Introduction

Care homes fall into two principal categories: residential care and nursing care. Residential care is for clients who are relatively able, but in need of support in daily living. It is the same level of care and help that a relative or friend looking after a vulnerable person would offer. Staff in a residential care home can help with washing, dressing, at meal times, with personal hygiene and going to the toilet. In some residential care homes, help in gaining skills that increase independence may be offered.

Nursing homes offer 24-hour nursing care by trained nursing staff (nurses and care staff). A nursing home will have a qualified doctor or nurse overseeing the care offered, and there will always be nursing staff as well as care staff on duty. Nursing care is for clients who need much more support, so people often need to move from residential to nursing care if their condition deteriorates – their move to the residential home isn’t necessarily for life.

In both residential care homes and nursing homes, some of the residents will have left their homes permanently – sold them and ended their time as an independent householder. Others will have been encouraged by relatives to come into a care home – “just for a while”, “until you feel better”, “while we get things sorted out”, “to see how you go on” – and may be cherishing a hope of returning home that those around them cannot share. Others again may come into a care home for respite care. Respite clients need care temporarily – if their carer at home is ill or on holiday, if they need a period of care following surgery, or if their spouse dies and they are temporarily unable to cope, for instance. A client may go in for respite care and then end up having to stay. Respite clients often do not know how long their stay will be. They may even have been taken against their will if their house was seen as unfit to live in – this happens when people’s homes are dirty and untidy enough to be a health and safety hazard, or are found to have an infestation problem, for example. Often new clients are confused and disoriented or angry, because they don’t want to be there and they don’t understand why they’ve been taken from their home.

So, it is important to remember that people have different levels of need and different or uncertain patterns of residential stay. But, in every case, people going into a care home are facing a level of change in their lives that will affect them emotionally and spiritually. Even those who go in temporarily, for respite care, are on a difficult journey, requiring soul work as well as practical support. We must acknowledge the magnitude of the emotional and psychological adjustment that confronts someone who must now seek this level of support in everyday living. Those leaving home for the last time to enter residential care accommodation, because of increasing frailty or debilitating illness, should be offered understanding and help to face this most difficult of journeys.

If we do this – if we permit the grief and bewilderment, the bitter losses of dignity, identity, and comforting memory to be addressed – then we strengthen the likelihood of enabling this last stretch of the journey (however long or short it may be) to be moved from the category of “dying” to that of “living”, for those leaving their own homes knowingly for the last time.

For those coping with multiple changes and uncertain futures, or seeking respite care for reasons of trauma, frailty, or vulnerability, help in adjusting to a new environment is strengthening and reassuring, assisting the process of healing and re-establishing personal equilibrium in someone whose context has lost stability.

There is no way for us to help others engage with this process without getting to grips with it first in our own lives and souls. The best pastoral help arises from authenticity, understanding, and the earthiness of compassion in a friend who knows the score.

So this is not a book about “them” but about “us”. Until “they” become “us”, none of our arm’s-length pastoral assistance, however kindly meant, will make a difference.

Who will need to consider these issues and read this book? It may be that people who have reason to believe they will soon be unable to manage in their own homes are looking for something to help them consider the issues as they order their thoughts. There may be some who are beginning to find the burden of caring for a relative at home overwhelming and will find some reading helpful as they think through the implications of alternatives. Care staff looking at the spiritual care aspect of their role may find their thinking stimulated. Church pastors or those newly appointed as chaplains (whether lay or ordained) may find useful pastoral pointers here, and those who are working, or beginning to work, as volunteers in a care home chaplaincy team may also find food for thought in this book.

I should explain at the outset that this book is not designed to address a particular one of the variety of care contexts (residential, nursing, respite, permanent, assessment), and it is not written for a particular one of the possible readership groups (potential residents, carers at home, care staff, or chaplains and their volunteers). What is addressed here is the work that must be done to support people spiritually and emotionally as they face the transition from living in their own homes to living in a care home. I hope it will be helpful to the individuals themselves, to all those involved in their support, and to any one of us – for all of us are likely at some time in our lives to find this material of relevance.

Often in the course of the book, mention is made of chaplaincy teams who may visit and offer support. By no means all residential care homes or nursing homes will have a chaplain or associated team of volunteers, but some do, and all could. A chaplaincy team will add valuable support and enrichment. If you are reading this and wondering why there is none in the care home you are connected with, perhaps you could be instrumental in the formation of a chaplaincy group.