CHAPTER 4
The people and the place
When it becomes too difficult to manage at home, and someone begins to contemplate a move into a place where they will be cared for and their meals provided, I wonder what they are hoping for. Priorities will vary according to the individual, but will mainly focus on four areas:
1. Location
This is likely to be a primary consideration. People want to be near their family and friends, their faith community maybe, and in the area that is familiar to them. Even if they do not expect to be able to get out much, if at all, they still want to be where it is easy for family and friends to visit. They are more likely to know already the nursing homes in their own area, and may find it easier to imagine themselves more readily in one place than another.
2. Special ideologies and needs
This is less likely to be a primary consideration for most people, but it will be overridingly important where it is relevant. Vegans, vegetarians, Quakers, Catholics, and Evangelical Christians are among those who may prioritize the ideological foundation of a care home above the accessibility of its location or any other factor. People who have been blind or profoundly deaf for all or much of their lives are among those who might seek out accommodation specially adapted for people with a similar needs profile.
3. The staff
One of the determining factors in choosing a care home will surely be the approach and attitude of the staff. The more vulnerable a person becomes, the more important it is that staff have been selected for the attitudes of kindness, courtesy, patience, common sense, and respect that they bring with them; and then trained to a high level of competence so that they can move and lift without danger to themselves or residents, understand how to minimize the risk of spreading infection, know how to carry out all care procedures that will be required, and understand how to (and when not to) administer feeds and drinks appropriately for the well-being of their residents. A nursing home where staff have a holistic approach to care and have received training in supporting the well-being of the whole person is likely to offer a happier experience of daily living for a vulnerable person.
4. Environment
This can affect choice in a number of ways. For some people, elegance of decor is an important matter; for others, who loved the garden they are leaving, the grounds will be of significant interest. Others will be principally concerned about privacy (single rooms, en suite bathrooms, and nooks available for private conversations). Many people are drawn to places that are full of light and airy, and look to see if there is a conservatory where they can sit in the sunshine; some enjoy the traditional atmosphere of heavier, grander, more formal items of furniture and large flower arrangements. Some people love to see a place full of flowers; others are made nervous by this, believing that the flowers have all come from funerals.
Nursing homes are restricted in what they can offer to make a place feel like home by health and safety and other regulations and requirements imposed upon them, but within those restrictions they can, and usually will, respond imaginatively to the personality and preferences of their residents, to ensure that their new accommodation allows them to blossom as the people they really are.
Imaginative care takes account of personality
Violet was like a fairy: tiny, magical.
I met her while I was pastor of a church by the sea. She was on my list of old people, and a visit seemed in order. How could I have known whom I was about to encounter?
She had been referred on to our pastoral list during the time of a previous minister, by Norma who attended another church down the hill from Violet’s home. Norma’s church was right down near the seashore, in among the jumble of second-hand shops, greengrocers, places you could buy a shopping trolley and get your keys cut, charity shops, emporia selling Halal food and fine jewellery and reconditioned washing machines, restaurants in every flavour – Indian, Chinese, Nepalese, Thai, Greek. Opposite the end of the road to the station, by the busy crossing, just up from the bus-stop, under the great wooden crucifix bespattered with seagulls’ mess that hung high on the wall of the church, Norma found Violet sunk down on her shopping trolley, too exhausted to climb the steep hill back up from the sea.
She bundled her into her car and gave her a ride home, and took her under her wing from that day, becoming a pastoral friend, getting in her groceries, and seeing to it that Violet got attached to our list, since “Methodist” was her stated church affiliation.
So I went to visit Violet, and I am unlikely to forget her.
Violet was in her late eighties, I think, at that time – so her birthdate was around the 1910 vintage. She came from a poor family who had neither the ability nor the aspiration to continue supporting her once she reached the age of sixteen. Violet did not get on well with her father.
