What do we mean by spirituality?  Spirituality can include religious faith and practices, but can also be experienced and understood in non-religious ways as well.  A definition that I like is:

Spirituality is the aspect of humanity that refers to the way individuals seek and express meaning and purpose and the way they experience their connectedness to the moment, to self, to others, to nature and to the significant or sacred (emphasis mine).*

I like this definition because it speaks to two essential processes of the spiritual journey of aging—continuing to find meaning and purpose in living and staying connected and engaged with oneself, others, and the larger world.  This definition also lends itself to some basic questions we can seek to answer with the older adults we serve:  Can they articulate what brings them meaning and purpose?  If they can, how can we support those activities or beliefs?  If they can’t, are there experiences or relationships that we could invite them to that would help them find an answer to that question?  And are there ways in the programs that we develop to help elders continue to build new and meaningful connections with others, themselves and the wider world?

When we view our services to older adults through the lenses of “meaning and purpose” and “connectedness” we can bring supporting the spiritual journey of aging into everything we do.  This definition also helps us to take spirituality out of the realm of the ambiguous and amorphous into the realm of practical practices and programs.

And because, I believe that all of us who work with older adults need to be attending to our own spiritual journey of aging, it also provides us with some questions for reflection.  What is bringing meaning and purpose to my life?  And how are my connections to the moment, to self, to others, to nature and to the significant or sacred doing?  As we wrestle with these questions for ourselves and with those we serve we will find all sorts of creative ways to support the spiritual journey of aging.

*  (Definition from Consensus Conference:  Improving the Quality of Spiritual Care as a Dimension of Palliative Care, held Feb. 17-18, 2009, Pasadena, CA.   Sponsored by the Archstone Foundation.)

Her story brought back memories of my own childhood, where playing in the sprinkler was the only way to be cool on hot summer days. And I remembered the time my dad took us kite flying in the middle of the day. And it brought back the memory of the time my brother and I played in mud puddles with great abandon—soaking our shoes and our clothes with muddy water—much to my mother’s chagrin. But it was such fun.

The problem with adulthood is that we get so serious. The responsibilities of job and family seem to rob us of the ability to engage in spontaneous and silly fun. We are, after all, productive people with serious business to attend to. We forget about playing in the sprinkler or making mud pies. We aspire to the neat and orderly rather than random, fun messiness.

In so doing we miss the spirit lifting opportunities that fun and play provide. Working with older adults is a serious business and there are serious issues that we navigate with them each and every day. We need to do that. But I also think we need to allow space in our lives for fun and play, for wonder and joy.

My memories of summer fun seem to involve water, ice cream, watermelons, music and games. What are your memories of summer fun? How can you find some fun this summer? And how can we encourage summer fun for the elders we serve so that all of us will have at least one moment of childlike wonder and joy?

— Nancy Gordon, CSA director

One of the major values that spirituality brings to the health care table is an emphasis that the caregiver cannot (and really should not) fix everything. While a nurse might be able to “fix” a headache with a prescribed medication (and should definitely try, that same nurse cannot ‘fix’ the spiritual pain that a resident/patient/client/faith-group-member might be experiencing.

The “cure” that comes from spirituality is through insight, not just information. It is an insight that cannot be taught or given or even prescribed. The person, the one in crises, can only discover insight themselves in their own terms and in their own timing.

Two years ago I was completing a long period of psychotherapy and I was experiencing a
breakthrough. Suddenly I could see my past, my present, and myself. Suddenly the long
depression began to lift. It felt like a new day was dawning in my life until I read a personal journal entry written over a year before, when I was caught in the mire of depression, and doubt, and struggle. There in that ancient journal entry, in my own words, was the very insight that I was celebrating as being ‘new’ today. I had been saying the right words for a long time, but the words had not captured my heart, only my head. Until the new vision was embraced by my heart, my soul, the words remained only words. But when the heart was engaged the long spoken words exploded into a life-changing insight. I don’t think that I am alone in my experience. In fact, I believe that such is the human experience. While information is crucial, guiding, providing structure, it is insight that sets fire to the soul and gives a grounding for living that is beyond mere knowing and thus is more lasting.

It would be ludicrous to even hint that spiritual care should replace traditional care that is based on the bio-medical paradigm. I want my health care workers to do all in their power and skill to assist me to live with a body that will do the many things that I love to do. At the same time, however, spiritual care brings an additional dimension to caregiving.

Instead of seeking to fix the problem every time, spiritual care seeks to learn from the problem and grow in the problem. Instead of managing and controlling, spiritual care is open and receptive. In place of solving things now, the spiritual caregiver waits expectantly, even hopefully. While traditional care might encourage action, spiritual care focuses on reflection and a search for insight. Spiritual care is more concerned with listening than fixing. Spiritual care is sensitive to what is breaking into life, changing life, renewing life, not with returning life to the way it has been.

