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Report of roundtables on funding spiritual care Prepared by Paul Sadler, 10 May 2024

Report of Roundtables on Funding Spiritual Care 10 May 2024 Meaningful Ageing Australia Page | 2 The Roundtables Meaningful Ageing Australia (MAA) conducted three online roundtables in April/May 2024 examining how spiritual care is funded in Australia’s aged care system. The roundtables were attended by organisational members of MAA as well as others interested in the topic. See Appendix 1 for a full list of attendees. The roundtables were conducted by Rachael Wass, CEO MAA, assisted by Paul Sadler, MAA Board Director, and Cynthia Payne or Carla Beheram, Anchor Excellence. The roundtables were held on 19 April, 29 April and 1 May 2024. Each roundtable followed the same agenda: • Rachael introduced the issue, outlining her contact with the Department of Health & Aged Care (DoHAC) and Aged & Community Care Providers Association (ACCPA). • Cynthia Payne’s contact with Provider Assist and Russell Kennedy was described. • An email from Claudia Dukas, Acting Assistant Secretary, Home and Residential Division, Funding Operations & Analysis Branch, DoHAC was discussed, focusing on the place of spiritual care in the Schedule of Specified Care and Services for residential care and in the Aged Care Quality Standards (see Appendix 2). • Attendees were encouraged to attend the MAA Community of Practice in June 2024 which will discuss mapping of the National Guidelines for Spiritual Care in Aged Care to the enhanced Aged Care Quality Standards. • Rachael noted that the National Guidelines for Spiritual Care in Aged Care are due to be revised later this year. • Rachael outlined the discussion on the Sector Reference Group for the Star Ratings about the inadequacy of the drop-down menu on faith groups on My Aged Care and the possibility of covering spiritual care under “specialised care not covered by verification”. • Rachael outlined opportunities to engage with ACCPA Special Interest Groups and the National Aged Care Alliance (NACA). • Two opportunities to learn more about the spiritual care workforce were discussed:

Report of Roundtables on Funding Spiritual Care 10 May 2024 Meaningful Ageing Australia Page | 3 1. The next National Aged Care Workforce Census will separate out spiritual/pastoral care workers from other allied health workers. 2. An opportunity to participate in a benchmarking study to be conducted with MAA members and non-member aged care providers. • Paul confirmed that spiritual care isn’t covered in either of the two major home care funding programs: Home Care Packages (HCP); or Commonwealth Home Support Program (CHSP). He outlined how providers may be able to fund spiritual care in community care (see Appendix 3). • Cynthia/Carla outlined how spiritual care is funded in residential care and the relationship with the care minutes target (see Appendix 3). • There was then an opportunity for general discussion.

Report of Roundtables on Funding Spiritual Care 10 May 2024 Meaningful Ageing Australia Page | 4 Funding Spiritual Care The most common funding mechanism was a spiritual care allocation as part of the provider’s overall budget. For example, BaptCare Victoria indicated that they allocated 1% of revenue and staff to spiritual care. This method relies on the provider being profitable overall, a situation that has been rare in aged care in recent years. Some providers manage this situation by relying on volunteers to do most of the pastoral care work. For example, Carrington has a paid coordinator to work with their team of spiritual care volunteers. Several roundtable participants noted that spiritual care is a broader concept - religious faith is a particular expression. Home Care Many providers reported planning to expand their home care services. Roundtable participants identified their interest in delivering spiritual care in the community. There were different experiences of how much 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 HCP recipients with little take up. There was widespread acknowledgement of the difficulty of charging HCP recipient budgets for spiritual care or charging recipients a fee. One successful approach by an HCP provider was to train spiritual care staff to help clients and their families undertake advance care planning. The provider then offered this service to HCP recipients and found it was taken up by many of them. It could be identified as a distinct service of HCP claiming purposes. Providers expressed uncertainty about the impact of the new Support at Home Program on funding of spiritual care. Residential Care By and large spiritual care is better established in residential care than in home care. For example, one roundtable participant commented that spiritual care assessments are being undertaken for all their aged care home residents. The email from Claudia Dukas indicated the position of the Department that emotional support, including from spiritual or pastoral care workers, is covered as