At sixteen years old, she found herself adrift in the world, and she wanted, but could not pay for, an education. So she found work in Oxford, making her nest under the eaves of great learning, and set about studying all that she could. By day she worked hard as a maid, a cleaner; in the evening she attended every free lecture she could find, and became enriched by an extraordinary and eclectic education from some of the finest academic intellects in the country. She lived in a trailer home.
In financial terms, she stayed poor all her life, but this was hardly a hindrance. At some point she made her way to the south coast of England and settled in the basement flat where I found her when I went to introduce myself as “the new minister”.
I made my way down the iron steps with care. Every one supported containers of plants. The area at the bottom of the steps was also in bloom. Margarine tubs, mushroom boxes, jam jars, old saucepans – every imaginable container had been pressed into service to accommodate Violet’s garden. Daffodils and bluebells, hyacinths and crocuses, auriculas and primroses; later, forget-me-nots and valerian, lavender, anemones, nasturtiums, pansies, and wallflowers. There was even a young cherry tree making good headway in a handle-less bucket.
I tapped at the door. Although on our list, Violet had not received a pastoral visit for some time, so I had no idea what kind of a person would answer my knock. I fell in love with her at first sight. Frail, bent, probably not even five feet tall, her eyes bright with interest and her snow-white hair in a disorderly cloud of strands and random wisps, dressed from head to toe in assorted shades of lilac, she welcomed me in.
I was introduced to the cats who shared her home. In the main, they lived in the back room and Violet in the front. I am not sure that she recognized any difference in status between the human and feline species. I believe they may have been more flatmates than pets.
Somewhere in Oxford in the twenties, thirties and forties, I think Violet must have come across Rudolph Steiner and probably the Theosophists and Rosicrucians. Somewhere among the free lectures she had attended, somebody had alerted her to the principles of colour therapy, and Violet had recognized a truth in the assertion that the different colours, with their different vibrations, each contribute something uniquely edifying to the well-being of our souls.
So she painted all her furniture pea-green – wardrobe, chest of drawers, cat basket – all of it. Each day of the week she allocated to a different colour: green, blue, lilac, pink, orange, yellow, and white which held all the colours within it. Over the years she had put together an assortment of clothes, shawls, and scraps of cloth that enabled her to dress entirely in the colour of the day.
With her possessions stowed around the front room of her flat that looked out on to the riot of flowers in the basement area, Violet lived frugally and happily. Her cupboard contained (like the store cupboards of so many old people) tins of peas, cartons of dried milk, cans of vegetable soup, Oxo cubes, Rich Tea biscuits, corned beef, and margarine. I don’t recall that she had a fridge.
Violet’s pride and joy was her collection of bone china tea-things. Exquisite cups and saucers (in not every case from the same set, but a near enough match) in the same colours as her clothes, and tea plates in the same clear, bright pastel shades. Some flowered, some in simple, plain, joyous colours, Violet’s china celebrated the rainbow.
There were no harsh or strong colours – all were delicate, the colours of the spring. I really felt I’d met a fairy.
On several occasions I visited Violet, and we became firm friends. We discussed the philosophies of life she had encountered at Oxford, and drank tea together from cups of Royal Doulton, Minton, or Coalport, as we sat by Violet’s two-bar electric fire and set the world to rights.
Nobody could say that Violet asked for much in this life. The cats who were her friends, the colours that fed her soul, the security of her own place, the flowering plants that were her joy and delight, and the several-times-a-day ritual of boiling the kettle to make a pot of tea enjoyed by the fire from a beautiful bone-china cup: and she was happy.
As time went on, I heard that Violet was to move into a residential care home. She had been unwell and was finding it hard to cope once she turned ninety. Norma had found her a place where she could live down in the basement, just as she had in her flat. The room opened on to an unused yard, so Violet’s flowers were to go with her. The cats, most of the pea-green furniture, and all but a few favourites from her china collection, she had to leave behind.
