Honouring life’s final stage

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“My goal in spiritual care is to have each resident find meaning and purpose in their life, and to be with them in the moment,” says Barr, seen here leading a group hymn sing. Photo: Contributed

Is there a role for Christian faith in the way we do long-term care?

Second in a two-part series. Read part one.

High rates of COVID-19 infection and death in Canada’s long-term care homes have drawn increased attention to their quality of care, and have spurred announcements by provincial and federal governments of new measures intended to improve it, including billions of dollars in new spending.

But some Canadian Christians whose work has involved the pandemic, long-term care and reflection on society are questioning whether the situation calls for change beyond what money alone can bring.

The Rev. David Pfrimmer, a retired professor at Martin Luther University College’s Centre for Public Ethics and a Lutheran pastor, doesn’t think simply throwing money at the problem is going to solve anything. He says reform must be guided by principles of accessibility, social justice, ethics and comprehensiveness if true change is going to take place. He adds that there’s a need for post-traumatic stress disorder training, more personal support workers to help with long-term care in people’s homes, better palliative care, and in general, a more “human-resources” approach to care—one that includes the health and well-being of workers as well as residents. For example, most long-term care workers are women, Pfrimmer says, so staff child care and other gender-based issues should be key considerations for managers.

He also says “accompaniment and service” will be particularly important for churches moving forward, and helping to build community in a forever-changed world.

“There’s a certain sense that there’s a crisis of meaning due to the pandemic: ‘What’s my life about?’ ” he says. “As churches, we do have something to offer on the question of meaning and purpose. I don’t know if we’re doing it well.

“There is a healing that needs to go on—a collective healing. How do we put the world and people back together again after something like this? Churches can say something about that.”

The Rev. Michael Garner, an Ottawa priest and former infectious disease epidemiologist at the Public Health Agency of Canada, wonders if cultural trends in recent decades have encouraged a certain self-centredness in society, which there could be a role for the church in addressing.

“I wish that selflessness and that care for others was common,” he says. “I’m not against social media and TV—I don’t want to come off as railing against culture—but I think there is a way that some of this stuff turns you in on yourself, and you become the focus of your life.”

In contrast, Garner recalls a sermon he once heard in which the preacher spoke of Jesus’s selfless way of living as truly human—and of the lives most of us take to be normal as actually subhuman.

The pandemic has shone a light, Garner says, on widespread indifference to the suffering of many in long-term care homes, as well as other marginalized groups. He hopes these people won’t be forgotten once the pandemic recedes.

“I really worry that we’re going to get out of the pandemic and just go back to ignoring the groups that don’t have voices,” he says. “And certainly poor, elderly people with diseases like dementia have zero voice.”

The Rev. Ephraim Radner, a professor at the University of Toronto’s Wycliffe College, has reflected publically on the pandemic and its effects on a number of occasions, including an interview published on anglicanjournal.com in June 2020. There, Radner touched on the pandemic in relation to one unique facet of modern life in Western countries—the segregation and isolation of the elderly, who now tend to live together with other elderly people instead of with their families, as they have through most of human history. He also said a movement toward increasing “atomization” of individuals in Western society today—that humans are seen increasingly as units bereft of essential connections to family or church—was one reason why so many died alone during the pandemic, a pattern he called “blasphemous.”

Asked in a more recent email interview about the pandemic, the elderly and modern society, Radner said COVID-19 had shown, among other things, the “existential threats” posed by grouping the elderly into homes. He also said the absence of any idea of sacredness, or divine giftedness, of life in society today was related to the way we segregate the elderly.

“Our larger culture does not approach individual lives in terms of their sacredness and limits … but more in terms of this or that person’s membership in a collective or group, whose value is ordered according to various utilitarian criteria (economic, political, etc.)” he wrote. This grouping of people according to abstract criteria actually has the effect of reinforcing the isolation or atomism in which they live, he added.

It’s noteworthy, Radner wrote, that Christians in the West today have largely entrusted the preservation of human life to the care of secular institutions— institutions guided by values that are not necessarily Christian.

“Christians have mostly passed this set of concerns off to the secular medical and political-economic establishment, ones that have their own set of (often shifting) values that determine policy. And Christian social thought has tended simply to follow their leads and methods of evaluation,” he wrote.

“Perhaps we are being shown directions of concern that deserve renewed apprehension and pursuit,” he added. “It will be interesting—and probably a matter of our future judgment in the eyes not only of our descendants but of God—whether we take them up.”

The Rev. Deacon Michèle Barr is spiritual care coordinator for the Fred Douglas Society, a United Church-affiliated non-profit that operates a personal care home and other long-term residences for seniors in Winnipeg. A Lutheran, Barr also serves as honorary deacon assistant, organist and choir director at St. Saviour’s Anglican Church. She says her work for the Fred Douglas Society became more hands-on during the worst of the pandemic, when staff shortages had the home’s leadership team taking on new tasks—helping residents connect online with family, for example, and conducting health checks when staff come to work.

During a COVID-19 outbreak at the home last winter, loved ones would sometimes come to a resident’s window, so that they could at least see each other while they spoke on the phone. Watching them, Barr says, was both “sad and heartwarming.”

Barr, who normally leads weekly chapel services and group hymn sings, recalls Christmas Eve, 2020. The centre is normally buzzing with activity and visitors at that time of the year, and usually holds a full Christmas service. Last year, it was quiet. Visitors were not allowed. Residents stayed in their rooms. There was no gathering in the chapel, no singing side-by-side.

“So I sang over the PA,” she says. “By myself. In the chapel. It was very strange … one of the loneliest, most profound services I’ve ever done.”

As this article was being prepared for publication in mid-October, Barr said she was hoping the home would be able to offer more in the way of yuletide festivities for its residents and allow them to worship together this Christmas, but the unpredictability of COVID-19 was making planning difficult.

One thing the pandemic seemed to reveal to her and her colleagues, she says, was the importance to residents of regular family contact.

“We always knew it was important that the family connections be there, but when we couldn’t have them physically there we became aware of what a change that made to some residents, to how isolated they would feel, and confused,” she says. “We had to rethink how we do things so people aren’t feeling isolated, and we learned how detrimental that isolation can be for them.”

Some practices spurred on by the pandemic, like frequent video chats with family, will likely continue once the pandemic is over, Barr says. But it would also likely boost the well-being of elderly people in need of daily care if there were more financial support to allow them to live longer in their own homes, she said.

The fact that her residence is church-affiliated and puts a high priority on spiritual care seems to make a significant difference to its residents—even to those at such an advanced stage of cognitive decline that they might not appear at first to be receptive of it, she says.

“I find they really value that,” she says. “You can see somebody that looks like they’re really just not with it, with their eyes shut. You start saying the Lord’s Prayer, or a particular hymn—boom, the eyes are open and it just comes out!”

“For me, my goal in spiritual care is to have each resident find meaning and purpose in their life, and to be with them in the moment. I’ve seen that with all the staff here—the extra time they spend.”

The leadership team now has a deeper connection to each resident’s family, as they sit with them during Skype visits, Barr says, and many have learned how to do things like feed residents who need assistance when the centre is short-staffed. “When you’re feeding somebody and they’re looking in your eyes like that—and some of them can’t communicate—it’s a pretty intimate thing,” she says.

“This is their home, and we’re here to serve them. This could be our own mother or father or grandparent,” says Barr. “As a diaconal minister, getting in there and washing someone’s feet, so to speak, being with someone dying—that’s where I need to be. I help them feel not alone, to feel loved, and to honour the end of life.”

—with files by Tali Folkins

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Amy MacLachlan

Amy MacLachlan

Special to the Anglican Journal.

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