Pastoral Care for LGBTQia Elders:
A resource for caregivers

By Rev. Marian Edmonds-Allen

My grandmother had no use for God.  She lived a long life tending a farm in rural New Hampshire, with her many children, and husband who predeceased her by 40 years.  When she was 99 and dying, she lost the ability to converse, but repeated over and over, “God will be with me, most of the way.”  This puzzled me.  I was in seminary then and my grandmother only shook her head about that choice of vocation, and never once asked about it.  But minutes before she died, she started saying, “God will be with me, ALL of the way.” 

My grandmother didn’t identify as LGBTQi or a, but like many older adults who do identify under the rainbow umbrella, at the end of her life God became important to her in some way, and I like to think, gave her comfort.

Too many LGBTQia people believe the lie that God hates them.  Many older adults, especially, have told me that God has rejected them, so they reject God. Some of these same people - not all - but some, started to think about God again and long for relationship with the divine in some way.  For those who chose to talk with me about it, I heard over and over again wondering questions, “Could God really love me, after all?” 

These resources will provide those loving people, whether clergy or not, the tools to support and care for LGBTQia older adults of faith or no faith, through the end of life.  What we call pastoral care is simply opening the circle wide enough for God to join in, and through that Divine presence, miracles happen.

Introduction
LGBTQia older adults have lived through tremendous changes in our society in their lifetime.  From changes in biological and psychological understandings to changes in laws and attitudes.  LGBTQia elders are more likely to have lived parts of their lives in the closet - or with their LGBTQia identity hidden.  Most, but not all, have lived through economic hardship because of discrimination, most have avoided preventative medical care or received substandard care because of lack of affirming providers, far too many have experiences family rejection.  Most LGBTQia elders count friends as part of their family, if not their only family.  And lastly, these elders face discrimination within a culture that values youth over age, and many have few social supports and community activities.  YOU are needed, and you can help!

Studies show that having an active, supported spirituality improves health and wellbeing.  Whether you are trained as clergy or simply an interested and caring adult, you have what you need to provide companionship, care and comfort to someone in need.

Pastoral Care for healthy LGBTQia older adults

Pastoral caregivers have the unique role of being able to ask the questions that few people ever ask, questions about faith, spirituality, religion and God.  During my years as a chaplain, elders I worked with ran the gamut of wanting to wrestle with "God questions" every time I saw them, to seldom wanting to talk about faith.  Some needed time to learn to trust me, that I wouldn't reject them as other clergy had.  There is no wrong way to have these conversations, as long as you are completely respectful and supportive of whatever your person (the elder you are providing pastoral care to) shares.  Chaplains learn to affirm all types of spirituality - that can be a goal of yours.  If you are providing care to someone within your religion or faith you may share affirming and helpful perspectives, for example, "As Presbyterians, we believe that all people, LGBTQia people included, maybe especially, are loved by God."

Here are some techniques for having those conversations with elders who have an active religious or faith life as well as those who do not identify as religious or as a person of faith: 

Conversation starters (these are ideas, you will have your own):
How has your relationship to faith and God changed over the years?
What was your childhood like, did you go to church?
Have you ever “come out” to God, and what was that like?
Do you pray or have some sort of spiritual practice like yoga, reading  
    spiritual texts or being in nature? Did you ever?
When have you felt most close to God / the Divine?

Beyond the conversations you will have, you may wish to go deeper by suggesting a spiritual journey exercise.  This provides your person with an opportunity to see how their faith has changed over the years.  For your own reference, you may wish to review Fowler's stages of faith (below) to see a typical faith progression.

Spiritual journeys
This exercise (By Nancy Cosgriff) is great for reflection and grounding, and may be done in an interview format with a caregiver asking questions, or it can be done as a journaling exercise alone or in conjunction with a group of people participating.  For interview, personal journaling or group:

1.   How would you describe your “spiritual journey” over the years?   What has changed for you and/or remained the same?

2.   What is your sense of your own spirituality at the present time?  Briefly describe your essential spirituality, your spiritual experience, beliefs, values and questions.

3.   Recall and describe one experience for each of the age periods below of when you felt closest to or deeply connected with something greater than yourself—however you might name that—and felt interconnected and enlivened at your core.  It might have been an experience in a church or in nature or with a group of people— whatever you recall as a memorable experience.

a.  Childhood years   b.  Teenage/young adulthood years   c.  Adult years   d.  Present time

4.   What patterns or forces do you see, if any, within you, in your life or in your external surroundings that might account for these experiences of close relationship or sense of connection to something greater?  For example, did they take place with others or when you were alone, in a church or out in nature—or did that vary?

5.   What is the significance of that for your spiritual journey now?  What can you learn from this about how you might live now or what you might do to increase your awareness of something greater, of what we might call the mysterious life force?