I visited Violet in her new place. It was clean and comfortable; not dark and poky like the old flat. Violet sat there in a chair amid the orderly remnants of her possessions. While I was there, a member of staff brought tea on the trolley, with a cup for me as well as for Violet.
Health and safety regulations would not allow Violet an electric fire with its cosy red glow – she didn’t need it, of course: no need to sit by a fire when central heating is provided throughout. Health and safety rules also could not permit Violet to make herself a cup of tea, in case she had an accident and was scalded. So her china tea things sat neatly in a glass display cupboard, where she could look at them, but not take the risk of using them. Appreciative, comfortable, but somewhat lost, Violet sat quietly alone in her fire-retardant, water-proofed chair, still marking the passing days with their allotted colours of lilac, yellow, green, pink, and blue.
Although it was not possible for her indoor routine to continue, the care home was able to affirm Violet’s delight in her garden. When the move happened, to welcome her into her new accommodation, I took along a huge terracotta urn for the cherry tree. After a week or two, an agitated Violet asked me to take it away: it was too big, too grand – not her style. The cherry tree sank back into its battered old bucket with a sigh of relief.
The staff in her new home were restricted by health and safety regulations, so that Violet could no longer make her tea and sit by her fire, but it made the world of difference to her quality of life that she could continue to potter among her cherished plants. This affirmation of her choices and priorities helped her to settle in well and to accept the limitations that government regulations had imposed on staff and residents alike.
Even good care cannot solve every problem
Of course, not all people who make the transition into residential care are very old, as Violet was.
I remember Marilyn, a woman in her fifties who had struggled with MS for many years, eventually reaching a point where her family could no longer care for her at home. For Marilyn, going into care meant saying goodbye to her family, leaving behind her husband and the home they had made together. He came to visit her sometimes, and on the wall Marilyn had a photograph that showed her sitting with him and their children in a family group, but it must have felt all wrong. A husband and wife relationship is not a thing of visits and cups of tea; it is the seamless web of everyday intimacy, bedded in the context of the couple’s own home, even if that is a bedsit or a trailer home or a rented studio flat. The essence of the husband and wife relationship is (for most people) that you live together.
Marilyn was not a wealthy woman, and her nursing home room was not large. A long rectangle, one end was occupied entirely by the door through which everyone came and went and the adjacent special clinical bed with its chrome bars. The other end was mostly filled with the electric recliner chair, a wheelchair draped with towels and bits and bobs, and a commode. Looking around and “reading” the room, it was possible to learn very little about Marilyn and a great deal about her condition. There was just that one picture, showing Marilyn and her family, that stated mutely, “This is where I’d rather be.”
Everything had to be done for her; she could not move at all, not turn herself over or sit up in the bed – almost nothing. She could get a feeder cup to her lips and manage the bowl of food with the aid of specially modified cutlery.
In the bustle of morning feeds and washes, care assistants entered and left her room. Staff did not knock and did not always greet her. If Marilyn was being washed, someone might pop their head round the door to see if help was needed, but the enquiry was addressed not to Marilyn but to the care assistant in with her. Sometimes staff members came in just to give or seek information. When this happened, Marilyn was not always included in the conversation. She was not a very popular woman, so bonds of affection had not developed between her and the care staff, and although they were not intentionally unkind, when they were busy with their errands they did not always think to acknowledge and affirm her.
The reason she was not popular was her habit of complaining to care assistants about their colleagues. She tried by this means to set up little conspiracies and alliances, but although these did occur among the staff, nobody wanted to make them with patients. Looking back, I think these unsuccessful attempts to gain attention were probably an indication of great loneliness.
Marilyn was a tall, heavy woman, whose immobility had caused her to gain weight, and her care routine at the beginning and end of the day was time-consuming. It was with relief that her carers left her room when she was “done”, but even had anyone been disposed to stay and chat, or a volunteer had come round, it was physically difficult to get close to her. The bed’s position adjacent to the door made it impossible to have a bedside chair. The bed was raised high to make personal care and feeding easy. Her chair, draped with clothes and blankets, was at the other end of the room, and anyone sitting there would have been far away and lower down. Everything about Marilyn’s life made her alone, and there was nothing she could do about it: she was in the best nursing home in town.