When my younger daughter was about four, she was sitting at the eating bar in our kitchen/family room as I worked on meal preparation. We were involved in a conversation that I thought was going fine. But she brought me up short when she said, “Mom, I need you to listen to me with your eyes.” I realized that I’d been only half listening as I did my work and I certainly was not looking at her and giving her my full attention. When I worked in a retirement community and was in daily contact with older adults, I often found myself in much the same position. I was listening, but I was also thinking about how this conversation was making me late to the meeting I was on my way to or I continued with my task of setting up a room for an event or folding bulletins as the conversation proceeded. It was ironic that often the people I was there to serve seemed to get in the way of doing my job!

On my better days, when I remembered why I was there, I was able to set aside my to-do list and tasks and actually listen, with my ears and my eyes. On those days I would come away with what felt like tremendous gifts. For it was in those times, when I gave my full attention to the resident in front of me, I received a story about their life. I remember meeting Carl in the Main Atrium one day. He had a picture with him of his parents and aunts and uncles taking a recreational boat ride on the pond in Chicago’s Garfield Park about 1902. His words to me as we looked at the picture together were, “I am so blest.” I knew that Carl lost his daughter, his only child, to polio when she was away at college. After moving to our community he’d lost his wife. He sometimes suffered from depression. Yet here he was saying, “I am so blest.” I left such conversations in awe of all that residents like Carl had been through and the strength and resilience that brought them to that day. I was amazed at their accomplishments, their memories of Chicago long before I had been there, their experiences of God’s faithfulness, their hopes for the future. And even when it was residents complaining about a service or a program that didn’t seem to be working to their satisfaction, on my good days, I could hear the needs for validation, for meaning, for support that were the root cause of their complaints (aside from the fact that sometimes we just needed to improve!).

In a culture that values busyness, productivity and youth, the old, who are no longer a part of “productive” society, are undervalued and often unappreciated. Their opinions are rarely sought; their stories are rarely heard. The people who care for them are often pre-occupied with their own lives and the many tasks that they must do both at work and at home. In that context they are present with older adults, completing the tasks of care but they are not present in a way that allows them to listen with their ears and their eyes.

Attentive and careful listening is the first step in providing spiritual care as part of our care for older adults. On one level we know this—but I’m convinced as with so many other things that we know, but do not necessarily practice—we don’t actually listen this way often enough. It takes focus and concentration. It calls us to let go of our own agenda and to be fully present to the person before us. It requires intentionality and discipline. And it requires at least a segment of time where the person we’re hearing and seeing is our only priority. We all know that when we’ve been in a place where someone has really listened to us, we leave feeling valued and affirmed. We may actually understand ourselves in a slightly different way when we’ve had the opportunity to reflect and to speak our story in someone’s presence. And as we are truly heard, we realize that our life does hold meaning, for ourselves and for others.

Attentive, careful listening is a wonderful gift to receive. And attentive, careful listening is a gift that we can give.

In Forget Memory: Creating Better Lives for People with Dementia, Anne Davis Basting ponders our expectations of memory and our fear of its loss. She points to our age-phobic culture that doesn’t like to think about either death or meaninglessness and the difficulty we have when we encounter Alzheimer’s disease, because it brings up thoughts of both. She points to our societal narratives around memory loss associated with dementia—where the theme is the tragedy of the fall from love and beauty, success and identity to a place of tragic separation from and loss of the self.

While the scientific community focuses on a cure for the disease, she calls us to “change our attitudes and our care practices.” This is a call that all faith communities need to hear. As more and more people live longer and longer lives, we will have more and more persons among us in the early, middle and late stages of Alzheimer’s disease. We can label the presence of the Alzheimer’s disease in our midst as a “tragedy” and not step beyond our fears. Or we can see an opportunity to be more fully a faith community responding with grace and intentionality to the needs in our midst.

Faith communities have particular resources to respond to the call to “change our attitudes and our care practices” in relating to those with Alzheimer’s disease. We have the theological affirmation that each and every one of us is created in God’s image—and we carry that image for our entire life. Loss of memory and intellectual capacity does not erase God’s image within us, nor does it negate our personhood. While our hyper-cognitive culture tends to equate loss of memory and mind power with loss of the self, we are more than our minds, and the affirmation of carrying God’s image in our being reminds us of that.

And while all of us forget things both large and small, we were created by a God who doesn’t forget, and who most particularly, does not forget his people. Scripture is full of stories of God’s remembering—from Noah floating in the ark, to the children of Israel in Egypt, to the return of the exiles to Israel. And when God remembers, God acts in ways that are salvific and redemptive. God’s remembering is not an intellectual exercise but is action on behalf of his people, action that is full of grace and mercy.

From a Christian perspective, part of the call for faith communities to “change our attitudes and our care practices” is to live into the call of being Christ’s body in the world, and as his body, remembering those with Alzheimer’s as God remembers—with concrete actions. Part of this remembering is finding creative ways to include those with Alzheimer’s disease and their caretakers in the life of the congregation. Isolation and loneliness are common for those with the disease and for those who care for them. Remembering them as God remembers—in concrete ways, actually re-members them, re-joins them to the body.