Report of Roundtables on Funding Spiritual Care 10 May 2024 Meaningful Ageing Australia Page | 5 part of Schedule of Specified Care and Services. This means that the funding residential care services receive from the Australian National Aged Care Classification (AN-ACC) can be used to support at least part of what spiritual care workers do. There was much debate at all three roundtables as to whether the care minutes targets can include spiritual care. It is clear in the guidelines that when personal care workers provide social and emotional support to individual residents, that time can be counted. The guidelines are silent on whether spiritual or pastoral care worker time can be counted towards the care minute target. It seems that different providers have taken varied positions in practice. There was agreement among roundtable participants that MAA should advocate for spiritual care to be clearly included in the care minutes target when it is increased to 215 minutes in October 2024. It was noted that group activities (such as a religious service, prayer group or Bible study) are clearly excluded from the care minute targets. Enhanced Aged Care Quality Standards Spiritual care is acknowledged in the current quality standards when they address palliative care. The draft new standards expand references to spiritual care. Standard 1- The Person includes reference to emotional and spiritual care. There are explicit references throughout the draft standards to spiritual care being included in cultural safety, diversity, palliative care, goal setting and wellbeing.

Report of Roundtables on Funding Spiritual Care 10 May 2024 Meaningful Ageing Australia Page | 6 Approach to Advocacy Roundtable participants, particularly at the 1 May session, talked about how MAA could advocate for a more stable basis of funding for spiritual care. The lack of specific funding of spiritual care was compared unfavourably with the situation in area such as palliative care, schools, prisons and the defence forces where funding chaplaincy is seen as acceptable. There was support for gathering more information about the scale of spiritual care being provided in the existing home care and residential care systems. In this regard, there was support for inclusion of a question about spiritual/pastoral care workers being included in the National Aged Care Workforce Census and for an MAA benchmarking survey on the topic. The possibility of adding data collection fields on spiritual care expenditure and staffing to the StewartBrown benchmarking survey was also raised. The importance of allies in the advocacy effort was noted. Asking the National Aged Care Alliance (NACA) to consider a paper on the importance of spiritual care was one strategy suggested. Asking faith-based providers to support advocacy was seen as valuable. Roundtable participants noted that the Australian Nurses & Midwifery Association (ANMF) is very influential with current ALP government. It was felt that advocacy by groups supportive of the overall strategy would be useful, particularly after the workforce census is conducted, providing an evidence base to mount the argument. Recommendations 1. Advocate for spiritual care and pastoral care to be explicitly included in allowable emotional support provided directly to individuals in residential care minutes and in guidelines for the new Support at Home Program. 2. Seek support from key stakeholders such as the Australian Nurses & Midwifery Association, National Aged Care Alliance, and faith-based providers. 3. Undertake a one-off MAA spiritual care benchmarking survey. 4. Pursue inclusion of spiritual care workforce in the National Aged Care Workforce Census and StewartBrown ongoing benchmarking survey.

Report of Roundtables on Funding Spiritual Care 10 May 2024 Meaningful Ageing Australia Page | 7 APPENDIX 1 Roundtable attendees 19 April 2024 Name Title Organisation Rachael Wass CEO Meaningful Ageing Australia Carla Beheram COO Anchor Excellence Paul Sadler Founder Paul Sadler Consultancy Paul Sadler Consultancy & MAA Board MAA Vicky Gonzalez Burrows Executive Director of Mission & Ethos MercyCare Maria Dimitriadis General Manager - Alliances & Partnerships Doutta Galla Aged Care Allan Waters GM Residential Services & Retirement Living Baptist Care Saskia Scott Spiritual Wellbeing Coordinator MercyCare Cheryl Kinder Mission & Chaplaincy Manager The Salvation Army Lauren Meredith GM Home Care MercyCare Jeni Goring Senior Chaplain Amana Living James Lewis Head of Spiritual Care BaptCare Penny Davis Manager In Home Care Spiritual Care BaptCare

