Liturgy in Nursing Homes

We have a long standing ritual of farewell when the body of the deceased resident is taken into the care of the undertaker. Residents who are able gather in the foyer of the facility with appropriate music playing. The paschal candle is lit and held awaiting the procession.

The deep sound of a singing bowl announces the arrival of the procession which includes members of the family, nursing and care staff, and the undertakers. The procession comes through the grounds of the facility and through the residents gathered in the foyer. It is led by a religious sister who plays the violin. All sing a hymn as they join the procession and then stand at the hearse to farewell the body of the resident. The undertakers have been instructed to walk the hearse part way down the road. This happens to the intermittent sound of the singing bowl.

This moving ritual of farewell for deceased residents happens at one of the Catholic nursing homes in the Archdiocese of Brisbane. We surveyed a number of institutions in an attempt to ascertain what the current situation is with regard to the celebration of liturgy in hospitals and nursing homes. The purpose of conducting the survey was to ascertain what information, formation and resources might be provided to assist and support those who are involved in planning and carrying out this important ministry.

Key people in four parishes and six aged-care homes were asked:

* Mass. Is Mass celebrated? When and where? Who organises it and sets up?

* Communion. Is holy communion distributed apart from Mass? When and how?

* Other Liturgy. Are there celebrations of the Liturgy of Word, ecumenical worship, or other prayers? How often? What format is followed? Where is it held and who organises and leads it?

* Anointing the Sick. Is this sacrament celebrated? When and how?

* The Last Rites. Does someone pray with the dying? Are they given communion as Viaticum? Does someone lead prayers after death?

* General. What issues and challenges do you encounter regarding Catholic liturgy in this institution?

It is clear that there is a big difference between what is provided in the way of liturgy in large hospitals or nursing homes with designated chaplains or resident religious and what parishes are able to provide for smaller institutions that are their responsibility.

The availability of Mass ranges from daily in some Catholic institutions to as seldom as once a year in nursing homes which offer only monthly worship provided in turn by different local Churches.

Communion apart from Mass is available more frequently, with parishes generally making great efforts to roster lay ministers of communion for the sick and home-bound in their area.

It was encouraging to see that several care homes offered residents opportunities to gather for worship apart from Mass, including Morning and Evening Prayer and the Liturgy of the Word.

Anointing of the Sick is held monthly in the majority of the institutions surveyed but in one or two places it occurs only when requested by residents or their families.

Christians have the responsibility of expressing their union in Christ by joining the dying person in prayer for God's mercy and for confidence in Christ. If the priest or deacon is unable to be present because of other serious pastoral obligations, other members of the community should be prepared to assist with these prayers and should have the texts readily available to them (PCS 213).

In most cases, members of the pastoral care team or resident religious pray with the dying. Viaticum is usually offered to those able to receive food or drink by mouth. Prayers of commendation and prayers after death are generally said only if an ordained minister is available and the family request this.

ISSUES AND CHALLENGES

In response to the question about the issues and challenges that people face regarding Catholic liturgy in their particular institution, it was encouraging that many respondents spoke of the great support they receive from the staff. One pastoral care director said: 'There is a great amount of cooperation and respect between all members of staff including doctors, the nursing and caring staff who recognise the important of pastoral care and attending to the spirituality of all residents. Pastoral carers attend to the spiritual needs of all residents regardless of their creed.'

Another common thread that came through was a concern about what the future holds. A rising demand because of the aging population coincides with the aging of present volunteers who carry out the ministry and the increasing difficulty in finding new people to replace them. In many Catholic nursing homes, liturgy is organised and led by resident religious but that situation is changing rapidly as religious themselves age and their numbers decline. Likewise, retired clergy are very generous in offering their services to nursing homes but that too will change as the number of priests in active retirement declines. This will place an additional strain on parish pastoral staff.

Priests have the special task of preparing the sick to celebrate the sacrament of penance (individually or in a communal celebration), to receive the Eucharist frequently if their condition permits, and to celebrate the sacrament of anointing at the appropriate time. To provide frequent communion for the sick, it may be necessary to ensure that the community has a sufficient number of ministers of communion (PCS 44, 72).

