaplaincy in Residential Aged Care in Australia.
An outline of a new Person-Centred, Multi-faith Chaplaincy Model for Residential Aged Care.
The proposed Residential Aged Care (RAC) chaplaincy model is grounded in the principles of person-centred care, recognizing the inherent worth and dignity of each individual and prioritizing their unique spiritual needs and preferences. It aligns with the philosophy articulated by Kitwood,[1] emphasizing the importance of preserving personhood and individuality in dementia care. As Kitwood puts it, "The person with dementia is not a collection of symptoms or a recipient of care, but a unique individual with a rich inner life, capable of experiencing a wide range of emotions, thoughts, and spiritual connections." This understanding of personhood seeks to challenge traditional medical models that too often focus on deficits and limitations, instead seeking to see beyond the disease and recognize the enduring humanity of the individual - a divine image bearer.
The model also seeks to embrace a multi-faith approach, acknowledging the diverse spiritual and cultural backgrounds of residents and promoting an inclusive environment where all beliefs are valued and respected. This model aligns with the findings of Mudge, Gilchrist, and Lawson,[2] who highlight the importance of providing multi-faith spiritual care in attempting to meet the diverse needs of residents in RAC settings. Their research underscores the ability of chaplaincy to create spaces where individuals from various faith backgrounds, and none, along with those who identify as "spiritual but not religious", can find solace, meaning, and connection.
The model further seeks to emphasize the importance of collaboration, both within the aged care facility and with external partners and groups. This collaborative approach aligns well with the recommendations of Fitchett,[3] who underscores the significance of spiritual care as a component of whole-person care. Fitchett rightly in my view, argues that "spiritual care is not an optional add-on, but an essential dimension of holistic care that addresses the fundamental human need for meaning, purpose, and connection." This challenges the compartmentalization of care, encouraging the integration of spiritual support into the broader framework of physical, emotional, and social health and well-being.
Key Components of the Model
Person-Centred Spiritual Assessment: The core of the model is a comprehensive and individualized spiritual assessment that seeks to gain an understanding of the resident's religious background, spiritual beliefs, values, sources of meaning and hope, along with any specific spiritual care needs or preferences.
The assessment should, of course, be conducted with cultural sensitivity and respect, and the chaplain should utilise appropriate language and communication tools. The Assessment is not a "tick and flick" exercise, and may be conducted over several meetings with the resident as the chaplain gains an understanding of who they are and how best to support them, over weeks rather than in a one off session.
The insights gained during the assessment should inform the development of a personalized spiritual care plan that reflects the resident's unique needs, background and preferences. This approach aligns with the recommendations of O'Connor, Cobb, and Puchalski,[4] who promote the importance of addressing spiritual distress in older adults through a framework that considers their cognitive abilities, life history, cultural heritage, and spiritual framework.
Multi-faith Chaplaincy Team: The model promotes the establishment of a multi-faith chaplaincy team, ideally comprising chaplains from diverse faith traditions, as well as individuals with expertise in secular spirituality and humanist approaches to pastoral needs. This team approach seeks to ensure that residents have access to spiritual care that is relevant and meaningful to their individual beliefs and practices. The chaplaincy team should also work collaboratively to develop and implement interfaith and multi-faith programs that foster a sense of community and belonging for all RAC residents and families. This collaborative, multi-faith approach resonates with the findings of Mudge, Gilchrist, and Lawson,[5] who point to the benefits of interdisciplinary and interfaith collaboration in providing spiritual and pastoral care in RAC settings.
Specialized Training and Education: Chaplains working within this model should receive specialized training in gerontology, dementia care, cultural competency, interfaith dialogue, and trauma-informed care, in addition to already expected training in theology and pastoral care and counselling.
Having this additional training will equip chaplains with the knowledge and skills needed to provide effective spiritual care to a diverse and multicultural population. Continuing education opportunities should also be provided to ensure that chaplains remain up to date with the latest research and best practices in the field. The importance of specialized training aligns with the advice of Cobb, Puchalski, and Rumbold,[6] who advocate for evidence-based approaches to spiritual care in healthcare settings.
Collaboration and Integration: The model seeks to emphasize the importance of collaboration between chaplains and other members of the aged care team, including nurses, social workers, psychologists, along with allied health professionals. This approach seeks to ensure that spiritual care is integrated into the broader care plan and that residents receive holistic support that addresses no only their physical, emotional, and social needs, nut also their spiritual needs. Chaplains should also work closely with families and caregivers, providing them with information, support, and resources to navigate the challenges of dementia care. This approach aligns with the person-centred philosophy advocated by McCormack and McCance,[7] which emphasizes the value of working in partnership with individuals and their families to provide holistic all of person care.
