This is a copy of my major assignment from last semester. Now that its been marked, I can post it here.
This essay looks at the subject of divine healing within a pastoral response to the elderly in aged care. I analyse and reflect on the practicalities of ministering within an aged care environment. I explore the cultural traditions of the person and how that may affect our response. And then look at the theological issues which need to be taken into consideration for a healing ministry to those who are in the latter part of their life and the expectation of death is close at hand. I then draw together the practical, cultural and theological discussion into formulating a pastoral response as to how to initiate and practice ministry with a broad exploration of what constitutes healing and how we can minister to those who are dying.
Pellegrino asks, “What is the relationship between caring and curing? What are the moral obligations of healers, physicians, nurses, all who come into direct, hands on contact with sick people?”
Within this framework of questioning we likewise need to further ask, what are the practical, theological, cultural, pastoral issues, in conducting healing ministry to the elderly in care? I acknowledge from the outset that while these four areas of concern are distinct questions and areas of concern, they also have a weakness in that they are or may be nearly invisibly entwined with each other in many aspects and so their answers may not be so easily delineated. In this regard, it’s important to note that while I will endeavour to provide the individual analysis in each area, lets note that the terminology of “healing / cure and care” comes from the same Latin root curo / curare which means to cure and take the trouble to care for or in other words meaning to intentionally, competently and completely care for the whole.
Often the subject of aged care conjures up images of the elderly hidden away in a room in a nursing home. Yet within the Australian context, aged care lays on a spectrum of retirees living semi independently in a retirement village, home care where someone visits the home on a semi / regular basis to help with a variety of needs such as cooking, sanitation, maintenance, shopping and nursing / medical supervision – through to hostel and or nursing home which provides more intensive care leading to palliative care for the dying.  For the purposes of this essay, I will narrow our focus to the Christian elderly in a nursing home needing more intensive care and supervision. Within this focus, I will look at the practical, cultural and theological concerns and draw them together to form a pastoral focus and response.
Tobin and Ellor note that the elderly are complete and unique persons in their own right and therefore need to be involved as much as they can with any decisions affecting their life, the programs they are involved with and that we must take this into consideration as to any programs, initiatives and developments that contribute towards creating a holistic lifestyle. Nursing homes take this mandate seriously and any ministry we offer to the elderly need to work in with the ethos and ongoing ministry and practical management of the nursing home.  The residents of nursing homes have a wide range of infirmities from being frail, incoherent because of strokes or other factors, deafness, skin disorders, dementia, thin skin which can break easily, bed sores and ulcers and other mobility limitations. Some, who are frail, are sound in mind, while others who are stronger and more mobile are limited through the limitations caused by various degrees of dementia.
There are however other practical issues that we can get involved with which can help alleviate worry and concerns. It may involve visiting and meeting with spouses and other family members and friends. We may be involved in organising those same people transport to come and visit the nursing home, the care of the family home, food and meals supplied. In the event of death or dying the practicalities could be of helping organise the funeral and the plethora of other activities surrounding this.
We also need to be aware of the institutions policy for those in care in regards to the instance of them those being cared for trying to give staff a gift of any description. (There could be a tension here if the person in question is a long-term member of the church and has been a regular giver to the church) Because of the vulnerability of those in care, we need to ensure they are safe from any manipulation and for many with dementia though they may be sincere in giving a gift at the time, they could be traumatised later when trying to find that item and find it missing.
In forming a theological praxis for a healing / curing ministry to the elderly in care, we can draw from the Orthodox traditions of humanity being made in the image of God.
