I have to say that some of the most compassionate people in my life have worked in elder care. The desire to create places and support people who provide care is huge – and a vision and task that is never finished, somehow in this imperfect system we often fall short. I am honored to know directors of programs who are the tireless advocates for the elders they serve. Despite differences of opinions, and sometimes lack of resources, they inspire their teams to be with clients, to understand that each person carries a sense of self and a personal story that we should learn about, not judge. Paula
by Donald Koepke
I believe that caregiving is one of the most vital tasks in which a person can become engaged. Day in and day out caregivers touch the lives of loved ones when they feel the most vulnerable and thus the most open to change.
No one likes to feel vulnerable and helpless. In the book, Tuesdays with Morrie, a man by the name of Morrie Schwartz is stricken with ALS, or Lou Gehrig’s disease where the nervous system deteriorates to the extent that the person becomes trapped in his or her own body. Early in his disease, Ted Koppel, a famous TV newscaster and professional interviewer interviewed Morrie. Ted Koppel was in Morrie’s living room videotaping for his next show. “The two men spoke of the afterlife. They spoke about Morrie’s increasing dependency on other people. Morrie already needed help eating and sitting and moving from place to place. What, asked Ted Koppel, did Morrie fear the most about his slow, continual, never-stopping decay? Morrie paused. He asked if he could say this certain thing on television. Koppel said go ahead. Morrie looked straight into the eyes of the most famous interviewer in America. “Well, Ted, one day soon, someone’s gonna have to wipe my ass.” (Tuesdays with Morrie, Mitch Albom, p. 22).
No one likes to feel vulnerable and helpless. Everyone wants to be in control, strong, capable. To be vulnerable is to feel on the edge, in danger of being hurt, exposed, open to ridicule or shame (or worse). To be vulnerable can cause a loved one to withdraw, become defensive, even angry because they want to feel safe again getting some distance between themselves and this illness that is providing such dis-ease. They want to again feel in control.
So much of whom we feel ourselves to be is wrapped up in our bodies. In fact, our bodies are our selves. What does advertising and TV tell us about the body? Youth is good, age is bad. Shapely-ness is good, too much weight is bad. Strength is good, dependence is bad. I think advertising tells us that if we don’t have strong bodies that are beautiful, even sexy, that we are less of a person and have less value. That is why so many people despair over loss of bodily function, especially bowel and bladder. Some of us can even remember when we first began to have control over bowel and bladder. How excited our parents were. How much praise we were given. We were now big girls or big boys. We were important, capable, valued. We were finally like mama and papa!
And thus, to lose that ability to control oneself, to require the use of “adult undergarments”, often means a loss of dignity and self-image. Thus a loved one can become ashamed, not over something that they can or can not do, but because of what they have become: less of value, more dependent, less capable. Americans value words like “I can, I will, I must.” They often feel shame when they are forced to say, “I can not, I need.” Human beings often feel shame when they feel vulnerable.
And this is exactly where the efforts of caregivers enter the picture. Each and every day caregivers touch people lives at the point of their vulnerabilities, at the point of what they can not do. And it is how they are treated, at this tender and open moment, that can make all the difference in the world. Whether it is helping them dress in the morning, or feeding them their lunch, or even changing their “adult undergarments”, caregivers are touching loved ones in their weakness, in their humanity. And if this moment is treated with respect, if the one-who-is-weak, incapable, limited, is received with dignity, they will feel renewed, even empowered by the presence and service of the caregiver. But if the caregiver treats this moment with disrespect or even an “I don’t care” attitude, our care-receivers will feel exposed, threatened, even shame not by what is done to them, but in how it is done.
Touching persons at their weakest moments can be likened to changing their diapers. During this time caregivers are physically touching them more intimately than perhaps any other human being, except perhaps their mothers or fathers. In changing their diapers, and, in the words of Morrie Schwartz, wiping their asses, caregivers are touching their souls, because, as we have said before, we are our bodies. Within the task of caregiving, our loved ones are literally naked before the caregiver. And in that act of care, caregivers convey more powerfully than any sermon by a priest or rabbi that they are of great worth, or are worthless; that they are of great value, or of no value at all; that they are of great importance, or are simply one more task to be done before the caregiver is able get on with what they really want to do. Why can’t the act of changing diapers, or providing any assistance to the weakness of another, be an act of caring that says “You are human! You are alive! You are important in spite of, and perhaps because of, your weakness.”
Wendy Lustbader, in her book Counting on Kindness, writes about an eighty-year-old woman who was hospitalized. She spoke of her caregivers. “I knew the nurses by their hands. There was one with such delicate fingers that I cried a little when I heard her come on duty. She made me feel like she had all the time in the world. The others made me feel like a lump of flesh, like they had to get me out of the way as fast as they could. But those hands! I knew it was going to be a good day when she squeezed my arm in the morning. She would put a fresh gown on me and brush my hair with such tenderness and patience. You can’t imagine how much it meant to me, there in that strange place, to be touched like that.” (Counting on Kindness Wendy Lustbader, p 52-53)
It is through a caregiver’s acts-of-care that can promote shame or pride, and convey value or lack-of-worth, for caregivers touch people when they are the most vulnerable. Caregivers touch them at the point of their weakness, their “I can’ts” and perhaps, for the first time in their lives, to feel vulnerable but still valued.
What a magnificent gift is caregiving.
Center for Spirituality and Ethics in Aging
Donald Koepke is the Director of the Center for Spirituality and Ethics in Aging at the California Lutheran Homes, Anaheim, California. Rev. Koepke earned his Master of Divinity from Lutheran School of Theology at Chicago and completed a year-long residency in Clinical Pastoral Care at the UCLA Medical Center in 1995. He also earned a Certificate in Gerontology at the Geriatric Pastoral Care Institute at the Center for Aging, Religion and Spirituality, Minneapolis, Minnesota.
Rev. Koepke is a member of the American Society on Aging, Forum on Spirituality and Religion, and serves on the Forum’s Governing Council as well as the National Council on Aging’s National Interfaith Coalition on Aging, serving as secretary to its Delegate Council. He is a Clinical Member of the Association of Clinical Pastoral Educators, a Board Certified Member of the Association of Professional Chaplains and endorsed by the Evangelical Lutheran Church in America for Specialized Ministry.
He has conducted numerous professional workshops at national and regional conventions of aging, service providers to the elderly, caregivers, churches and other faith communities, families and older adults specializing in spirituality and aging.
Center for Spirituality and Ethics in Aging
891 South Walnut Street
Anaheim, CA 92802