“Spiritual care is care that recognizes and responds to the needs of the human spirit (including the need for connection, emotional support, respect for values and beliefs, and the search for meaning in life/suffering). Spiritual care facilitates religious care from one’s own faith leader/community, meeting needs for relationship and continued participation in religious practices/tradition. Spiritual care includes, but is not confined to, religious care”.
- What impact has the pandemic had on spiritual care in your home?
- Has your role and/or hours changed?
- How have you been meeting spiritual needs during this time?
- What has worked particularly well?
- What spiritual needs have been hard to meet?
- What have we learned about spiritual care in long-term care because of the pandemic?
- Any pleasant surprises?
- What advice would you give to the long-term care sector to ensure that spiritual needs are met as this pandemic continues and into the future?
- The circumstances in the home and experience of the individual chaplain;
- Practical adaptations in the provision of spiritual care;
- Needs that have been difficult to meet;
- Learnings and intentions for the future.
3.1. The Circumstances in the Home and Experience of the Individual Chaplain
3.1.1. Their Role
3.1.3. Provision of Care
3.2. Practical Adaptations in the Provision of Spiritual Care
- Whether or not the SCP was able to be present;
- Whether the SCP was restricted to a certain area of the home;
- Whether or not it was safe for residents to gather, and if so, the group size permitted.
3.2.1. Virtual Services
“Some residents keep asking me, ‘When are you coming back?’ So, I take it that, in their minds, the Zoom church service is not the same as going to the chapel”.(SCP 8)
“We realized we’re doing something good here when a resident is watching mass virtually from their hometown; they see the church. They see their church, the architecture, the beauty, and the experience they remember from childhood, back home”.(SCP 37)
3.2.2. Other Virtual Connections
“It created some sort of conversation again for them—to pick up something that they had done apart and yet together”.(SCP 36)
3.2.3. Mini-Services and Groups
- Hallway hymn-sings or services were led from the middle of the hallways, with residents participating from their doorways.
- Many SCPs took short services to individual home areas (often dining rooms) where they could gather a few residents. These small groups were repeated throughout the home (as many as 7 times in one day).
- Some chaplains worked more on Sundays during the pandemic, to cover programming that used to be provided by volunteers, and to deliver multiple services throughout the home. (This was not considered sustainable by most);
- Other staff were invited to help with spiritual care. For example, a local parish priest was willing to train a Roman Catholic staff person to deliver the Eucharist to residents in a home where the SCP was not Catholic, and the priest was not permitted entrance.
3.2.4. Room Visits
- Lots of listening.
- Offering prayer, or other spiritual resources including readings, and music. Some SCPs assembled a spiritual care cart to take from room to room, with music, literature/readings, something beautiful like artwork or flowers, etc.
- Tablets were useful to access familiar religious resources (e.g., Rosary prayer) or to share something interesting and uplifting, including music. One SCP commented on the uptake of this technology in long-term care “[Residents] got the idea that we have input into this, we can direct what we are seeing… ask for something...after awhile they would say ‘You know I really want to see something with birds’. So, it became a very engaging experience with the residents!” (SCP 36)
“People are happy to have someone to talk to. And it wasn’t about praying or singing hymns. Just someone to come and visit when you’ve been in your room for three or four months… I also saw the importance of connecting with family members on behalf of the residents. When we did FaceTime, family members were saying ‘Thank you, thank you so much! I don’t know what I would do without you, we appreciate it so much!’”(SCP 8)
3.2.5. Printed Material
- Handouts connected to worship services, or in the place of worship services (some chaplains provided a service to read when they could not come to the home).
- Regular pamphlets with quotes, meditative thoughts, prayer, focusing on themes such as hope, lament, waiting, worry, etc.
- Bible study discussion sheets, to replace their weekly gathering, were distributed in at least one retirement home. Interested residents were encouraged to discuss its contents when they were together at mealtime, or to plan a phone call with another resident for discussion.