Orthodox Christian anthropology is founded on the premise that humanitywas created to participate in divine life. Thus, with the help of the HolyScripture, man succeeds in discovering himself, finding out his own natureand who he really is, and what his mission is in relationship to God, his neighbour, and the whole universe around him
Within a Pentecostal ethos, we do believe that God heals today; yet the reality is that nursing home residents are at the later stages of life where death is to be expected. Therefore we must ask how we balance and theologically reflect on the tension between the certainties of death and a healing ethos. How do we help the elderly to continue participating in and discovering their own divine purpose and participate in the divine nature of healing. Because we are contextually talking of a Christian ethos of the promise of eternal life, death in many ways is the final rite into that existence. MacNutt suggests that while it’s natural for us to age and die, we can continue to pray for healing and relief from the symptoms of sickness and injury that are deemed to be a natural part of aging, in the same way we would others. Pain, poor circulation leading to skin ulcers, brittle bones leading to fractures, dementia and other mental health issues which can greatly reduce the quality of life are considered to be the norm of aging – but within an ethos of expectancy of faith, perhaps the severity of these issues can be reduced. Within this context Jackson notes there are no diseases that only afflict the aged and within the framework of healing, we can pray expectantly for the elderly in the same way we would others.
He also notes that that the elderly are prone to social and psychological disintegration and therefore a holistic theological reflection in this area for the aged is needed to prevent boredom of life, continued purpose for life as well as a participation in life is needed.
We also need the theological awareness that elderly Christians are still a vital part of the community of God. And within this framework we need to get back to the traditional understanding of the pastoral calling is to be about curing souls. Therefore we need to reflect on the fellowship aspect of ministry of how that continued fellowship is practiced and promoted and perhaps reconciliation with others is brought about. Keller in his book about Taming Tension talks about the antidote to loneliness is that of communion with God. And therefore our role of ministry is likewise one of encouraging that communion with God, through fellowship with each other and God.
Within the healing experience we need to recognise the value of counselling to help facilitate the processes of healing the emotions, discipline the thought life and aid in the dispelling of confusion and compartmentalising of life. One area of life that is common to the elderly is that of regrets: Have they lived as well as they could, did they work as hard as they could, did they raise their children as they should and the list goes on. And it’s within this framework that the work of confession and the absolution of sin through forgiveness and even the role we play in any reconciliation they have with others is vital for any ministry to the elderly. 
Reconciliation is a powerful ministry in its self, for we cannot focus on the elderly in care as if they are in a vacuum. They have family and friends who they will worry about. And in many varied ways, the knowledge they are and will be cared for can be a deep source of comfort for those in aged care.
Finally, though hinted at earlier, we need a robust theology of death and dying. Within this theological reflection, we have the joy of knowing that death for the Christian is only a transitional stage of resurrection life. But our ministry doesn’t stop for the person who is dying, as we need some preparedness of ministry to support the family and friends of those who will be left with the mix of hope and grief of the one facing death.
The cultural scope can be complex and cultural sensitivity and awareness is needed. Most imagine culture as being race / gender orientated with language and ethnic traditions, experiences and world views being different to our own.
While indeed this indeed covers some cultural awareness, it’s also important for us to recognise there are a variety of cultural differences in denominational affiliations, the way we perceive and practice our faith in community and individually as well as a difference within the same denomination because of generational / contemporary changes.
Until about a century ago, what pastors did between Sundays was of a piece with what they did on Sundays. The context changed: instead of an assembled congregation, the pastor was with one other person or with small gatherings of persons, or alone in study and prayer. The manner changed; instead of proclamation, there was conversation. But the work was the same: discovering the meaning of Scripture, developing a life of prayer, guiding growth into maturity. This is the pastoral work that is historically termed the cure of souls. 
One of the strengths of the Pentecostal movement is the priesthood of all believers. We have a robust practicality in which we don’t believe the senior pastor is the person who does all the work of the ministry. Within this sense, the ministry of curing souls belongs to the church body. Jackson say’s “The pastoral ministry to the aged should help create a image of a self, filled with vitality in a life worth living.”
We have already presumed that our ministry to those in care are Christians and within this scope our focus is one of care and not evangelism. Therefore our ministry to the elderly in care should be one of helping them to live well, despite their immediate limitations. To do this well, we have to draw from and pierce together the practical, cultural and theological implications to do this with fruitful sensitivity.
Theologically we have noted that they are members of the body of Christ and therefore we need to pastorally care for them as members of the body. One way to do this is to have a regular church service in the nursing home. Depending on those in attendance (medical and physical limitation), the sacrament of communion can be administered as a group or on an individual basis during visitation. As well another possibility is to organise transport for them to have a day trip out to join in the regular church service. In this regard as is normal practice in most church services, prayers for health, comfort, strength and an increased knowledge of God’s love and presence can be prayed for.
