Ed. note: While this piece is written in Heeba’s voice, both authors have contributed equally to the article.
“What is the point of living if I can’t do anything or see anyone?” An elderly gentleman, a resident in a long-term care (LTC) facility in Cornwall, Ont., poignantly asked me this while undergoing months-long isolation in his room during the COVID-19 pandemic.
In 2020, Ontario’s LTC lockdown policies led to the elimination of religious, recreational, therapeutic and social activities for residents, resulting in a spiritual health crisis in LTC homes. As a front-line occupational therapist (OT) working in LTC during this time, I witnessed first-hand the devastating consequences of the removal of spiritual care.
Although the Ontario LTC Home Act mandates the coverage of spiritual care in LTC homes, it does not define spiritual care, leaving it up to the interpretation of each home. For many, spiritual care simply means providing religious services. One Toronto LTC home I worked in placed great emphasis on this by facilitating regular pastoral services and designating multiple places of worship to accommodate resident diversity. Many residents told me they selected this home because of these religious accommodations.
For many residents, social connection is core to their sense of purpose in life.
However, spiritual care is not only for those who identify with a religion. I have worked with the geriatric population in Ontario for almost 20 years and my definition of spiritual care has become more holistic: Spiritual care helps individuals live their lives in a manner that is most meaningful for them. Beyond religion, it encompasses aspects of psycho-social-spiritual support, including social, recreational, physical, occupational and religious activities.
For many residents, social connection is core to their sense of purpose in life. As such, spiritual care means helping them meet their social needs. LTC staff can help fulfill their needs through daily interactions and active listening. They can also facilitate social connections by coordinating visits with families and volunteers and organizing in-house activities to encourage resident interaction. During the pandemic, several LTC homes made exceptional efforts to facilitate window visits between residents and their loved ones because they understood the importance of providing spiritual care through social connections. Beyond human interaction, I have also seen pet therapy trigger so much joy and life in residents, inspiring many to get up from bed and spend time with animals.
Yet another source of purpose for many residents are recreational, leisure and occupational activities that bring them joy. Spiritual care interventions would then involve helping residents identify and take part in activities that are most meaningful for them. This is often my role as an OT. For example, when non-ambulatory residents share how important it is for them to go outside and enjoy nature, I would construct customized wheelchairs that allow them to do this. When residents who value reading novels lose their vision, my role is to find alternative solutions, such as helping them use adaptive e-books or audiobooks. Other recreational activities like bingo and scrabble, music and dance nights and festive holiday celebrations are essential in making people feel valued, heard, seen and loved.
Given the importance of spiritual care, its absence can have many direct and indirect consequences on residents’ mental and physical health, health spending and staff burnout. During the lockdown, I saw a spike in depressive symptoms and suicidal rumination among residents, including the gentlemen in Cornwall. I listened as many residents expressed their desire to end their lives after being cut off from spiritual care services. As a result, it was difficult for staff to motivate them to get up from bed.
Unfortunately, this increased time spent in bed led to a greater incidence of pressure ulcers, rapid deconditioning, including cardiovascular concerns, and more episodes of depression and anxiety, all of which only worsened their existing pain and health status. Their deteriorating health led to more significant spending on medications and new equipment. For example, in one LTC home I worked in, it easily cost more than $50,000 to purchase new therapeutic mattresses for the new and worsening cases of pressure ulcers during the early months of the pandemic.
This is a call to action for policymakers and shareholders to invest in spiritual care.
Furthermore, the removal of spiritual care also affected LTC staff. Before the pandemic, the LTC sector was already marked with staffing shortages and staff burnout, limiting their ability to provide personalized care. This was further exacerbated when resident health worsened after the removal of spiritual care, leaving staff with the burden to care for these increasingly complex health needs. These impacts on resident health and the health system could have been prevented with access to spiritual care.
The Ontario LTC Homes Act mandates that LTC homes provide spiritual care to residents. Despite this, many homes are not structurally equipped to cater to residents’ spiritual needs. Given that Statistics Canada projects that seniors aged 65 and older will represent 25 per cent of the population by 2036, the LTC system must urgently expand and adapt to these growing LTC demands.
This is a call to action for policymakers, officials and shareholders to invest in spiritual care in LTC homes as an essential determinant of resident health and well-being. I also invite resident and family councils of each LTC home to advocate for residents’ spiritual needs so that people like the Cornwall LTC resident can suffer no more.
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