She was a pleasant and gentle person, friendly and welcoming in her demeanour, and undemanding, but the atmosphere about her was of deep unhappiness, bitterness, and misery. I could feel it, but I never heard it expressed.
Looking back, I wonder what we could have done differently. In that nursing home she would have been offered visits from the chaplaincy team and from the complementary therapists who came to give hand or foot massages to the residents who would benefit from such extra support, so there were opportunities for healing contact and conversation. But there was something we could never really reach. Perhaps Marilyn would have benefited from a regular time with a counsellor, to help her process the comprehensive – almost total – losses that illness had brought about. And perhaps there is a place for recognizing that, although we can support people and travel with them faithfully, even so we cannot fix everything.
Relationship and personal encounter
Dignity, privacy, respect, affirmation, understanding, and affection are gifts we offer each other. They cannot be demanded, and they do not occur as a result of regulations or mission statements: they appear interpersonally, new on every encounter.
Although care staff must have a tolerant and understanding attitude towards all the residents, inevitably there will be easier rapport between some individuals than others. I have not experienced this manifesting as unfairness or preferential treatment, but care assistants often appreciate the chance to care for those residents with whom a special bond has developed, and this seems to me to be natural and life-enhancing.
In residential care homes, there are usually two possible environments in which to meet the people who live there: in their own rooms or in the common areas.
Neither of these scenarios is necessarily ideal for pastoral encounter. Nursing home rooms can quickly be filled up with the equipment and commodities needed for the residents’ care, and many of us would feel uncomfortable asking a visitor to sit alongside our flannels and denture powder and incontinence pads, perched on the commode. Equally, conversation can feel constrained in the communal sitting room, where others can obviously hear and see all the interaction. There would be few who felt relaxed about sharing personal matters or a time of informal prayer, observed by a number of onlookers.
In some care facilities, small group spaces are imaginatively contrived for just this purpose. A conservatory, a cul-de-sac area in an odd-shaped room, a spacious hall or landing, or the part of a room that goes into a bay window might offer the opportunity for a small group of two or three chairs and a coffee table – a place for separate, private encounter. Even where there is no separate room available, grouping the furniture to afford visual privacy can be very helpful.
Such spaces offer the chance for encounter without the sense of social inappropriateness arising from inviting someone into the bedroom when they would normally be received in the sitting room at home, and without the embarrassment of having personal conversations observed and overheard. Not only does this enhance the possibility of an enjoyable chat, it also allows new residents, coming to terms with the change from living in their own homes to living in a care home, to share their concerns and explore their emotions in an environment of relative privacy.
Remember the human
Who really knows you? How did they come to know you so well?
My children know me the best of anyone, I think. We have shared so much and faced so much together. Our commitment to each other was absolutely unquestioned. My firstborn remarked once to her partner that she knew without a shadow of doubt that her sisters and her mother would always be there for her; she could rely on them completely. There comes a moment in the film Gladiator when the hero, Maximus, says to his terrified and beleaguered companions in the arena, “Whatever comes out of these gates, we’ve got a better chance of survival if we work together. Do you understand? If we stay together, we survive.” There have been times when those words would have expressed perfectly the mindset that conjoined my children and me as we shot the rapids of the problems life delivered.
So they know me because we went through so much together, because we knew we could trust one another, because we talked about everything, because we faced and beheld so much.
My first husband knows me as well as anyone: he knows what I think and how I think. We were nineteen and twenty years of age when we became a couple, and we travelled together for twenty-five years. He has seen me at my lowest ebb. We grew up together; we made our mistakes together. The man I am married to now has had less time to get to know me; but his love and sensitivity quickly create trust and understanding.