6.   How do you nurture your soul or essence now?  What do you do that animates, affirms or gives you a sense of the fullness of life?

7.   Where do you want to go from here?  What is missing for you?  What do you hunger or yearn for?  What do you still seek?

Spiritual Practices
There are as many different spiritual practices as there are people in the world.  Often if it helpful and sometimes even transformational to suggest new spiritual practices for an elder to try alone, with you, or in a group.  Some people enjoy Lectio Divina, a Benedictine practice of scriptural reading, meditation and prayer, others prefer prayer walks, time in nature, expressions of faith through art, yoga, meditation - the varieties of spiritual practices are endless and enriching.  There are many books and websites with ideas, here are some examples.  For elders who are "spiritual but not religious" there will be practices that are not faith specific, and for elders who identify as faithful in some way, you will be able to find new practices to support their faith.  Ask what you person most enjoys and look for something similar.

Community of Faith
For LGBTQia elders who attend worship and faith services, think about ways to involve them in volunteer or leadership roles.  Intergenerational activities are especially meaningful for all involved.  GenOn Ministries has wonderful resources and ideas.

Many older LGBTQia people have gone to church at some point, not as many have gone to an affirming or celebrating church or faith community.  Invite your person to your church or to go with you to visit a celebrating church that matches the tradition or perhaps your person’s interests.  Some churches and faith communities have special “sit with me!” Sundays / Sabbaths, where LGBTQia people who are beginning to explore going to services or events as an option for them.  If your faith community doesn’t have one, why not start one, and advertise it widely, perhaps with your local LGBT Center, SAGE Chapter, AARP, community center, or whatever LGBT groups or elder services are in your area.

Pastoral care for LGBTQia older adults who have physical and other challenges, including dementia and Alzheimer’s disease.

Many national and local health and elder organizations have resources for LGBT people.  For example, the Alzheimer’s Association has their own LGBT specific resources as well as referrals.  Even if you don’t see LGBT information listed, it is well worth emailing or calling to ask.  You may learn something that isn’t widely publicized, or you may be the catalyst for change!  

It’s impossible to be an expert on everything, but familiarize yourself as much as you can about your person’s physical challenges, and ask questions.  Having an opportunity to talk with a caring person who listens with compassion is an invaluable gift.

Involve your person in local groups if circumstances permit, and if you have time, be an ally or advocate for them.  Participate in a walk for a cause, include your person if you are able to, or take pictures if they are not able to be there.  Tangible signs of care and commitment are life enhancing for everyone, and helps to provide supportive communities.  Read this excellent study for insights: Religion, spirituality, and older adults with HIV: critical personal and social resources for an aging epidemic.

If attending faith events and worship services is not possible, you can bring (or arrange for) communion and / or other meaningful sacraments and rites to be available.  One of my treasured memories as a nursing home chaplain was doing hymn sings and communion with groups or in individual homes or nursing home rooms.  Many times I saw the eyes of my patients clear, and maybe even join with a robust portion of a prayer or hymn.  These treasured memories of faith last a very long time, sometimes even deep into the subconscious of a person with dementia.

Highly recommended:  Godly Play.  This interactive, Christian children’s program is easily adapted and tremendously meaningful.  The use of story telling through objects is especially appropriate for people with dementia.  Read more on their site.  

A note about nursing home care:  do your research, support your person or your person’s family in selecting the best facility.  It’s vitally important to ask about LGBT competency, particularly for transgender seniors and then to follow up by asking for references from families and LGBT seniors.  Read more about LGBT seniors in nursing home care, learn (and share!) about best practices, be involved and support the family in being involved with your person’s care at the facility.  Studies show that the presence and involvement of family and friends makes all the difference in the quality of life for the nursing home resident.  

Pastoral care for LGBTQia seniors at end of life

LGBTQia people need particular planning for end of life to ensure that there is appropriate care and that their wishes are being honored.  Advance planning is a must (see Resources, below).  If you are a caregiver for someone at the end of their life, you will want to familiarize yourself with the stages of the dying process. The Hospice Foundation of America has wonderful information and even a webinar about end of life and LGBT seniors on their web site.  

You can help your person prepare for end of life by making note of what music they enjoy, whether they are someone who enjoys touch, and what type of environment is comfortable and comforting to them.  For example, as a person nears death playing their favorite music, rubbing lotion on their feet, holding their hand, and / or saying their favorite prayers out loud are just some of the things that might bring comfort during that special time.  It is a privilege to be with someone as they pass, what some people call a “thin place” between one life and the next.

Resources:

5 Tips for Churches and Faith Communities

  • Involve elders in your worship, education and volunteer programs - invite them to speak, mentor, lead a group
  • Start a faith group for LGBTQia elders and advertise it widely.  It could be a support group, reading group, film group, discussion group - the possibilities are endless
  • Start a ministry.  This could be a respite ministry for caregivers of LGBTQ elders, a community of care group that checks in on elders and helps with simple tasks, this could be a mentoring ministry for intergenerational learning.
  • Get involved in social justice issues that impact LGBTQia elders
  • Volunteer as a group to provide worship or sing at a nursing home, provide a meal for a community center...

