Care in Time
The Catholic Church is celebrating longer lives in England and Wales with the publication of a new report 'Care in Time'. The fourth Caritas Social Action Network (CSAN) report on this topic since 2002, though, doesn't pull its punches about the challenges facing society in general and Catholics in particular. 'Care in Time' is a call to act… now.
Care in Time was launched in Westminster yesterday evening, along with resources for parishes and dioceses which are the fruit of several years work, the Embrace Project, to empower lay people at grassroots level to do more to support those in their later years. You may download the 'Reaching Out' tool kit by clicking here.
Archbishop of Westminster
Originally invited to the launch of 'Care in Time' as a guest, I was then asked to chair the evening at which the Archbishop of Westminster, Cardinal Vincent Nichols, spoke movingly of his own first experience of death.
As a child he recalled how his mother used to pop in daily to see a neighbour called Mr Shannon. On one occasion she returned home and asked her young son to 'come and see'. There in the house nearby was Mr Shannon, sitting in his chair having died peacefully in the night. Close at hand was his copy of the book The Imitation of Christ by Thomas a Kempis. The experience had a profound impact on the young Vincent, informing his whole view of the 'treasure' that is Catholic spiritual care.
'Old age is a vocation'
At several times during the evening, speakers referred to Pope Francis' words that ‘old age is a vocation’, with its own challenges and opportunities for discipleship. It is one stage in a human story that continues into eternity. Compare this, detailed the report, with the ‘culture of death’ that considers ageing as little more than a process of inexorable loss and decline into irrelevance as a precursor to an empty and meaningless end, inflicting a ‘burden’ of care on younger, fitter individuals who deserve to be released from it.
'A national scandal'
The report's authors include Peter Kevern, Professor of Values in Social Care at Staffordshire University, and independent researcher Dr Kathryn Hodges. They argue that 'the church has a pastoral responsibility to protect the old and the needy: the portrayal of older people as dependent and greedy can be used to justify woefully inadequate levels of social care amounting to a "national scandal".'
That phrase 'national scandal' was used by the House of Lords Economic Affairs Committee, calling for 'a White Paper, not a Green Paper, with clear and plausible proposals for sustainable adult social care funding'.
The context into which 'Care in Time' speaks is one in which the number of people in England and Wales over 90 years of age has increased by 50% over the 15 years to 2017, with virtually no change in the working age population. (The Office for National Statistics)
The proportion of the population who are retired will rise to about 24% in 2050 from the 12% recorded in 2012, and there will be around eight million adults aged over 80 years old, three times more than there are currently (RSA Action and Research Centre, 2012).
Forecasts suggest that by 2040 there will be double the number of older people needing social care support, of whom 1.4 million would be diagnosed with dementia.
Looking more closely at what has affected Catholic care in particular, the authors pinpointed among 'omissions and stresses', the fact that:
Many Catholics consider what care is too late, including priests and dioceses
Absence of statements on ageing and care for 25+ years from the bishops.
The number of Catholic care homes have diminished as a result of the dwindling numbers of vocations and the broader social care landscape.
'There needs to be consideration about how this care will be provided in the long-term as the number of vocations dwindle and older people become an even more dominant proportion of the Catholic population in many places.'
Elsewhere in the report it was observed that 'religious and spiritual care has been left to individual providers or interest groups, without central direction or support'.
Yet, this is at a time when the Care Quality Commission (CQC) states, ‘Assessments of people’s care and treatment needs should include all their needs, including health, personal care, emotional, social, cultural, religious and spiritual needs.’ Providers must have regard to this guidance. (Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 9.)
I'd argue (and I voiced this from the chair) that churches have an opportunity here to capitalise on what the secular sphere now recognises should be part of holistic care of individuals when they move into residential care. Anna Chaplains are helping individuals in care homes to articulate their religious and/or spiritual needs.
Calls for coordination
The report adds that, 'Coordination of practical support among a range of organisations is now needed – including dioceses, religious orders, and specialist charities in the Caritas network – to prioritise and realise new ways of winning support for and resourcing Catholic care in future.'
Letter from a Carer
Prominence is given to a heartfelt letter from a Carer who made this plea:
I am asking you please to thunder out about this and somehow get the position of the Catholic Church in the news and media. This is not a party-political point, but please, can we do more to make the public stance of the Catholic Church about this out there and to be a leading voice for people who have nobody to speak for them…
Please can this be something that we yell about, that we become a boring nuisance about – please may we be prophets, not diplomats, because carers are at the end of their tethers and elderly people are abused and neglected in full view of us all because of cuts to council budgets reflecting totally unchristian priorities.
'Buckling under the pressures'
A note of urgency was sounded, given there have now been 'three earlier reports on Catholic services for older people between 2002, 2007 and 2009, families are buckling under the pressures of industrial society.'
'In this kind of context, the elderly, often enough, finish by becoming an encumbrance' (Pope John Paul II).