3.2.6. Sacred Space
3.2.8. Palliative Care
“We moved the palliative care bed in one section right to the window so that family could be standing by the window and just be there. We would open the window, so they could talk with each other and those kind of things. That opportunity of being there, joining with one another in conversation, but also in prayer, during this time was a heartfelt deep experience of presence there and the family still talk about it and say, ‘this was good, this was meaningful, this gave us some peace and closure over all of this’”.(SCP 36)
3.2.9. End of Life Rituals
“We would gather people in a big socially distanced circle with masks on in the parking lot and the funeral directors were always really supportive as well, in the sense that they would give us the time and the space. And we would have a prayer circle around the resident for the families, and the staff was allowed to join as well that wanted to. And I think actually that was… it was quite beautiful and very deep and meaningful for people to participate in”.(SCP 36)
3.3. Needs That Have Been Hard to Meet
- Loneliness—In the words of one chaplain, “We can do all we can do but—I think of one woman who is dying of cancer and is longing for things to be normal so her family could come in whenever they want. She has 7 children and they come two at a time if they’re lucky. I can help but I can’t alleviate the loneliness”. (SCP 43)
- Missing cultural and religious connections/festivals/celebrations—People are missing the sense of belonging to the wider community that came with visiting volunteers and special events. They feel cut off from their community.
3.3.3. Mental Health Needs
“I think that grief, which there is lots of in the pandemic, needs a person dedicated to it. There’s a lot of pain, loneliness, angst, sorrow, in LTC homes… SCPs are not afraid to sit in that sorrow, and we need them right now”.(SCP 43)
“It was quite chaotic and hard to see where you fit in, other than to say ‘Here I am; use me for whatever you need to use me’”(SCP 21)
“People were starting collectively breathing again; there was hope there… and I began to gently move people forward in their mourning, so, while we remember those who have died, we need to concentrate on those who are still with us… I post memorials for a shorter time now, to offer a breathing space. When [our memorial board] was empty, that said nobody has died today… a reprieve from the broken heartedness that enveloped our home”(SCP 21)
3.4. Learnings and Intentions Going Forward
3.4.1. The Role/Importance of Spiritual Care
3.4.2. Enhanced Spiritual Care Practice
“What I’ve discovered is that the therapeutic value for a group of residents is higher in a group of 5 than a group of 15. I used to think “there’s only 5 people here, this isn’t good”. But then the quiet person might say something, you can have eye contact with everyone”.(SCP 43)
“Since we’re not gathering centrally for worship services there is less movement for the residents. So, they don’t have long wait times, portering times, which led some to decline attending. So now when I lead a service on each floor, when there might have been 5 come before, now there are 17, and I can do it right after exercises, and can customize the worship to these particular residents, which I can’t in a larger group…before COVID, that joint worship experience would have been about 35 residents. Now I’m at 42 over in long-term care plus about another 20 in the retirement side. So it’s a shift, right? They’re more alert, it’s more personal”.(SCP 36)
3.4.3. Team Members Also Need Support
“You had staff that were watching people die, and they were… well, whether it was fear or just exhaustion. So you end up being a calming pastoral presence in a very upside-down time and I think that was a huge benefit—to have a chaplain here”.(SCP 28)
“They felt some degree of comfort from my presence. They would see me and say, ‘Are you coming up today?’ or ‘We didn’t see you for two days, what happened?’. And there was a look of satisfaction when I walked into the neighbourhood”.(SCP 8)
“The role of supporting staff is different than it used to be. I have put up poetry and prayers in the newsletter. I’m part of a team that’s trying to think abut how we pick up some of the things that are missing, like how do we help people in their grief?”.(SCP 43)
“We didn’t realize how much our staff needed spiritual oxygen… they appreciated messages of hope, uplifting, inspirational, encouraging messages, that we printed out or put on our big TV”.(SCP 37)
3.4.4. SCPs Need to Continue to Be Adaptable, Creative and Innovative to Provide What Is Needed
“[I’ve learned] to say, those are the restrictions, what can I still do with this? How can I find another way of doing something that’s creative and spiritually life-giving for our residents?”(SCP 36)
3.4.5. SCPs Need Support as Well
- Employ an in-house spiritual care provider (avoiding reliance on volunteers);
- Encourage meaningful spiritual care practices, community rituals and ways of connecting that are adaptable to infection control protocols;
- Ensure their SCP is both creative and adept with technology, and have enough team member support to get residents connected;
- Ensure enough spiritual care time to provide for multiple small gatherings, one-to-one connections, and team member and family support.