Sometimes I make a new friend; an inexplicable chemistry draws us into a rapport. There are those people met at a party, at church, in the workplace, at the school gates; your eyes meet and you think, “Yes. I know you.”
Who doesn’t really know you?
Those who know me least are those with whom I have a formal or professional relationship: congregations I have pastored, colleagues, my doctor, acquaintances from any context. Those relationships are one-faceted, two-dimensional. They are also shaped by inequality. In a clinical setting, the doctor has power and superiority. In a pastoral situation, ministers have considerable status. Colleagues are often competitive in the way they relate to one another. Acquaintances are usually eager to make a good impression. Power, superiority, status, competition, and the cultivation of image have one thing in common: they do not create or encourage trust. You will never really know someone who does not trust you.
Trust is essential to well-being. If you do not trust the place and situation you are in and the people you are with, you will not be understood or contented there.
When someone makes the transition from own-home living to residential care, it is important to establish a sense that this is an environment that you can trust, where you will feel at home. Who are you? What can I expect from you? Am I safe with you? These are the unspoken questions flowing in both directions as prospective residents and their relatives meet with the manager of the home, and each begins to feel the measure of the other.
As time goes on, and the new resident settles in and becomes part of the care family, their personality and idiosyncrasies will come to be very well known indeed by the care staff. Even so, people still continue to surprise us.
In one nursing home where I worked, the care assistants warned me about the erratic behaviour of Alice, one of the elderly residents. Alice, I was told, had become even more confused of late, carting bags of her clothes about the place. If I found her doing this, I was to return Alice and the clothes to their rightful places in her room.
Sure enough, one evening after I had been tidying away the tea things, down the stairs came Alice carrying two plastic bags full of clothes.
“What are you doing, Alice?” I asked her, in tones of pleasant enquiry.
“I’m bringing these down for the jumble sale,” she said. “What things have you got there?” I asked, and sat down with her to have a look through the bags. The contents included a golden brown, lightweight acrylic sweater in perfect condition.
“Why are you throwing this away, Alice?” I asked. “Because I loathe the colour,” she replied.
Alice was not as confused (or not about her sweaters anyway) as we thought! She just hadn’t seen the need to explain herself.
Trust and boundaries
It is no mere coincidence that residents in nursing homes and residential care may especially confide in their carers when they are being washed or fed or helped on the toilet. Apart from the obvious reason that this is when the carer is devoting time to being with them, there is also something about the intimacy of the giving and receiving of personal care that promotes trust and opens the possibility of real sharing.
Care assistants often regard their work as emphatically physical, yet the intimate and personal nature of it takes them close to the residents’ areas of vulnerability and implies a significant spiritual care dimension to the work.
Cheerfulness, gentleness, and respect should characterize the care relationship, and a kindly sense of humour has a leavening effect on the life of the community.
It is always helpful for residents if the care staff explain what they are doing, and why. Quite often, in a nursing home setting, a carer on a routine task – trimming somebody’s toenails or making their bed – may be called away to help with a procedure that needs two people and cannot wait. When that happens, it is helpful to explain to the resident, to give assurance of the speediest possible return, and to apologize for the interruption. In a residential care home or a nursing home, a culture of appreciation and courtesy creates a positive atmosphere that can be felt.
This is not the responsibility of the care workers only; the residents contribute considerably to the forming of relationships of goodwill and affection. In one nursing home where I worked as a night care assistant, everyone enjoyed looking after Hilda. She had left-side paralysis and loss of speech following a stroke, but she had recovered a few words and was able to communicate what she needed us to know, with some guesswork assisting the process. Mostly what she wanted to say was “Thank you” and “I’m so sorry to trouble you”. Even when we gave her the wrong thing or did something that didn’t work very well for her, she was inclined to be gracious and accepting, sorting things out discreetly once someone who understood her better came along. Hilda had a quiet, retiring nature, but her face had a quality of eagerness and kindness that made us feel welcome as we entered the room. It was a pleasure to be of service to her, and feeding and washing Hilda felt like something of a restorative refuge if the night had been hectic and eventful.
