For many older people, increasing age is often associated with chronic illness and even disability severe enough to require nursing home care. In fact, although only about 5 percent of the elderly live in a nursing home on any one day, the risk of nursing home placement increases greatly after age eighty. To find out how older people experience the religious and spiritual dimensions of life in the nursing home, researchers from the Park Ridge Center visited three homes in the Chicago area and talked to more than 45 residents, staff members, and administrators.
All three homes are affiliated with nonprofit organizations. In all three, there is a high quality of care, high levels of staffing, some connection to surrounding communities, and a variety of programs and activities, including religious ones, available to residents. The residents were very elderly, almost all were white, and most came from the same general economic background and were of similar religious background to other residents in the home in which they lived. All the residents in one home were Jewish.
Seven important issues emerged from this research.
Although people move to nursing homes when confronted with significant illness and disability, nursing homes are very much about living.
Diversity affects nursing home life in two arenas: the religious beliefs and practices of residents, and the ethnic, racial, and religious differences between staff and residents.
Given the increasing prevalence of persons with dementia in nursing homes, special attention must be given to enhancing these residents' religious experiences.
Of all the psychological issues particularly relevant to old age, loss is the most frequently cited and most acutely felt.
Confrontation with death seems to be less of a problem for nursing home residents than it is for staff and families.
Chaplains provide leadership in the religious and/or spiritual dimension for staff and families as well as residents.
Religious activities within nursing homes serve multiple social and psychological functions.
Although respondents' concerns are largely with living, death is a constant aspect of nursing home life. Most residents were quite direct in addressing dying and mortality, saying they use their time to "take stock," to evaluate the importance of their lives. Residents who cannot provide satisfactory answers to the questions of living are often those who experience the most difficulty in coming to terms with their mortality.
Staff also struggle to accept the nearness and constancy of residents' deaths. As one administrator stated, "Sometimes you wonder if you're a professional griever." Death brings an added stress to the work of staff in the nursing home and demands increased sensitivity to staff and residents' needs alike.
Although death and dying are so much a part of the nursing home experience, none of the homes does any consistent training or education in dealing with these issues.
Chaplains are called upon to counsel residents and families in regard to coping with the many questions around death and dying, such as writing advanced directives, dealing with grief, and even planning funerals and memorial services. Staff may seek counsel themselves, especially when a favorite resident dies. At the institutional level, chaplains are seen as important resources in ethical decision making.
While religious activities engage residents in religious action, they also address important psychological needs, including social interaction, spiritual enrichment, and emotional connection with self and others. As one staff member commented, "[Residents] may never be religious, but relationships with people to them are important."
More and more residents of nursing homes have significant cognitive impairments, so special attention must be given to enhancing the religious experiences of residents with dementia. One nurse told an especially poignant story:
Photo by Todd Hochberg
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One of the most sacramental moments of my life was when Lily stood straight up carrying her purse and her earrings and all of her make-up, straight up and sang the entire song with Judy Collins. Sang the entire "Amazing Grace." There wasn't a dry eye in that dining room. We just stood there crying. Here was a person who, every other word out of her mouth was what time is it, what time is it, what day is it, what day is it. That's all she could say. I think songs and music get through more than prayer, verbal prayer. I think music gets very rich for people with dementia.
When considering the meaning and function of religion in contemporary nursing homes, it is important to acknowledge the larger social, political, and economic context influencing policy and practice within these facilities. With the increased medicalization and regulatory requirements of long-term care, religion is at risk of becoming segregated from issues of care. Yet, while obstacles exist, there are numerous opportunities within the long-term care setting to meaningfully integrate religion and spirituality into the lives of these older adults.