One respondent explained: ‘Pastoral carers are not rostered here on Sundays and the ratio of pastoral carers to the number of residents is limited anyway, so our need for suitable volunteers is always present. Pastoral care volunteers play an important role at Mass (readers, altar servers, collectors, greeters, communion ministers, music leaders) and in bringing holy communion to residents in their rooms. Some volunteers have been assisting us for many years.’

Apart from the difficulty of finding and training volunteers to undertake this ministry, parishes and institutions today have to deal with Government policies and regulations which require that all involved have proper police checks and are aware of the duty of care involved in their engagement with the elderly and housebound.

Finally the nature of institutions for the sick and elderly is changing. There is a move to establishing retirement communities whose occupants range from those who live independently to those who are bed-ridden. Catering for the liturgical needs of such diverse groups presents an organisational and logistical challenge to pastoral carers and local parish staff.

ECUMENICAL COOPERATION

The concern that Christ showed for the bodily and spiritual welfare of those who are ill is continued by the Church in its ministry to the sick. This ministry is the common responsibility of all Christians, who should visit the sick, remember them in prayer, and celebrate the sacraments with them (PCS 43).

While some facilities roster presiders from different Churches to lead liturgy, it seems that Churches are not routinely working together to provide liturgical ministry to local nursing homes and hospitals. A body such as the Australian Consultation on the Liturgy could do well to encourage ecumenical cooperation in this area and provide principles, guidelines and resources.

Working ecumenically requires an additional skills set: Catholics need a knowledge of the Ecumenical Directory and all ministers should understand the different beliefs and attitudes towards ecumenical sharing in various Churches.

The responses show that those responsible for arranging worship in aged facilities and nursing homes often come to the task from their own background and experience. They may not always be aware of the practices of other Christian traditions. They may not even be aware of changes that have taken place in the liturgy in their own tradition. One nursing home, for example, was using a resource to celebrate the Liturgy of the Word that was no longer suitable because of revisions to the liturgical texts and because it presumed the presider to be a priest which is now seldom the case.

COMMUNION AS PARTICIPATION

Both parishes and institutions often focus their attention and resources on the important and demanding task of providing holy communion for those who are no longer able to participate in parish Sunday Mass. What is sometimes overlooked is the fact that these people are not only deprived of receiving communion regularly but of celebrating liturgy and ritual as part of the Christian community.

It is important that lay ministers of communion to the sick be aware that bringing communion is more than a pastoral visit with communion as an added extra. They are in fact celebrating the Church’s liturgy with that individual or small group. It is vital that the ministers be given adequate formation to enable them to carry out this responsibility with confidence and grace.

Those who visit the sick should help them to pray, sharing with them the word of God proclaimed in the assembly from which their sickness has separated them. In receiving the body and blood of Christ, the sick are united sacramentally to the Lord and are reunited with the Eucharistic community from which illness has separated them (PCS 46, 51).

RESOURCES

Several respondents raised the issue of dealing with the families of residents, especially those whose condition had deteriorated and were nearing death, or those who had just died. Often family members want to ritualise these moments but do not know what to do or who to ask. Occasionally they have unusual expectations or make unreasonable demands on staff at these times.

There is a need to inform the wider community about Catholic prayers at times of family illness and death. It is hoped that parishes, hospitals, nursing homes and other institutions for the sick and aged will have appropriate brochures and other resources on public display and make them freely available to residents and their friends and families. Putting these materials into the hands of the sick, parish ministers and family members will help them understand the prayer and liturgical resources the Church offers in the various circumstances of illness and provide them with prayers they can use. There are also a range of books, published in Australia and beyond, which can be left with the sick person who will find rich spiritual support in the anthology of psalms, prayers and poems. 

CONCLUSION

The process of surveying liturgy in institutions for the aged and sick revealed two specific areas where work is needed: formation for all involved (chaplains, pastoral care staff and volunteers, parish clergy, and lay communion ministers) and resources to provide both information and appropriate liturgical rites for use in pastoral care.

This article was originally published in Liturgy News ​Vol 43(3) September 2016. Reprinted with permission.

Image Attribution - Retirement Home, Etan J. Tal