An essential consideration in care work is the matter of setting and maintaining boundaries. Both trust and respect are about boundaries, and for relationships to flourish, clear boundaries must be set.
In a nursing home or residential care home, there is the clear and simple physical boundary of the client’s room. This is especially important and helpful where some residents are temporarily confused or suffering from dementia. It is clearly understood that a client’s room is their space, into which other residents may enter only by invitation. Residents are usually kind and understanding towards the occasional confused individual wandering in, but this protection of the privacy of the client’s space is taken very seriously, because it quickly starts to feel invasive and even frightening if another resident regularly enters without invitation or cannot be disabused of the notion that this is, in fact, his or her bed!
The boundaries of the relationship between resident and carer have to be set and maintained in other ways, and this is of real importance because traditional social boundaries for our interactions with strangers and acquaintances are crossed in the giving of personal care. This is why the carers must be careful in their humour: many residents like to exchange banter, to crack a joke, tease, and be teased, but the career must always err on the side of respect, being mindful to stay within the boundaries appropriate to the relationship, avoiding suggestiveness, mockery, or over-personal observations.
It is also of first importance to remember to greet a resident on entering their room. It is surprisingly easy for a nursing home care assistant in a hurry to become task-focused rather than people-focused, and move directly to the task of changing a pad or putting out clean clothes without remembering to take a moment to make eye contact, smile, say hello, and explain what they have come to do. Especially, it is easy to do this when called to assist someone else – perhaps in lifting and moving a client, or washing a client in bed. Ordering priorities on coming into the room, by greeting first the client and then the other care assistant, does much to affirm the resident as a person and enhance the culture of courtesy and respect. People feel reduced and humiliated if those who perform their care chat over them without including them, or don’t bother to talk to them as the procedures are carried out.
One of the ways roles (and therefore also boundaries) are defined in a care setting is in the wearing of uniforms. The doctor, the nursing staff (junior and senior), the care staff, the cleaners, and the kitchen staff will all have distinctive uniforms, usually modelled on hospital styles. These are practical, easy-care clothes without anything that flows or trails. Many people like to keep their work clothes and their home clothes quite distinct, stepping into a professional persona as they dress for work, and so find it helpful to wear a uniform.
Uniforms are also helpful for security. In the UK, everyone working with vulnerable individuals will have had to undergo a Criminal Records Bureau check, so to be given a uniform to wear implies trustworthiness. In a care facility where agency staff often work, the carers may not all be personally acquainted with each other. The uniforms help to identify at a glance that this is someone who is legitimately working here, not a relative who needs help finding a resident or a random interloper off the street.
Uniforms are also a boundary statement in giving personal care, adding relational distance in carrying out intimate procedures, and this helps maintain client dignity.
However, uniforms can be terrifying to some residents, especially if their mental processes are temporarily or permanently confused; carers in uniforms are not infrequently mistaken for police, spies, or the military forces of the enemy. In such cases, it can often be a challenge when the only people available to calm the frightened individual are also wearing uniform. As doctors usually wear their ordinary clothes under their white coats, a doctor who takes off the white coat can be of great help in such a circumstance, especially as medical diagnosis and assistance is likely to be necessary anyway.
Chaplains and chaplaincy volunteers
A chaplaincy team can bring real benefit to a care facility. Nursing homes, especially those which have developed a specialization in palliative care, are likely to have created a formal relationship with ministers of religion in the local area, some of whom may visit all residents who welcome such pastoral contact.
Residential care homes are less likely to have chaplains or regularly visiting ministers of religion, though some do.
Often it is at the initiative of the manager, activities manager, or interested individuals among the care staff that a relationship with a religious body is created, either by residents being supported in attending worship if they are too frail to go alone, or by organizing pastoral visits and opportunities for corporate worship within the care facility itself.
