The Spiritual Gift of Caregiving

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.
Donald Koepke
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

Healing Horses


A horse is the projection of peoples’ dreams about themselves–strong, powerful, beautiful–and it has the capability of giving us escape from our mundane existence. 
– Pam Brown


The most therapeutic activity for my mother when she was dying of cancer was being with her animals. They seemed to know when she needed them. A cat would jump onto the bed and softy cuddle, the dogs would lay at her feet and breathe warm air through her toes, another cat would quietly purr in the corner. I could feel the connection; there was no need for words or explanation. So when my sister brought my mother’s beloved tall black horse into her bedroom to just be with her, you can only imagine the strength of the connection, the healing and in this case letting go. I visualized him right then and there carrying her weak body along her journey with her arms wrapped lovingly around his neck. The power of healing and interconnectedness with animals is powerful to witness, as well as being well documented in the research annals.

Equine horsemanship is a growing program especially among children and young adults and now veterans suffering from PTSD. There are equine horsemanship, leadership and therapy programs. All have very specific areas of focus and expertise. The common denominator in each field is that the horse is our teacher and partner in the experience of living in the moment. The benefits of this work include a greater sense of focus, increased confidence, ability to listen, to trust, to have purpose, and to experience the interconnectedness we all have with animals, nature and each other. Although underfunded, I have found the people who work with horses in the horsemanship, leadership and therapeutic programs are exceptional human beings dedicated to doing good work with people and horses.

We are inspired to embark on an exploration of creating an equine horsemanship program for people living with dementia and their families. We are excited to develop a program that supports a group of people who understand what it means to live in the moment and who will benefit from the unconditional connection with horses. If you are interested in learning more about our program please let us know. We welcome feedback and volunteers.


Mills Peninsula – Blood Pressure & Blood Glucose Screenings

Held Every Other Month on the Second Wednesday

Blood pressure and blood glucose screenings include:

  • Blood Pressure Screening – FREE
  • Blood Glucose Screening – $2 (Exact change please)
  • 8 hour fast required
  • Take blood pressure medications and all others as scheduled
  • Delay diabetes medication until after the screening
  • Drink water before the screening
  • Bring a snack for after the screening

Please note:

  • Doors open at 9 a.m.
  • Location: 1720 El Camino Real, Suite 10, Burlingame, Across the street from Peninsula Medical Center
  • In 2012 the drop-in blood pressure, blood glucose screening will be held every other month on the second Wednesday.
  • Cholesterol screening by appointment will be offered for a fee on the alternating months on the second Wednesday.

Looking at our own blind spots in elder care

Scott is a colleague of ours who has worked in senior care for many years – driven by his own passion to improve the approach to care he shares is knowledge, insight and experiences with many family members and professional.

Dealing With Denial

By Scott Eckstein

Denial can be a dangerous reaction or response (in actuality, some medical experts describe it as more of an unconscious process), especially as it relates to senior care.

In my time in senior care operations, I saw and dealt with denial of all shapes and sizes. Usually, it takes the form of not admitting your loved one has any form of dementia.

Other times, it’s a lack of awareness of the level of care your loved one needs.

I have seen denial at work in my own family and have even caught myself not wanting to admit uncomfortable realities about elderly family members.

One recent episode involved a family acquaintance who, three years prior, had asked for my advice regarding her elderly aunt. My advice was met with dismissal and a snub, even though she was the one who reached out.

Fast forward three years, and this person is in a crisis mode, in fear for herself, her quality of life as well as her aunt’s safety and well-being because the now advanced Alzheimer’s was taking its toll.

When this family acquaintance sought me out again recently, she was overcome with guilt because she hadn’t acted sooner as was suggested.

She went on to tell me everything I said would happen. I certainly took no pleasure in being right in this case; in fact, I felt a deep sense of empathy for this family.

They lost so much quality time that could have still been shared if they had only taken action. They also lost money they could have directed to more productive events and services that would have improved quality of life.

While denial can initially be a coping mechanism, it can ultimately create major health and welfare problems.

It is important to realize that, while there is currently no cure for Alzheimer’s and many dementias, there are actions that can be taken to improve a family and a love one’s situation. These action can create a larger window available for improved quality of life.

Probably the most difficult situation created by denial is when the view of reality is split within a family. Denial, in this case, causes many other problems, one of which is usually regret, the other is animosity.

My point here is more to highlight the issue for awareness rather than to condemn anyone for having a normal reaction or for experiencing a natural coping mechanism.

The problem stems from getting stuck in denial and then loosing valuable time to improve quality of life. The other dilemma with denial is the clash and resulting anger that can cause a “locking of horns” within a family.

It is all too easy to get stuck in a circle of anger. Denial masks many emotions, including grief and fear. Illogical and counter-productive behavior can result from getting “stuck”.

Everything gets compounded when there are out of town family members that do not see the day-to-day symptoms that are more easily hidden during short visits or telephone conversations.

While maybe not scientific, there are a few things that I have seen in my experience that sometimes help dealing with denial:

1.Try to listen with an open mind to others who may be more objective in what they see.