Report of Roundtables on Funding Spiritual Care 10 May 2024 Meaningful Ageing Australia Page | 8 Jenny Blok GM Chaplaincy and Spiritual Care Manager Baptist Care Sr Antonia Pastoral & Spiritual Care Leader Scalabrini Aged Care Roundtable attendees 29 April 2024 Name Title Organisation Rachael Wass CEO Meaningful Ageing Australia Cynthia Payne Founder Anchor Excellence Paul Sadler Founder Paul Sadler Consultancy Paul Sadler Consultancy & MAA Board MAA Graeme Tutt Head of Chaplaincy and Pastoral Practice Uniting Fr Rod Bower Director of Mission Anglican Care Newcastle Clare Brockett Director of Mission Uniting AgeWell Rachael King Spiritual Care Coordinator Carrington Care Cathryn McMillan Chaplaincy Practice Lead Churches of Christ Queensland Laura Haylen Director Aged Care Policy Catholic Health Australia

Report of Roundtables on Funding Spiritual Care 10 May 2024 Meaningful Ageing Australia Page | 9 Roundtable attendees 1 May 2024Name Title Organisation Rachael Wass CEO Meaningful Ageing Australia Cynthia Payne Founder Anchor Excellence Paul Sadler Founder Paul Sadler Consultancy Paul Sadler Consultancy & MAA Board MAA Christine Henderson Pastoral & Spiritual Care EducatorWesley Mission QLD Robyn Sampson CEO Baptist Care Australia Amber Mills Director Policy Australian Association of Gerontology Asher Kirby Spiritual Care Supervisor Baptcare VIC/TAS David Izzard National Executive Advisor - Aged Care Calvary Health Care Kathryn Butcherine Pastoral Care Councillor Sawtell Catholic Care

Report of Roundtables on Funding Spiritual Care 10 May 2024 Meaningful Ageing Australia Page | 10 APPENDIX 2 Email from Claudia Dukas, Department of Health and Aged Care The Schedule sets out the range of care and services that Government funded aged care homes have to provide, including the provision of ongoing support to residents to ensure their emotional health and wellbeing. This relates to both new residents who may need help adjusting to their new living environment, as well as existing residents who may be experiencing loneliness and emotional distress. As part of providing emotional support, it is expected that aged care homes will monitor the emotional state of residents (e.g. asking how the resident is feeling when assisting them to get out of bed in the morning). Whilst staff may not be able to stay with a resident who is feeling down, they should ensure the resident is checked on a regular basis and facilitate access to any support required (e.g. family visit, counselling). Aged care homes can determine the supports provided, but it is expected they will also ensure access to any professional support services that are required (e.g. psychologist). Aged care homes may also consider whether tailored activities within the aged care home can be introduced to encourage residents to socialise and improve emotional wellbeing. This could include (but not limited to) group-based activities, such as social functions, arts and crafts programs or group outings, as well as individual entertainment or leisure activities (e.g. reading library, TV lounge, DVDs). The Schedule is not prescriptive about the types of activities and programs aged care homes use to support residents, but they are required to encourage residents to take part in social activities in accordance with the resident’s needs, wishes and abilities. The strengthened Standards are designed to place the needs of older people at the centre of care, to ensure holistic approaches to the care being delivered. The term ‘holistic approach’ means to provide support that looks at the whole person. In the provision of clinical care, the provider should consider the older person’s physical, mental and emotional, social and spiritual wellbeing.