Sometimes the care facility has a religious foundation and continues to be linked to and overseen by a religious denomination, and trustees will include faith representatives who ensure that pastoral and liturgical support and opportunities are offered.
Sharing in an act of worship gives shape to the week, helps to knit the residents together as a community, and is often something that residents look forward to and enjoy.
Ministers of religion will have many responsibilities, and the formation and training of chaplaincy teams for the care facilities in their pastoral area may not make it to the top of the list of their priorities. A chaplain need not be an ordained person, however; there are many lay chaplains.
A small team of volunteers, trained in listening and pastoral visiting, would have much to offer a care facility where the staff may be too few in numbers and too burdened with duties simply to chat for any length of time.
Where residents are alone in the world with no relatives to pop in and see them or bring a bag of sweets or a magazine, a chaplaincy volunteer can fill some of the roles of a friend or relative, offering added stimulus and enrichment to life.
Hermione was a determined and doughty old lady whom I visited regularly as a chaplaincy volunteer over some years. She and I disagreed profoundly about almost everything, but delighted in each other’s company and looked forward to our times together very much.
Working as a chaplaincy volunteer, I have been asked to sit with someone recently paralysed by illness who was afraid to be left alone, to take down letters of farewell from a dying lady too weak to write, chat with people whose speech was impaired by illness and for whom conversation needed extra time, or simply spend time with people who otherwise had no visitors. Care staff often willingly go the extra mile with their residents, fetching items from the shop or taking them on outings, but a team of volunteers can offer a welcome additional input.
Chaplains in dark suits and dog-collars, who arrive on the premises holding a Bible and equipped with a clipboard, are less likely to reach a place of real honesty than those who are dressed simply as people. The clerical collar and attire may enable role recognition, but although clerical attire may inspire respect and a set of assumptions about trustworthiness, it will be hard for residents to let down their guard with anyone so formally dressed. A more informal style of dress accompanying the clerical collar helps to signal an approachable, human style, and many clergy now prefer to wear clergy shirts in a colour other than black for pastoral visiting and preaching.
Even so, some people will always feel inhibited in the company of a minister of religion, and chaplaincy volunteers can provide helpfully informal pastoral support.
In the words of the writer Elie Wiesel: “You can’t talk to a rabbi, for he is too concerned with relaying your last words to God. You can confess your sins, recite the Psalms or the prayers for the dead, receive his consolation or console him, but you can’t talk, not really.”
There is tremendous healing in a relationship with someone we can really trust. As the theologian Anthony Padovano said, “In an hour of desperation or loneliness, the voice of the right person can transform us. Even as we die, the voice of someone who meant life for us can assure us we are not lost, we have been heard, we are safe, we shall not die altogether.”
The first work in accompanying someone through the great transition from living alone to living in residential care is to establish a relationship of trust. In order to do this, we must have the ability to offer ourselves authentically; to allow ourselves to be seen, as well as ourselves observing and examining; to be ordinary and on the same level, transparently human. The moment we take refuge in a persona or retreat into the shelter of professional status, we have let slip the hand that was holding ours in the dark.
Dr Sheila Cassidy, in her book Sharing the Darkness,4 which came out of her work at St Luke’s Hospice in Plymouth, describes in a series of simple line drawings the different possibilities in the ways a patient may relate with their doctor or chaplain.
The first two drawings show the chaplain or medical professional ministering to the patient, supported and equipped with the accoutrements of their profession. The third drawing shows them coming to the meeting without their sacramental vessels or stethoscope, but still bolstered by their skills and professional expertise. The fourth and final picture, of profound encounter, Dr Cassidy describes in these words: “The drawing shows both patient and carers stripped of their resources, presented to each other, naked and empty-handed, as two human beings. There is terrible pain in this impotence, in admitting that one has nothing more to give.”
Terrible pain, yes – but also life-giving strength and the foundation for real trust.
