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Message DISCUSSION PAPEREnhancing Spiritual Care and EmotionalWellbeing in Aged CareJanuary 2024
Meaningful Ageing Australia acknowledges the Australian Aboriginal and Torres Strait Islanderpeoples of this nation and the traditional custodians of the lands where we conduct our work. We pay our respects to ancestors and Elders, past, present and emerging. We recognise theirunique relationships to the land and waters and are grateful for their spiritual resilience and culturalwisdom.Meaningful Ageing Australia supports person-cantered care that is inclusive for all people.The intersex-inclusive Progress Pride flag is a reflection of recent conversations around inclusivityunderneath the broader umbrella of the Silver Rainbow.ContentsOur reason for being1Introduction2Recommendation 12Recommendation 2.14Recommendation 2.25Recommendation 3.1 & 3.26Recommendation 47Appendices8Our Members & partners11Authors: Paul Sadler, Board Director,Meaningful Ageing Australia and Rachael Wass, CEO of MeaningfulAgeing AustraliaRelease date: 6 January 2025Acknowledgements to: Participants of the Funding SpiritualCare Roundtables, Roundtable co-convener, Cynthia Payne; and variouspolicy and researcher contributors. Contact for this discussion paper: Rachael Wass, CEO of MeaningfulAgeing Australia email: rwass@meaningfulage.org.au mobile: 0481 044467 Meaningful Ageing Australia
We hear from our members about their need to find ways to carry peace to others through timesof challenge and change - and the need to reduce the impact of isolation that these challengescan mean.We hear their need for establishing the routines and rituals that mark and honour significantturning points and the crossing of thresholds; the way we welcome, observe, celebrate andfarewell.We hear from our members that they are looking for deeper ways to recognise and respond toolder people on a daily basis that makes them feel seen and known and safe.More than ever, person-centred care is widely accepted as a standard but a tension exists withinthe sector between offering this level of care, regulatory changes and the level of resourcesavailable.Meaningful Ageing Australia is on a mission to help provide the sector with the leadership and theresources they need to be able to ensure every person in their care - be it residential orcommunity-based - experiences meaning, purpose and connectedness in their lives.This means advocating on our members’ behalf and elevating the role of advanced practitionersand ensuring their professionalism is recognised. It means creating practical resources andprograms to support aged care providers to build staff confidence and capability so that they canintegrate emotional support and spiritual care into their day to day work.Ensuring older people can continue to experience meaning, purpose and connectedness isspiritual care. And it’s our reason for being.Meaningful Ageing Australia Not For Profit(SD) Limited is registered with the AustralianCharities and Not-for-profits Commission(ACNC).Our reason for beingMeaningful Ageing Australia
This Issues Paper explores some the key issues with funding of spiritual care in Australia’s agedcare system and is based on three online roundtables Meaningful Ageing Australia (MAA)conducted in April/May 2024 examining how spiritual care is funded. This final discussion paper was launched at the National Aged Care Alliance (NACA) meeting inNovember 2024, and gained wide support across constituencies. Further input has beenincorporated from stakeholders, in particular NATSIAACC and the PiCAC Alliance. The Core IssueThere is a lack of specific funding of spiritual care in aged care. This compares unfavourablywith the situation in areas such as palliative care, schools, prisons and the defence forceswhere funding Spiritual Care Practitioners (Chaplains or Pastoral Carers) is well established.By and large, individual practitioners are not singled out for funding in aged care, with fundingmechanisms generally targeted to support provision of holistic care.First Nations health and wellbeing is intrinsically connected to mind, body and spirit. So too,older people from CALD communities and currently there is a lack of culturally appropriatemodels of care in aged care. IntroductionRecommendation 1.1Advocate for greater recognition of spiritual care in Australia’saged care systemMeaningful Ageing AustraliaRecommendation 1.2Advocate for a culturally safe and appropriate model of care foraged care, in line with The National Guidelines for Spiritual Care inAged CareFirst Nations Perspective on Health and Wellness emphasises the importance of mental,emotional, spiritual, and physical facets of a healthy and balanced life, and it is crucial to nurtureall these aspects together to create a holistic level of well-being and cultural safety. Similarly, older people from Culturally and Linguistically Diverse (CALD) communities facechallenges due to the lack of culturally appropriate models of care in aged care.