5 Tips for Individuals

  • Volunteer as a companion / pastoral caregiver for a local hospice, nursing home or community center
  • Volunteer at a LGBTQia center or SAGE chapter as a pastoral caregiver 
  • Lead a faith / spirituality group at a center or through an organization or at your faith community
  • Spearhead a project!  Organize people to become a respite or caregiving network, create a learning program
  • Get involved in social justice work or with organizations, do a fundraising walk, become an advocate for LGBTQia elders

National Resource Center on LGBT Aging
The National Resource Center on LGBT Aging is the country's first and only technical assistance resource center aimed at improving the quality of services and supports offered to lesbian, gay, bisexual and/or transgender older adults. 

SAGE
SAGE is the country's largest and oldest organization dedicated to improving the lives of lesbian, gay, bisexual, and transgender (LGBT) older adults. https://www.sageusa.org/

Movement Advancement Project
Several reports about legal and social issues impacting LGBT elders.

Compassion and Choices - LGBT Elders

  • Dementia Provision – This includes language one can add to any advance directive that advises physicians and family of the wishes of a patient with Alzheimer’s disease or other forms of dementia. Download the Dementia Provision here.
  • A Letter to My Doctor – To ensure that advance directives are communicated to and respected by healthcare providers, individuals may want to use this sample letter to their doctor to discuss their end-of- life wishes. Download.
  • Assisted-Living Facility (ALF) Rider – If a patient is living in an assisted living facility (ALF) and wants to remain there until the end, they can use the ALF contract rider to ensure the home is suited to their choice. Download.
  • Sectarian Healthcare Directive – This addendum clarifies that admission to a religiously affiliated facility does not imply consent to care mandated by the institution’s religious policies and directs a transfer if the facility will not follow the preferences in an advance directive. Download.
  • Values Worksheet – This worksheet includes questions to consider when making end-of-life decisions and preparing documents concerning ones healthcare preferences. Download.
  • Hospital Visitation Form – This gives unmarried couples hospital visitation authorization for their partner. For same-sex couples this form may be necessary to ensure that their partner may visit them in the hospital. Download.

 

Stages of faith development:  Dr. James Fowler
Fowler’s work is not focused on a particular religious tradition

  • For Fowler, faith is a universal quality of human life
  • “Faith” is a dynamic, changing evolving process, a way of being
  • Fowler’s “stages” are “still shots” in a complex, dynamic process
  • Fowler’s stages are not meant to be an evaluative scale.  There are individuals at each stage who are persons of serenity, courage and genuine faith
     
  • Stage 0 – "Primal or Undifferentiated" faith (birth to 2 years), is characterized by an early learning of the safety of their environment (i.e. warm, safe and secure vs. hurt, neglect and abuse). If consistent nurture is experienced, one will develop a sense of trust and safety about the universe and the divine. Conversely, negative experiences will cause one to develop distrust with the universe and the divine. Transition to the next stage begins with integration of thought and language which facilitates the use of symbols in speech and play.
  • Stage 1 – "Intuitive-Projective" faith (ages of three to seven), is characterized by the psyche's unprotected exposure to the Unconscious, and marked by a relative fluidity of thought patterns.[4] Religion is learned mainly through experiences, stories, images, and the people that one comes in contact with.
  • Stage 2 – "Mythic-Literal" faith (mostly in school children), stage two persons have a strong belief in the justice and reciprocity of the universe, and their deities are almost always anthropomorphic. During this time metaphors and symbolic language are often misunderstood and are taken literally.
  • Stage 3 – "Synthetic-Conventional" faith (arising in adolescence; aged 12 to adulthood) characterized by conformity to authority and the religious development of a personal identity. Any conflicts with one's beliefs are ignored at this stage due to the fear of threat from inconsistencies.
  • Stage 4 – "Individuative-Reflective" faith (usually mid-twenties to late thirties) a stage of angst and struggle. The individual takes personal responsibility for his or her beliefs and feelings. As one is able to reflect on one's own beliefs, there is an openness to a new complexity of faith, but this also increases the awareness of conflicts in one's belief.
  • Stage 5 – "Conjunctive" faith (mid-life crisis) acknowledges paradox and transcendence relating reality behind the symbols of inherited systems. The individual resolves conflicts from previous stages by a complex understanding of a multidimensional, interdependent "truth" that cannot be explained by any particular statement.
  • Stage 6 – "Universalizing" faith, or what some might call "enlightenment". The individual would treat any person with compassion as he or she views people as from a universal community, and should be treated with universal principles of love and justice.