Community Engagement: The model encourages chaplains to engage with the broader community, fostering partnerships with local faith communities, community organizations, and volunteer groups. This engagement can provide a pathway to provide additional resources and support to residents, along with opportunities for intergenerational connection and social participation. Chaplains are also encouraged to play a role in raising awareness of dementia and reducing stigma within the community.
Technology Integration: The model promotes the potential of technology to enhance spiritual care in RAC settings. Tele-chaplaincy, virtual reality experiences, along with online spiritual resources can help to overcome barriers to access and provide new avenues for spiritual connection and engagement. This is particularly important for residents with mobility limitations or those living in rural and remote areas. We have also seen with the advent of Covid 19 how quickly access and support services can be be limited, and future pandemics are a matter of when, rather than if.
Chaplains should be trained in the ethical and effective use of technology in spiritual care and should explore innovative ways to utilize these tools to meet the evolving needs of residents. The use of technology in spiritual care gained prominence during the COVID-19 pandemic, due to the sudden need to adapt to circumstance. This transformation has been highlighted by Piderman, Hamilton-West, and Liu,[8] who explored the experiences of chaplains providing telehealth spiritual care during this time.
Advocacy and Social Justice: Finally, the model encourages chaplains to be vocal advocates for the rights and dignity of older adults, particularly those living with dementia. This might involve raising awareness of elder abuse and neglect, promoting policy changes that improve the quality of aged care, and supporting residents and families in accessing the resources and services they need. Chaplains also have a role to play in challenging stigma and discrimination associated with dementia, fostering a more inclusive and compassionate society.
Theological Reflections
This person-centred, multi-faith chaplaincy model resonates with core Christian theological principles that affirm the inherent dignity and worth of every human being, regardless of age, ability, or belief system. The model's emphasis on compassion, empathy, and active listening echoes the teachings of Jesus, who consistently reached out to the marginalized and vulnerable, offering them healing, hope, and unconditional love.
The model's embrace of diversity and inclusivity is reflective of the biblical vision of a "great multitude that no one could count, from every nation, tribe, people and language, standing before the throne and before the Lamb" (Revelation 7:9). This vision challenges us to create communities of belonging where all are welcomed and valued, regardless of their faith background or spiritual journey, for we are all divine image bearers and worthy of the care, dignity and respect that demands.
The model's focus on collaboration and partnership reflects the interconnectedness of human life and the importance of working together to create a more just and compassionate world. As Saint Paul reminds us, "we are all members of one body, and each member belongs to all the others" (Romans 12:5). This interconnectedness calls us to move beyond individualistic approaches to care and embrace a collaborative ethos that recognizes the contributions of all members of the aged care community.
Conclusion
This short outline has proposed a new model for chaplaincy in RAC. One that is grounded in person-centred care, embraces multi-faith inclusivity, and fosters collaboration to address the complex spiritual needs of a diverse and aging population. The model emphasizes the importance of specialized training for chaplains, collaboration with other members of the aged care team, community engagement, technology integration, and advocacy for social justice. The implementation of this model has the potential to transform spiritual care in RAC settings, ensuring that all residents have access to compassionate and meaningful support that honors their unique spiritual needs and preferences.
[1] T. Kitwood, Dementia reconsidered: The person comes first (Open University Press, 1997).
[2] D. Mudge, A. Gilchrist, and L. Lawson, “Multifaith Spiritual Care in Residential Aged Care: A Qualitative Study of Chaplain and Staff Perspectives,” Journal of Religion, Spirituality & Aging 30, no. 4 (2018): 315-332.
[3] G. Fitchett, Assessing spiritual needs: A guide for caregivers (Augsburg Fortress, 1993).
[4] D. O'Connor, M. Cobb, and C. Puchalski, “Spirituality and Aging: A Research Update,” Journal of Religion, Spirituality & Aging 22, no. 1-2 (2010): 120-141.
[5] Mudge, Gilchrist, and Lawson, “Multifaith Spiritual Care in Residential Aged Care.”
[6] M. Cobb, C. Puchalski, and B. Rumbold, Spirituality in health care: An evidence-based guide for improving patient care (Oxford University Press, 2012).
[7] B. McCormack and T. McCance, Person-centred nursing: The theory and practice of nursing (Wiley-Blackwell, 2010).
[8] A. Piderman, K. Hamilton-West, and C. Liu, “Telehealth Spiritual Care During COVID-19: Chaplain Experiences and Lessons Learned,” Journal of Pastoral Care & Counseling 75, no. 2 (2021): 112-121.