Thank you for the opportunity to provide input to the draft of the Revised Aged Care Quality Standards including the expectation statements for older people, intent and enforceable outcomes included under each standard. We appreciate the considerable effort undertaken by the Department of Health and Aged Care to ensure the implementation of this particular recommendation from the Royal Commission into Aged Care Quality and Safety.  Commencing with “The Person” (Standard 1), the seven proposed standards provide a comprehensive approach, though with one major omission: recognition of spiritual care.

As the national agency of the Uniting Church in Australia concerned with community services, including ageing and aged care, this submission focusses on the need for aged care quality standards to make explicit reference to spiritual care as part of overall quality and wholistic care of older persons.

UnitingCare Australia has previously undertaken advocacy to include consideration of the spiritual aspect of people in the Australian Disability Strategy. That strategy incorporates a policy priority to ensure people living with disability can fully participate in social, recreational, sporting, religious and cultural life.

Recommendation 1

That the draft Aged Care Quality Standards be amended to include a reference to spiritual care in a way that is meaningful to the person’s beliefs, culture, and circumstances. One way to do that would be to include the definition of a ‘person’ which encompasses the domains of physical, emotional, social, psychological and spiritual needs.

Recommendation 2

That the expectation statement for the older person  in Standard 1 be amended to state “…My identity, culture, spirituality and diversity are valued and supported, and I have the right to live the life I choose…”

Recommendation 3

That Outcome 1.1 in Standard 1 be amended to “The provider understands and values the older person, including their identity, culture, diversity, beliefs, spirituality and life experiences…”

Background and Rationale

What is spiritual care?

The National Guidelines for Spiritual Care in Aged Care (Meaningful Ageing Australia, 2016), developed with funding support from the Australian Department of Health and Aged Care,  distinguish between spiritual care and religious care. The guidelines describe spiritual care as the umbrella term under which religious and pastoral care sits. Spiritual care is not necessarily religious care. Religious care includes spiritual care given in the context of shared beliefs, values, and practices. Spiritual care encompasses both faith specific care and non-religious care.

UnitingCare Australia member organisations provide spiritual care within the context of chaplaincy services. Fundamental to the approach of members is to not promote a particular denomination, religion or doctrines within chaplaincy services. The dignity and choices of the individual older person are fully respected.

In 2015 the Australian Aged Care Quality Agency found that during conversations with participants that “Psychological and spiritual wellbeing and social inclusion were regularly cited as key factors in quality care” (Australian Aged Care Quality Agency, 2015, p. 6). The National Health Service (NHS) in Scotland has produced impressive work in this area (NHS Education for Scotland, 2009). They defined spirituality as encompassing a wide perspective on well-being and holistic care:

“Spirituality is found in the integration of several deep connections: the connection with one’s true and higher self; the connection with society and especially with the poor, the deprived and underprivileged; the connection with the world of nature and other life forms; and for some, a connectedness with the transcendent.” (p. 19) 

Spiritual Health Victoria has defined spiritual care as a “supportive, compassionate presence for people at significant times of transition, illness, grief or loss. Spiritual care is a collaborative and respectful partnership between the person and their health care provider. It is an integral component of holistic care” (Spiritual Health Victoria, 2016, p. 7).

Spiritual care and Quality Standards

Each of the revised quality standards seek to embed “person-centred care”. This is strongly supported and is consistent with major changes which have been taking place not only in aged care, but also disability services and health care. It is not clear from the draft that those reading and applying the Standards will appreciate the totality what is meant by a ‘person’.

A person is more than their physical embodiment. The physical needs of older Australians are well provided for in the Revised Standards but the domain of spirituality as a part of personhood is not mentioned. For example, Outcome 5.4, “comprehensive care” makes no mention of spiritual care. Likewise, although Outcome 5.5. (“care at the end of life”) properly refers to the management of pain and symptoms, this is a time when many people are thinking about questions concerning meaning and purpose often framed in the context of spirituality.

Without offering older people a sense of purpose and meaning by relating to them holistically, older people will be less able to flourish, independent of how well they are cared for physically.

Some of the common challenges for older people include:

• Loneliness
• Bereavement
• Fear of dying
• Regrets in life
• Lack of purpose
• Grief of leaving family home and/or pets
• Physical changes
• Chronic illness
• Psychological changes
• Poverty

Each of these transitions or life events can cause pain and suffering, both physical and spiritual. It is for this reason that spiritual care needs to be explicitly referred to in quality standards.

Spiritual care, health and wellbeing

There is an increasing body of research that shows the importance of spiritual care in health and aged care in reducing distress, enhancing a person’s ability to cope with illness, and positively responding to changing life circumstances (Boero et al., 2005; Carr, 2008). Care that values spiritual elements such as faith, hope, meaning making, compassion, and connections has been shown to promote health and quality of life.

The Australian Commission on Safety and Quality in Health Care has identified the importance of patient-centred care that incorporates a focus on people’s beliefs and values as a key component of safe and high-quality care (Australian Commission on Safety and Quality in Health Care, 2011). Spiritual care in health care is concerned with care for the whole person, and includes the physical, mental, and emotional, as well as spiritual.

It is often in times of crises and change that spiritual care takes place in the health setting. The role of spiritual health care practitioners, such as the chaplains and spiritual care practitioners in aged care, is to listen closely to questions to help people understand the spiritual dimension of change and help them find and affirm meaning, purpose, connection, dignity, self-worth, and hope when they are faced with health and life challenges (Wells, Fetherstonhaugh, & Hunter, 2021). This may happen through interventions that involve story, ritual, nature, and creativity, or simple appreciation for the miracle of life (Manitoba’s Spiritual Health Care Partners, 2017). ‘‘The focus on the whole person requires an intentional commitment to holistic care in leading to the optimal patient experience. It requires attention to emotional, social, and spiritual needs in addition to the physical well-being central to healthcare today” (Wolf, Palmer, & Handzo, 2015).

In conclusion UnitingCare Australia believes that the work undertaken to revise the quality standards would be assisted by direct reference to spiritual care in the standards.