Report of Roundtables on Funding Spiritual Care 10 May 2024 Meaningful Ageing Australia Page | 11 Under the Standards, there is a strong focus on an expectation for providers to deliver person-centred care which means care and services must be holistic and developed with and tailored to the older person taking into account their needs, goals and preferences. In particular, Standard 1: The Person underpins the way providers and workers are expected to treat older people and is relevant to all of the strengthened Standards. Providers are required to demonstrate they understand that the safety, health, wellbeing, and quality of life of older people is the primary consideration in the delivery of care and services (as reflected in Outcome 1.1). Standard 1 also reflects important concepts about dignity and respect, older person individuality and diversity, independence, choice and control, culturally safe care, and dignity of risk. These are all important in fostering a sense of safety, autonomy, inclusion, and quality of life for older people. The term ‘quality of life’ in the strengthened Standards means an older person’s perception of their position in life taking into consideration their environment and their goals, expectations, standards, and concerns. It includes their emotional, physical, material, and social wellbeing. The term ‘wellbeing’ in the strengthened Standards is referred to as encompassing an older person’s physical, spiritual, emotional, and mental health and strongly linked to quality of life. As mentioned above, the requirement to support the wellbeing of older people commences with Standard 1 and is reinforced throughout the strengthened Standards to accommodate various aspects of care delivery.

Report of Roundtables on Funding Spiritual Care 10 May 2024 Meaningful Ageing Australia Page | 12 APPENDIX 3 Presentation slides on home care and residential care Home Care As in residential care, there is no specific funding for pastoral or spiritual care available through the major home care funding programs. Where home care providers choose to provide pastoral care, they usually budget for it through allocation of surplus funds. Home Care Packages There are particular difficulties in using HCP funding to support pastoral care. HCP funding is allocated on an individual basis and the provider has to agree with the recipient on the care plan and the funding amount put aside for services delivered by the HCP. • At the moment, individual funds cannot be merged to provide a service such as pastoral care available to multiple recipients. • If the provider has a profit margin built into its services, it could use the profits/surplus to fund pastoral care. Services in scope for HCP include: o Ageing related services to keep people well and independent. o Ageing related services to keep people safe in their home. o Ageing related services to keep people connected to their community, including social support. Support services can include: o Counselling from a psychologist. o Ongoing emotional support in adjusting to a lifestyle involving increased dependency and assistance for the care recipient and carer, if appropriate. o Encouragement to take part in social and community activities that promote and protect the care recipient’s lifestyle, interests, and wellbeing.

Report of Roundtables on Funding Spiritual Care 10 May 2024 Meaningful Ageing Australia Page | 13 Commonwealth Home Support Program (CHSP) • CHSP services are grant/block funded to deliver a certain number of outputs (hours) to eligible clients. Unexpended funds at the end of each financial year must be returned to the government. • Service types potentially relevant to pastoral care include: o Allied Health including formal counselling from a qualified social worker or psychologist. o Social Support Group to assist frail older people to participate in community life and feel socially included through structured, group-based activities that develop, maintain, or support independent living and social interaction. o Social Support Individual to assist frail older people to participate in community life and feel socially included through meeting their need for social contact and company. Residential Care Care minutes include RNs, ENs and PCWs/AINs. PCW/Care worker activities include social and emotional support - supporting residents to be and 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 - grant funding? • Consideration for reclassification of workers - implications for agreements/awards, position, and role descriptions. • How might you quantify a proportion of time? - the process for care planning and delivering social and emotional support (spiritual care) is more complex and sophisticated.

Report of Roundtables on Funding Spiritual Care 10 May 2024 Meaningful Ageing Australia Page | 14 Next steps • Dissemination of this report back to Roundtable attendees and member organisations of Meaningful Ageing Australia • Whitepaper discussion paper to cover major challenges and opportunities • Engagement in one off Benchmarking of spiritual care survey across sector • Continue meetings with stakeholder organisations and other peak bodies For more information about this document: Contact Rachael Wass, CEO of Meaningful Ageing Australia on email: rwass@meaningfulage.org.au or mobile: 0481 044 467