What is spiritual care?We champion the emotional wellbeing of older people so that their lives have meaning, hopeand connection. So that they retain their spirit – the thing that makes them feel whole and atease. We call that spiritual care. Spiritual care is a broad concept - religious faith is a particularexpression. Enhanced Aged Care Quality StandardsSpiritual care was acknowledged in the current quality standards when they address palliativecare.The new strengthened standards expand references to spiritual care. Standard 1- The Personincludes reference to emotional and spiritual care. There are explicit references throughout theenhanced standards to spiritual care being included in cultural safety, diversity, palliative care,goal setting and wellbeing.The National Guidelines for Spiritual Care in Aged Care have been mapped to the newstrengthened Aged Care Quality Standards (refer fig 1 below). The National Guidelines forSpiritual Care in Aged Care are due to be revised early 2025.Fig 1. Meaningful Ageing Australia resource:Mapping the revised ACQS with The NationalGuidelines for Spiritual Care in Aged Care Meaningful Ageing Australia
Funding Spiritual Care NowThe most common funding mechanism is a spiritual care allocation as part of the provider’soverall budget. This method relies on the provider being profitable overall, a situation that hasbeen rare in aged care in recent years. Some providers manage this situation by relying onvolunteers to do most of the pastoral care work.Home CareAppendix 1 outlines the current position in Home Care Packages and Commonwealth HomeSupport Program (CHSP). Many providers are expanding their home care services and have aninterest in delivering spiritual care in the community. There are different experiences of howmuch demand for spiritual care there is from people receiving home care services.Some providers had attempted to offer it as part of the suite of services they offered to HCPrecipients with little take up. There was widespread acknowledgement of the difficulty ofcharging HCP recipient budgets for spiritual care or charging recipients a fee for service.One successful approach by an HCP provider was to train spiritual care staff to help clients andtheir families undertake advance care planning. The provider then offered this service to HCPrecipients and found it was taken up by many of them. It could be identified as a distinct serviceof HCP claiming purposes.There is uncertainty about the impact of the new Support at Home Program on funding ofspiritual care.Recommendation 2.1Spiritual care should be listed as an eligible emotional supportservice in the guidelines for the Support at Home ProgramMeaningful Ageing Australia
End of Life Pathway - Support at Home ProgramThe journey towards death is the last important journey that each of us takes in life. At the heartof spiritual care is the need for aged care professionals to recognise their role is offeringemotional support, which includes acknowledging the pain and suffering that both the dyingperson and their family carers are going through. The new End-of-Life Pathway funding, part of the Support at Home program, is specificallydesigned for older people with three months or less to live. This initiative has been positivelyreceived by Meaningful Ageing Australia. The program offers up to $25,000 in additional agedcare support for individuals residing at home during their final weeks and months. During thiscritical time, spiritual care is essential for the well-being of the dying person. Spiritual Care Practitioners are uniquely skilled to provide support not only to the dying but alsoto their family caregivers and the staff involved in delivering end-of-life care and need to beincluded as an eligible emotional support service.Recommendation 2.2Spiritual care should be listed as an eligible emotional supportservice in the guidelines for the End of Life Pathway operatingwithin the Support at Home Program.Meaningful Ageing Australia
Residential CareBy and large spiritual care is better established in residential care than in home care. Forexample, it is common for some providers to conduct spiritual care assessments for all their agedcare home residents.Appendix 2 outlines the current position for residential care. Providers can use funding from theAustralian National Aged Care Classification (AN-ACC) to support at least part of what spiritualcare workers do. There is much debate as to whether the staffing care minutes targets can include spiritual care. Itis clear in the guidelines that when personal care workers provide social and emotional supportto individual residents, that time can be counted. The guidelines are silent on whether spiritualor pastoral care worker time can be counted towards the care minute target. Or recognise thatSpiritual Care Practitioners are a highly trained member of a multidisciplinary team rather thanworking under the supervision and guidance of a RN or EN as personal care workers do.It was noted that group activities (such as a religious service, prayer group or Bible study) areclearly excluded from the care minute targets.Recommendation 3.1Spiritual care should be listed as an eligible emotional supportservice in the care minutes targets applying from 1 January 2025.Recommendation 3.2Spiritual Care Practitioners should be recognised as highly trainedprofessionals and valued members of multidisciplinary teams intheir own right.Meaningful Ageing Australia