Signs of hope, though, include news that the collaborative 'Embrace Project' has resulted in more than '1,000 people within and outside the Catholic community engaged in new and extended social activities' thanks to ‘Reaching Out – Older People and Catholic parishes – making memories together’ – offering parishes ways to build confidence in forming activities with older people, based on the results of three years’ grant-funded practice development in parishes and deaneries, facilitated by Caritas Salford, Catholic Care (Diocese of Leeds) and Father Hudson’s Care in the Archdiocese of Birmingham.
Summarising the aims of 'Care in Time', its publication is intended to:
Help Catholics and professional care providers understand, describe and prepare for Catholic care in later life, beyond arranging access to the sacraments.
Increase parishes’ confidence in reaching out to older people beyond the church’s walls.
Encourage parishes and Catholic care providers to deepen mutual support, so that Catholic care – especially residential care – is recognised, promoted and supported as a shared enterprise, and embraced within parish activities.
Highlight pressing challenges for Catholic care that affect the quality and financing of current provision and planning by dioceses, religious orders and Catholic households.
Garner support for national dialogue between Christian and public agencies in England and Wales that leads to more strategic action, relevant advocacy and education.
No one should be in any doubt of the scale of the problem, though, in these unprecedented times of a fast ageing population. The report declares:
'Rapid increases in longevity, confusion on the roles of the government and wider society in care, and the operation of some aspects of the care market, have all contributed to paralyses in developing care and the "warehousing" of older people.'
It speaks of 'a lack of confidence in parishes, described in earlier research, to take greater responsibility for creating the kind of care they want to see'.
Meantime, 'Global Catholic thought has been equally clear for at least 20 years that Catholics need to get to grips with the opportunities offered by increased longevity for Christian mission and plural communities, and the threats of new, dehumanising approaches to care practice.'
Loneliness and social isolation
All this, at a time when 'loneliness among older people is now commonplace. Age UK has forecast that by 2026, without additional action, two million people aged over 50 in England will often feel lonely.'
'Care in Time' states that 'social isolation is overtaking material poverty as the primary pastoral need: 2 million over-75s in 2018 live alone and in England more than a million older people say they go for over a month without speaking to a friend, neighbour or family member.’
It points to 'some new community-led provision has opened at national (e.g. The Silver Line, established in 2013) and local (e.g. Linking Lives and Anna Chaplaincy) levels.'
Again, speaking up for carers, the report refers to how a 'survey by the NHS of over 50,000 adult informal carers in England found that two thirds had been providing support and care for over five years, and 21.4% for over 20 years; 36% provided more than 100 hours’ care per week... caring for relatives… was often described as tough, frightening and horrible... It is thought that there are six million informal carers in the UK providing unpaid care and support to older people.' (Age UK)
A common thread throughout the evening was a call for a unified voice. 'Unlike in hospital contexts, no one at national level – in public policy and Catholic contexts – appears to accept responsibility for promoting spiritual and religious care or safeguarding its future in the care system.'
Silences speaking volumes
Kathryn Hodges conducted scores of interviews with participants with first-hand experience of the care system, noticing how women are carrying out the majority of care roles. 'There are times when participants struggled to put things into words, when they were unable to answer, or glossed over subjects. There were also "silences" on particular topics, or the things that are not talked about. In the focus groups this related to gender and caring, the expectation of family to care in the future, and for those who had not been exposed to the realities of caring for others in later years, their understanding of what this might look like for themselves.
'There is also much commentary on the need to engage the church (at various levels) with provision of care for those in need of support in the local community,' she wrote.
'There were some stories of individuals and the things they did in their local community, such as holding coffee mornings, inviting neighbours for dinner, and taking people shopping. For many, there was a desire to do something, but lack of clarity on what and therefore how to proceed.'
Urgent calls for action
'Care in Time' says, 'Coordination among more Catholic organisations is needed urgently, to address with other Christian and public agencies the opportunities offered by increased longevity for Christian mission, spirituality and plural communities, and the threats of new, dehumanising approaches to older people and care practice. The Catholic Church in England and Wales needs to counter negative portrayals of older people. Silence could be read as approval for further reductions in social care, paving the way to neglect of the aged poor, and may add momentum to calls for assisted dying.'
Another challenge 'is to provide animating support for parish development – more than a toolkit – where parishioners wish to commence action themselves'.
There's 'a need to counter negative characterisations of ageing', the strong suggestion is 'that the public attitudes and imagery that we adopt in relation to old age may be providing momentum to the movement for introducing euthanasia or assisted dying in the UK'.
Again, 'care of the aged poor and Catholic care need far more confident institutional advocacy within the Church and in public policy. First, there is a need for more joint communication of Catholic care by providers... there is a need for dioceses and care providers to work together, to improve understanding of, and commitment to it, in the wider Catholic community, relative to investment in other issues. These processes are in addition to, and underpin, confident Catholic engagement in a plural society.'
This should include 'new forms of mission from the lived experience of an older population,' and 'the need to raise awareness among priests and parishioners of the realities of care, to promote ‘relational care.’
In other words, 'those receiving care noticed how staff paid attention to the detail, describing what they experienced as caring as being kind and pleasant, putting people at ease and not talking down to people. Both recipients and providers of care emphasised the importance of sustained relationships in caring, and the environment that enables carers to take time and be present with residents.'