Because of the nature of those in care, we have to be perhaps more deliberate in our visitation. The promotion of this ministry doesn’t have to be any different to the organisation and promotion we give to any other small group or ministry in the church. We expect our congregation to get involved in small or larger groups. We expect our congregations to be involved in fellowship and care for one another, and so we too can extend these same principals to meeting with the elderly in care.
An effective method of helping the elderly gain a perspective of their life is to allow them to share their life journey. However, again sensitivity to context is important. Sometimes your visitation will be one of just sitting with the person in silence.
It’s been noted that part of our mission is to give those in care a purpose of being. One way to grant this is to ask them to pray for the various issues of the church, team, or personal / family basis. Another was for those able to take part in mission / care initiatives through knitting booties, beanies and scarves for new born babies. Other ways of drawing them in is to tell them about what has been happening with the church life, showing them photos of people they recognise and know is a great way of engaging and drawing them into life. 
Prayer is an important part of the Christian ethos. However, it’s my personal observation that Pentecostals can be fairly verbose in their praying with the laying on of hands. So we need to be cautious in first gaining permission if it’s ok to lay hands on someone for prayer and when we do, it’s important because of the fragility of the elderly that we do so with a gentle touch. Most of the time its best to pray short and succinct prayers; though, I have had extended prayer sessions with an old faithful prayer warrior who wanted to pray for an extended time.
Perhaps the hardest of all ministries is that of being present with the dying. We don’t know what to say and perhaps those people also don’t know what to say or do. But, it can be extremely helpful for them to know they are not going to die alone and that someone cares enough to ask how they are coping with the fear of death and even give them permission to die. 
The overall calling is to be fruitful and effective in what we do. Within the discipline of ministering healing to the elderly in aged care, the importance of building and continuing relationship has been noted and therefore it’s essential for regular visitation / ministry to be effected. We have discussed the foundation and ethos of any healing ministry to the elderly in care is that of a holistic nature, helping them to live well within the limitations of their life and helping them through the journey into eternal life as they pass through death.
Australian Federal Government on Aged Care http://www.agedcareaustralia.gov.au/internet/agedcare/publishing.nsf/Content/Where+To+Start?Open&etID=WCMEXT05-WCME-86X3ME
Cloud, Dr Henry and Townsend, Dr John, How People Grow (Zondervan Publishing, USA, 2001)
Jackson, Edgar N. The Pastor and His People, (Hawthorn Press, New York, 1963)
Kilner, John. F, Miller, Arelene b. and Pellegrino, Edmund d. Dignity and Dying a Christian Appraisal (Paternoster Press, UK, 1996)
Kraus George & Muller Norbett, H. coordinating editors Pastoral Theology (Concordia Publishing, St. Louis, 1990)
MacNutt, Francis, How to Pray for the Elderly, (April/July Healing Line Newsletter ) http://www.christianhealingmin.org/newsletter/archives/prayer_ministry/How_to_Pray_for_Aging.php
Muller, Norbett H. & Kraus, George. co-ordinating editors Pastoral Theology (Concordia Publishing, St. Louis, 1990)
Pellegrino, Edmund. D &. Thomasma, David .C..Helping and Healing, Religious Commitment in Healthcare (Georgetown University Press, Washington DC, 1997)
Peterson, Eugene H. Curing Souls: the Forgotten Art (July 1, 1983) http://www.jmm.org.au/articles/19218.htm
Philliop, Kellor, W. Taming Tension (Baker House, U.S.A, 1979)
Porterfield, Amanda. Healing in the History of Christianity (Oxford Press, New York, 2005)
Purnell, Douglas, Conversations as Ministry (Pilgrim Press, Ohio, 2003)
Stan, Nicolae Răzvan, Human Person as a Being Created in the Image of God and as the Image of the Son: The Orthodox Christian Perspective http://orthodox-theology.com/media/PDF/IJOT3-2011/Stan-Human.pdf
Tobin, Sheldon S. Enabling the elderly (New York Press, Albany, 1986)
Ward, Hannah and Wild, Jennifer, Human Rites Worship Resources For An Age Of Change. (Tower Imprint, London, 1995.)