Conflicts of Interest
- Büssing, Arndt, Daniela Rodrigues Recchia, Rudolf Hein, and Thomas Dienberg. 2020. Perceived changes of specific attitudes, perceptions and behaviors during the Corona pandemic and their relation to wellbeing. Health and Quality of Life Outcomes 18: 374. [Google Scholar] [CrossRef] [PubMed]
- Canadian Institute for Health Information. 2020. Pandemic Experience in the Long-Term Care Sector: How Does Canada Compare With Other Countries? Ottawa: CIHI. [Google Scholar]
- Drummond, David A., and Lindsay B. Carey. 2020. Chaplaincy and Spiritual Care Response to COVID-19: An Australian Case Study—The McKellar Centre. Health and Social Care Chaplaincy 8: 165–79. [Google Scholar] [CrossRef]
- Giffen, Sarah, and Gordon Macdonald. 2020. Report for the Association of Chaplaincy in General Practice on Spiritual Care During the COVID-19 Pandemic. Health and Social Care Chaplaincy 8: 265–76. [Google Scholar] [CrossRef]
- Jones, Kate Fiona, Jennifer Washington, Matthew Kearney, and Megan C. Best. 2020. Responding to the ‘unknown assailant’: A qualitative exploration with Australian health and aged care chaplains on the impact of COVID-19. Journal of Health Care Chaplaincy, 1–15. [Google Scholar] [CrossRef]
- Klitzman, Robert. 2021. The ‘Amazing Grace’ of Chaplains in the Pandemic. CNN. April 19. Available online: https://www.cnn.com/2021/04/19/opinions/frontline-worker-pandemic-chaplain-klitzman/index.html (accessed on 15 March 2022).
- Kuepfer, Jane, Angela Schmidt, Thomas St. James O’Connor, and Melanie James. 2022. Spiritual care in Ontario long-term care: Current staffing realities and recommendations. Journal of Pastoral Care & Counseling 76: 29–36. [Google Scholar] [CrossRef]
- McFadden, Susan. 2021. Pandemic Disruptions of Vital Connections: What Have We Learned? Paper Presented at the 9th International Conference on Ageing and Spirituality, Waterloo, ON, Canada, June 17–18. [Google Scholar]
- Micklewright, Michele Mickie. 2020. A Chaplain’s Reflections in Long-Term Care in the Early Days of COVID-19. Blog Post. May 21. Available online: https://www.kevinmd.com/blog/2020/05/a-chaplains-reflections-in-long-term-care-in-the-early-days-of-covid-19.html (accessed on 15 March 2022).
- Ontario Long-Term Care Homes Act. 2007. Available online: https://www.ontario.ca/laws/statute/07l08 (accessed on 16 May 2022).
- Seidman, Howard. 2021. The Changing Role of Chaplains at Long-Term Care Facilities. Next Avenue. January 15. Available online: https://www.nextavenue.org/the-changing-role-of-chaplains-during-the-pandemic/ (accessed on 15 March 2022).
- Snowden, Austyn. 2021. What did chaplains do during the Covid pandemic? An international survey. Journal of Pastoral Care and Counseling 75: 6–16. [Google Scholar] [CrossRef]
- Swift, Chris. 2020. Being there, virtually being there, being absent: Chaplaincy in social care during the COVID-19 pandemic. Health and Social Care Chaplaincy 8: 154–64. [Google Scholar] [CrossRef]
- Swinton, John, and Harriet Mowat. 2016. Practical Theology and Qualitative Research, 2nd ed. London: SCM Press. [Google Scholar]
- Tan, Heather, Cheryl Holmes, Eleanor Flynn, and Leila Karimi. 2021. ‘Essential Not Optional’: Spiritual care in Australia during a pandemic. Journal of Pastoral Care & Counseling 75: 41–45. [Google Scholar] [CrossRef]
- Tata, Beba, Daniel Nuzum, Karen Murphy, Leila Karimi, and Wendy Cadge. 2021. Staff-care by chaplains during COVID-19. Journal of Pastoral Care & Counseling 75: 24–29. [Google Scholar] [CrossRef]
- Vandenhoeck, Anne, Cheryl Holmes, Cate Michelle Desjardins, and Joost Verhoef. 2021. ‘The most effective experience was a flexible and creative attitude’: Reflections on those aspects of spiritual care that were lost, gained, or deemed ineffective during the pandemic. The Journal of Pastoral Care & Counseling 75: 17–23. [Google Scholar] [CrossRef]
- Yidirim, Murat, Muhammed Kizilgeçit, Ismail Seçer, Fuat Karabulut, Yasemin Angin, Abdullah Dağci, Muhammed Enes Vural, Nurun Nisa Bayram, and Murat Cinici. 2021. Meaning in life, religious coping, and loneliness during the Coronavirus health crisis in Turkey. Journal of Religion and Health 60: 2371–85. [Google Scholar] [CrossRef] [PubMed]
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