Can I encourage you to practice remembering as God remembers—concretely, in ways that are redemptive, and in actions filled with mercy and grace—and focus such remembering on those in your midst who can no longer remember because of Alzheimer’s disease or other dementias? What kind of ministries of care and presence might result because we are seeking to remember as God remembers? And what might we learn about belonging to God and being remembered by him in this process?

In the documentary Young@Heart a choir composed of senior citizens, average age of 80, is shown learning several new songs as they prepare for their annual concert. The choir has been together for over 25 years and when it began in 1982, all the participants were residents of a housing project for the elderly in Northampton, MA. In 1996 they performed their show “Road to Heaven” in Rotterdam and that was the first of 12 tours to Europe, Australia, and Canada.

When watching the movie it’s easy to fall in love with these seniors who are full of such energy and life. They love the singing. They love the group. And they will do almost anything, including checking themselves out of the hospital, to get to rehearsals. And these are not easy rehearsals. For the music they’re singing is not music that one usually associates with senior choruses. They’re singing music from the Rolling Stones, Cold Play, The Clash, Outkast—music of their children’s and grandchildren’s generations.

At one point their director, Bob Cilman, was ready to cut “Yes You Can Can” from the program. They were struggling with the rhythms and the repetition of all the “Can Cans” in the song. But they refused to give up; instead they told him that they could learn it and it was his job to push them. And he does. He demands a lot from them, and they give him their all, in ways that are inspiring and touching.

As I’ve been thinking of this film in the weeks since I saw it, I find myself contrasting the type of music and the challenges the conductor gave to the group with the way that we usually conduct programs in senior centers, retirement communities, and in assisted living and nursing care. Often, I think, we fall into what I would call “comfort” programming. We do sing-a-longs with the old favorites from their generation. We provide arts and crafts that are easy for older hands to do. We do sitting exercise classes that follow the same routine week after week and never really challenge the participants to extend their range of motion or their level of their exertion. We gather weekly for the same current events discussion, reminisce group, and to play the same games.

The elders we serve do need supportive programming and routines that can be counted upon. But I think they also need programming that challenges them to go beyond what they know and what they think they can do. And I suggest that providing programming that challenges older adults to new learnings, and to doing something new and even difficult, is one way of providing spiritual care.

It’s spiritual because without challenges, problems to solve, some sense of newness and growth, life becomes boring. There isn’t much joy in anything. When we meet challenges, try new things, solve a problem our spirits rise and expand. We have a sense of possibility, a sense of our own value, and the hope that there can be another new thing tomorrow. Being challenged to something harder increases our sense of vitality, even in the face of mortality. One of the striking things about the film Young@Heart was the energy and vitality of the participants, even as they struggled with health issues and the loss of two of their members.

We are reluctant to challenge those we serve because they often perceive the challenge as change (therefore to be resisted!) or as being somewhat painful. They are reluctant to leave their comfort zone and often resist when offered something new. And because we care for them we are hesitant to propose anything that might be at least momentarily painful.

But ironically, providing challenges for those we serve is a significant way of caring for them, because we know that navigating the challenge and experiencing some pain in the process is the price that we all pay for continued growth and spiritual vitality. And that is ultimately what we want for them. While Bob Cilman, the founder and conductor of Young@Heart, pushed and challenged his singers, it was obvious that he cared for them deeply. He put challenges before them because he cared about them and the performances they would give, but they accepted his challenges because they knew he cared for them.

I challenge you to take a look at your programs through the lens of comfort and challenge. What’s the balance between them? How many programs actually leave your participants energized and smiling? How can you take some of the things you are now doing and move them to be more challenging, interesting, and engaging? What are the resistances you feel within yourself and that you think you will get from participants if you move towards more challenging programming? How do you communicate care as well as challenge?

Caring for elders is like being let into a big secret, the biggest secret of all: the meaning of life. Caring for elders, becoming an intimate part of their lives, understanding and misunderstanding, experiencing their frustrations and joys brings us into connection with a part of life and a part of ourselves that we have yet to experience.

Have you ever wanted to live your life with the benefit of experience that could assist you in avoiding some of life’s pitfalls and bring both meaning and a way out when we fall into the pit anyway? Well, those for whom we care have experienced life, they have weathered storms and have been stuck in the mud. They have survived and are still growing. That life shapes each of us differently is an amazing lesson. To learn how the texture and character of one’s life is shaped as we age by our interactions and reactions to life informs the caregiving (and care receiving) experience. The spirit of a person is as unique as a fingerprint or face.

When tragedy strikes (like airliners being deliberately flown into buildings) and we can’t see any meaning or purpose, there are people around us who have experienced many sufferings and thus have much to share. Why do we care for our elders with keen attention to who they are? Because it helps us understand ourselves.