 Edmund D. Pellegrino, David C. Thomasma.Helping and Healing, Religious Commitment in Healthcare (Georgetown University Press, Washington DC, 1997) p 26
 Ibid. p.26
Australian Government Information Website on Aged Care http://www.agedcareaustralia.gov.au/internet/agedcare/publishing.nsf/Content/Where+To+Start?Open&etID=WCMEXT05-WCME-86X3ME Accessed 10/06/2013
 Sheldon. S ,Tobin, Enabling the Elderly.(New York Press, Albany, 1986) p.15
 Ibid., p; 109 It’s noted that nursing homes have a activities / program director as well as a chaplaincy service for the residents of the home. Through my own experience of being involved in a nursing home church service as well as being a church representative on the activities board – nursing homes are more than willing to have outside services help with the activities and visitation to the residents in the home.
 From a personal perspective, it can be very rewarding to help someone dying to organise their funeral. I had one such experience when a friend asked me to organise his funeral as he was dying from liver cancer. It helped him and his family come to grips with the looming death and yet celebrate his life and in the end he too also accepted Christ.
 Nicolae Răzvan Stan, Human Person as a Being Created in the Image of
God and as the Image of the Son: The Orthodox Christian Perspective
http://orthodox-theology.com/media/PDF/IJOT3-2011/Stan-Human.pdf p.142 (accessed 12/06/2013)
 Hannah Ward and Jennifer Wild, Human Rites Worship Resources For An Age Of Change. (Tower Imprint, London, 1995.)p.3.
 Francis, MacNutt. How to Pray for the Elderly, (April/July, 2006, Healing Line Newsletter ) http://www.christianhealingmin.org/newsletter/archives/prayer_ministry/How_to_Pray_for_Aging.php Accessed 10/06/2013 In this article, he encourages the laying on of hands on a daily basis, though the practicalities of doing this in a nursing home may be limited, unless you’re a pastoral team member / chaplain involved in the regular activities of the home.
 Edgar N. Jackson, The Pastor and His People, (Hawthorn Press, New York, 1963) p 126
. Ibid., p.124
 W. Philliop Kellor, Taming Tension (Baker House, U.S.A, 1979) p. 203
 Dr Henry Cloud, and Dr John Townsend, How People Grow (Zondervan Publishing, USA, 2001) p 15 – 26.
 Norbett H, Muller & George Kraus, co-ordinating editors Pastoral Theology (Concordia Publishing, St. Louis, 1990) p. 121.
 I was a licensed Layreader for our church in the Sydney Anglican Diocese, which allowed me to preach and minister in the local parish. The church service I regularly attended was a contemporary family friendly morning service with little overt liturgy. I was invited on a number of times to participate and preach at a neighbouring High Church service, which was attended by elderly people, the youngest being in her late sixties. At first I was horrified at the formal liturgical format of this service as being old hat and super traditional. But, as time went on, I was able to appreciate that they had been reared on that kind of ministry, it really ministered to their needs as well as gave them a chance to feel actually cared for, instead of the isolation they had felt in the more contemporary services and that the congregation had a very real and lively faith.
 Edgar N. Jackson, The Pastor and His People…p.127
 I was involved in such a weekly service, held on a Thursday, and was run by a number of churches in the area working together.
 It was my experience when visiting congregation members in care that they loved being asked to pray for a variety of issues. Of course context is the key depending on the person, as some would forget who you were in the midst of conversation. Giving someone a purpose in life is an act of healing in its self. It creates a higher level of self-esteem in that they are able to still contribute in some way.
 My first pastor used to tell us the story of having to tell his mum it was ok to die and to go home to glory. He had to tell his family to release her to the Lord in prayer and stop praying for a miracle to happen for their own grieving reasons. When they prayed a prayer of release, his mum peacefully died.