2.Take deep breaths, and pause, before responding to anyone that seems to be in denial regarding a loved one’s care needs or living situation.

3.At some point, the choice is either to try to engage in rational discussion in hope of “shaking some sense into them” or work around them and do whatever you have to do in order to satisfy your own need to do the right thing.

4.Attend a support group, especially if ideas have been raised about the issues of dementia or care needs you question. The objective feedback might be enlightening.

5.Read! There is so much information out there relative to these topics that it is likely you will connect with something that will enlighten you.

Unfortunately, there are those times when nothing you do will break through the denial, and the consequences will be suffered. If you are the one in denial, you will likely look back and likely have a guilty realization.

We are all human. Most of us are all doing the best we can at any given moment. We feel emotions and have coping mechanisms, and denial is a normal one of them.

My purpose here is to remind the reader that there are steps than can be taken to contribute to possibly breaking the cycle of denial before a negative outcome arises that jeopardizes the care, health and quality of life we want for our loved ones.

“It’s not denial. I’m just selective about the reality I accept.”
-Bill Watterson (Author of the Calvin & Hobbes comic strip)

Check on someone you care about today.

Reprinted from

Tips on Forgiveness

This post from Kristy Campbell provides some excellent reflections and support for how families, caregivers and others can work on conflict and the idea of forgiveness.


Not So Fast With Forgiveness

By Kristy Campbell

I have been struggling with the concept of forgiveness this past year. It’s as if the universe knows this and has decided to present me with numerous scenarios in order for me to work it out.

From a failed marriage to betrayal by friends, I continue to be presented with the same question: Can I forgive? My answer isn’t as simple as you’d think.

Forgiveness has been a basic tenant of my life since I can remember. It comes from my religious upbringing where I was taught that it is my duty and responsibility to offer forgiveness…always. ‘To err is human, to forgive is divine’ was a household principle.

As a little girl, someone stole the watch I had received as a birthday present and when caught, she mumbled her apology in the principal’s office. I said, ‘It’s ok, I forgive you’.

Through the years, when people have hurt my feelings, talked about me behind my back, betrayed me, bullied me, or committed any sort of wrong doing toward me, I would say, ‘It’s ok, I forgive you’.

However, as I’ve aged, I’ve learned something about apologies: not all are heart-felt. Instead, many are a dismissive way to get out of trouble or to casually patch up a deep issue or to pass back the forgiveness ball by saying ‘hey, I said I’m sorry’.

I’ve been struggling with the apology-forgiveness scenario and trying to figure out what to do you do when you feel an apology isn’t genuine. What do you do when the apology doesn’t feel substantial enough to cover the hurt or betrayal? Do I still have a duty or responsibility to forgive?

I recognize the parallel between my personal struggle with forgiveness and the struggle on a global level, so I headed to the library to see what had been written from various viewpoints. I was referred to a book that gave me the answers I needed.

The Sunflower: On the Possibilities and Limits of Forgiveness by Simon Wiesenthal is a classic text in forgiveness. Wiesenthal was a prisoner in a concentration camp when a dying Nazi called Wiesenthal to his bedside and asked him for forgiveness for his crimes. Wiesenthal was dumb-founded and left the room without saying anything.

Thirty years later, he wrote this book about his experience. In the book, he also poses a simple question to theologians from around the world including the Dalai Lama and Archbishop Desmond Tutu. He asks them, “What would you have done?” It is eye-opening to see the various perspectives and insights about forgiveness.

After finishing the book, I asked myself the same question: Can I forgive? My answer is yes, absolutely, but it is no longer an automatic response. In my healing, I have recognized my power with forgiveness.

I have stopped saying ‘It’s ok’ and instead say ‘thank you for apologizing’.

I have stopped beating myself up for not immediately being able to forgive someone who has not apologized or taken any accountability for the wrongdoing to me.

I have found freedom in eventually letting go – forgiving in my own time –  without carrying a grudge or hoping for some karmic boulder to come the person’s way.

What I’ve Learned on My Forgiveness Journey

1. Forgiveness is not a single action that you begin and complete in a short period of time. Forgiveness comes on your own terms…in time, when you are ready. Honor your truth about not being in a place to forgive.

2. Forgiveness requires accountability, a commitment to amend the wrong, and a sincere apology.

3. Forgiveness doesn’t mean restoring a toxic relationship. You can forgive and move on. Forgiveness does not equal reconciliation.

4. Forgiveness means you have made a choice to move on from the negative experience. It means you have decided to put the focus back on yourself rather than the other person. Forgiveness is about you.

5. Forgiveness is not denying or minimizing your hurt. It doesn’t mean you condone what happened.

6. Forgiveness allows you to let go of being a victim and to move on to becoming someone who has shown courage and has overcome adversity.

7. Forgiveness can’t change the past but it can enlarge the future.

Do you struggle with forgiveness? How do you let go and move forward? What do your beliefs direct you to do with regard to forgiveness?