Better Data on the Spiritual Care WorkforceMAA recognises that there is a need to gather more information about the scale of spiritual carebeing provided in the existing home care and residential care systems. This would in turnprovide an evidence base to mount the argument in support of the funding systems recognisingspiritual care.This could be achieved through inclusion of a question about spiritual/pastoral care workers infuture National Aged Care Workforce Census. Spiritual Care Practitioners were included in the2023 workforce data as ‘Other’ Occupation. W(c) Other category includes Aboriginal and TorresStrait Islander health practitioners, diversional therapists, oral health professionals,pastoral/spiritual care workers, and other roles that were not defined. In 2025, Meaningful Ageing Australia (MAA) and Aged & Community Care Providers Association(ACCPA) will conduct a benchmarking survey on the extent of the spiritual care workforce; andlater in 2025, promote the importance of spiritual care across the sector. This work is undertakenas part of existing programs funded by The Department of Health & Aged Care with ACCPA. It was also suggested in the Funding Spiritual Care Roundtables of the possibility of adding datacollection fields on spiritual care expenditure and staffing to the Stewart Brown benchmarkingsurvey.Recommendation 4Gather additional information on the scale of the spiritual careworkforce.Meaningful Ageing Australia
APPENDIX 1SUMMARY OF SPIRITUAL CARE IN HOME CARE AND RESIDENTIAL CAREHome CareThere is no specific funding for spiritual care available through the major home care fundingprograms.Spiritual Care Practitioners are routinely providing support older people dying, to their familycaregivers and for staff involved in delivering end-of-life care. There has been no specificfunding for spiritual care within the newly announced End of Life Pathway supplement. Where home care providers choose to provide spiritual care, they usually budget for itthrough allocation of surplus funds.Home Care PackagesThere are particular difficulties in using HCP funding to support spiritual care.HCP funding is allocated on an individual basis and the provider has to agree with therecipient on the care plan and the funding amount put aside for services delivered by theHCP.At the moment, individual funds cannot be merged to provide a service such as spiritual careavailable to multiple recipients.If the provider has a profit margin built into its services, it could use the profits/surplus to fundspiritual care.Services in scope for HCP include:Ageing related services to keep people well and independent.Ageing related services to keep people safe in their home.Ageing related services to keep people connected to their community, including socialsupport.Support services can include:Counselling from a psychologist.Ongoing emotional support in adjusting to a lifestyle involving increased dependency andassistance for the care recipient and carer, if appropriate.Encouragement to take part in social and community activities that promote and protect thecare recipient’s lifestyle, interests and wellbeing.Meaningful Ageing Australia
APPENDIX 1 continuedSUMMARY OF SPIRITUAL CARE IN HOME CARE AND RESIDENTIAL CARECommonwealth Home Support Program (CHSP)CHSP services are grant/block funded to deliver a certain number of outputs (hours) toeligible clients.Unexpended funds at the end of each financial year must be returned to the government.Service types potentially relevant to spiritual and pastoral care include:Allied Health including formal counselling from a qualified social worker or psychologist.Social Support Group to assist frail older people to participate in community life and feelsocially included through structured, group-based activities that develop, maintain orsupport independent living and social interaction.Social Support Individual to assist frail older people to participate in community life and feelsocially included through meeting their need for social contact and company.Meaningful Ageing Australia
APPENDIX 2SUMMARY OF SPIRITUAL CARE IN RESIDENTIAL CAREResidential CareThe position of the Department of Health & Aged Care is that emotional support, includingfrom spiritual or pastoral care workers, is covered as part of Schedule of Specified Care andServices.This means that the funding residential care services receive from the Australian NationalAged Care Classification (AN-ACC) can be used to support at least part of what spiritual careworkers do.Care minute targets include RNs, ENs and PCWs/AINs.PCW/Care worker activities include social and emotional support - supporting residents to beand feel connected, heard, valued and fulfilled, and provide regular monitoring of residents’health and wellbeing.Guidance material is silent on Pastoral Care or Spiritual Care workers.Opportunity for education funding for upskilling workers in spiritual care.Consideration for reclassification of workers - implications for agreements/awards, positionand role descriptions.Meaningful Ageing Australia
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