An opinion piece by Jess Sanders, Masters of Social Work, RMIT University
The current standard 3.8 Cultural and spiritual life of the Residential Aged Care Quality Standards can be seen as one of the most relevant standards to the work of Meaningful Ageing. The equivalent of standard 3.8 Cultural and spiritual life in the new quality standards is Standard 4 – Services and supports for daily living. The time between the first publication of the current standards and the emergence of the new set of standards is significant and this has resulted in some dramatic changes. In this opinion piece I will compare and contrast these two standards from a spiritual care perspective whilst exploring the following questions: what has changed and what is missing?
The first significant shift is that the new standards now apply to all aged care services whereas the current standards only applied to residential aged care. The second significant shift to occur was the deliberate movement towards a consumer choice framework. This change in approach and language is reflective of a cultural shift prompted by the ongoing privatisation of the welfare state. Providing ‘the consumer’ with choice is promoted frequently throughout the document, however, the practicalities of upholding consumer choice within the financial and organisational restraints of the aged care sector are not explored.
The current standard 3.8 locates spirituality within cultural, ethnic and religious frameworks. Spirituality is not specified as existing outside of these categories, but this has been rectified in the new standards. Meaningful Ageing views spirituality as being about meaning, purpose and connectedness which is expressed through beliefs, values, traditions and practices. The connectedness component typically has five domains: connection to self, others, nature, creativity and something bigger than one’s self. Nurturing each of these domains in an older person will enable them to find meaning and purpose, consequently supporting their social and emotional wellbeing. All five domains of connectedness need to be addressed in order to adequately care for an older person’s spirituality.
As a social work student new to the aged care sector, I was shocked to discover that an aged care home was not required to employ a social worker, psychologist, counsellor or spiritual care practitioner (pastoral carer or chaplain, for example). During my time at Meaningful Ageing I have met several spiritual care practitioners who I see as doing an excellent job to tend to the spiritual needs of the older people in their care. However, their role is not required. This is particularly concerning considering that the rate of suicidal thoughts in residential aged care settings can be as high as 46%.[i]
An equally shocking discovery for me was that older people living in residential aged care are not eligible for a mental health-care plan as they are not deemed as being “a part of the community” by the Australian Government.[ii] This perception of older people in residential aged care is concerning in and of itself. These barriers to receiving emotional and psychological support send a clear message; that the emotional and psychological wellbeing of an older person is not perceived to be of importance to policy makers.
The importance of spiritual care practitioners cannot be underestimated. Through conversations with older people and visits to aged care homes, I was able to see their presence as integral to the holistic wellbeing being of an older person. Spiritual care practitioners appear to be natural candidates to oversee the integration of Standard 4. Outside of residential aged care, professionals if equipped with adequate training as specified in the guidance materials, could be able to identify the diverse and holistic needs of older people and make relevant referrals/suggestions to care for those needs.
In summation, the new standards do well to uphold the agency, personhood and humanity of older people. The standards encompassed by Standard 4 are closely aligned to the values of Meaningful Ageing and serve to validate the work of the organisation. The take away question is how will these standards be executed in environments which are low on time and resources?
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[i] O’Riley A, Nadorf MR, Conwell Y, Edelstein B.“Challenges associated with managing suicide risk in long-term care facilities,” Annals of Long-Term Care: Clinical Care and Aging 21, no.6 (2013):28-34.
[ii] Magarey, Joel. 2017. “Nursing Home Residents Denied GP Mental Health Treatment Plans And Psychological Therapy”. The Sydney Morning Herald, , 2017. https://www.smh.com.au/healthcare/nursing-homes-story-headline-20161228-gtiqc6.html.