CSAN has identified needs for more structured dialogue with the following ten audiences:
Policy makers and commissioners
The Care Quality Commission (CQC) in England and Care Inspectorate Wales
Care home managers
Investors and funders
Catholic groups in England and WalesInstitutional Church in England and Wales (e.g. parishes, dioceses, religious orders and trusts)
Dicastery for Integral Human Development
Those who want to identify precisely what good care looks like, might look no further than:
Kindness – ‘tenderness’, the ‘mercy ethos’, a ‘generous gift of self’
Physical resources, such as a chapel or prayer room, fittings and consumables
Substantive provision for religious and spiritual growth in community, such as liturgies, other celebrations, and pastoral support/chaplaincy
The time to sit alongside people during the last weeks of their earthly life, and to pray with them and their relatives before and after death
A wholesome approach to individual human development that shapes and runs throughout care provision and monitoring systems
Conditions that enable staff and carers to progress in their family life, employment, formation and reflective practice
The education, financial and in-kind support of the local Catholic community, funders and decision-makers, to ensure these features continue to thrive.
If these factors are absent, we risk 'a transactional, rather than relational approach, eroding the ability to “respond to individuals, to recognise their differences and to engage with the complexity of individuals and their community.” And there is "the language of kindness and grief, of loneliness, love and friendship, of the ties that bind, our sense of identify and of belonging" (Unwin, 2018, p.9 and p.11). Relationship-based practice, “explores not only the ‘how and what’, but also the ‘why’ of practice”, with practitioners developing a holistic understanding engaging with all aspects of an individual’s behaviours, recognising that “individuals are complex, multifaceted and more than the sum of their parts” (Ruch, 2005, p.113). The report contains an extensive bibliography.
Kathryn Hodges recalled, for instance, how one participant wished they could find more staff that 'care, but with a little more warmth… The relational aspect of the interaction matters: getting to know someone, understanding what is important to them, and paying attention to this when you meet them.'
Time is, indeed, running out. The report makes clear that from the Caritas point of view, 'With the publication of Care in Time and Reaching Out, CSAN’s national team has taken the work as far as possible within its resources, for the foreseeable future.'
Care that comes in time, then, depends on fully appreciating that, in the authors words: 'Catholic care options and expertise are disappearing, silently and permanently, in much of England and Wales… Catholic care is not a luxurious pampering or emotional prop, but embraces the whole person in community, body and soul. It is a sacramental sign of what is truly beautiful and good... It is critical to understand how members of the church community hope to experience care in the future, and to explore their role in creating the environment of support that they may want or need in their later years.
'Being a local well of good practice might be great for a regulatory inspection but falls short of engagement by the wider church. We need to build reservoirs capable of irrigating a national grid of Catholic care. Some directors of Catholic social services consider the engagement on this – particularly the lack of a dedicated, joint statement from the bishops – as a serious failure in pastoral leadership in the church for the Catholic population as it is now, and as it ages further.
'To nurture the identity of Catholic care, and to ensure the contribution of Catholic care is heard in public policy making, providers should consider developing a federation of Catholic care homes, with collective representation through CSAN, and in dialogue with other major Christian providers... A federation may also open up opportunities for some professional services to be shared, to release resources for strategic development.'
Leaflets describing the spiritual care offered by Anna Chaplaincy were given out with every copy of 'Care in Time' distributed at the launch. It was, perhaps, pertinent to read in the report that 'new forms and methods [of pastoral care], more consonant with the needs and spiritual aspirations of older people, need to be sought; new pastoral plans… need to be formulated. These are essential conditions for encouraging older people to make their own contribution to the mission of the church and helping them to derive particular spiritual enrichment from their active participation in the life of the ecclesial community'.
'Virus of death'
This, at a time, they said, when 'society “carries with it the virus of death”. [Pope] Francis has observed that society’s failure to care for the elderly is linked to its denial of frailty, decline and death. This is clearly a problem for elderly people in need, but may also be understood as diminishing everyone in society. A society that cannot contemplate frailty is one that “carries with it the virus of death”, stunting everything creative that it tries to do. The paradox is that “life spans have increased, but society has not ‘expanded’ to life!”, as its fear diminishes it.
For at the heart of Catholic teaching is the assertion that our ‘true identity’ as human beings does not depend upon what we are capable of achieving or our exercise of personal power, but our status as children of God. This cannot in any way be undermined by frailty or loss.
'Pope Francis, again, has expressed a vision in powerful language : “The prayer of grandparents and of the elderly” would be “a great injection of wisdom for the whole of human society: above all for one which is too busy, too taken, too distracted. . . Homes for the elderly should be the “lungs” of humanity in a country, in a neighbourhood, in a parish; “sanctuaries” of “humanity”.' (Meeting of the Pope with the elderly. Address of Pope Francis, Saint Peter’s Square, Sunday, 28 September 2014.)
The full report 'Care in Time - Celebrating longer lives in England and Wales' may be downloaded by clicking here:
The 'Reaching Out' tool kit is available by clicking here:
More photos coming soon...