Dr Cassidy was writing about a hospice situation, working with people facing the challenges of terminal illness. “Terrible pain” and “impotence” might therefore seem like extreme terminology to make a useful carry-over to the situation of someone who has decided the time has come when it would be more practical to move into a residential care home. Even so, the principles that underlie her observations apply to their situation too – and probably to us all. Imaginatively eroding the potential for “them and us” that could arise from living in a care facility (especially a nursing home) is a contribution the chaplaincy team, the management, and the care staff can between them put in place. It is a question of maintaining, by courtesy and respect, the boundaries that support personal dignity, while developing the empathy and interpersonal skills that facilitate healing encounter.
In addition to a regular programme of outings and events laid on by the activities manager, if there were people with just time to be – to sit and chat or be silent, have a cup of tea, knit or read, or just be quietly getting on with something that can be interrupted for a chat – the sense of “home” would be deepened and increased. If the sitting rooms of residential care homes included volunteers dispersed among the residents, working on crosswords together, maybe playing the guitar and singing together, chatting and reminiscing, the tissue of community relationship would develop.
Asking honest questions, chatting together, sharing life, music, coffee, magazines, jokes, and memories – and all without uniforms: this is how trust and friendship begin to form and grow, and how an institution becomes a community – in truth a home.
Pets
By no means all people are animal-lovers, but, for many, home would be incomplete without their pets.
Care homes without animals are easy to find for those who prefer to live without them, but those homes where pets are included and important make a significant contribution to the well-being of residents who enjoy the companionship of their animal friends.
I took a funeral once for Emma, an old lady who had spent the last year or two of her life in a nursing home, where she was content and felt loved. In describing her situation, her daughter made particular, grateful, mention of the role of a little cat in her mother’s last week of life.
The cat, which lived at the nursing home and wandered around freely making friends with everyone, kept Emma company in the days when her life was ebbing away, never leaving her side, curled up close to her on the bed. Both Emma and her daughter derived the deepest comfort from the faithful support and companionship of this little creature.
PAT (Pets As Therapy) dogs and cats also provide a regular therapeutic service to over 100,000 people in care homes, hospital, hospices, special needs schools, and prisons in the UK. Their visits are transformatively healing, often becoming the highlight of the week, and even allowing deeply depressed people to feel they once again have a reason for living.
A loved, temperament-assessed dog or cat can be a real asset in the induction or settling-in period for someone who enjoys the company of animals and finds their presence soothing and helpful.
There are many people of shy or reserved temperament who find it easier to tell their troubles to an animal, and whose souls are nourished by the touch of stroking a pet dog or cat, even though they feel inhibited about touching another human being.
I remember making a bereavement visit to Arthur, a man in his later seventies, following the death of his wife after more than fifty years together. The couple had several small spaniel dogs, whom they loved dearly and who loved them in return. On the occasion of my visit, three of the dogs were curled up together in an armchair, while two were lying on the hearthrug. All were apparently fast asleep.
As we talked, and as he shared with me his memories of his wife and their life together, Arthur began to cry. Immediately, one of the little dogs got up from the hearth rug and went to sit close beside Arthur, the whole length of her body leaning comfortingly against his leg.
I am sure that, although nothing could diminish the sorrow of that loss, having the companionship of his spaniels must have made a profound difference to his experience.
Some care homes, of course, do allow residents to bring their own pets with them, and this, too, provides tremendous comfort and makes the transition much easier.
Resident pets are beneficial to staff and visitors as well as to residents, playing a central part in the development of an ambience of warmth and gentleness, softening the clinical and formal atmospheres created by uniforms and routines.
The twelfth century Abbot Aelred of Rievaulx wrote in his book Spiritual Friendship, “Your friend is the companion of your soul – one to whom you entrust yourself as to another self, one from whom you hide nothing, one from whom you fear nothing.” For many people such a relationship, and such a confiding, is possible with an animal where it is not possible with another human being.
Points to remember