The Sacred Art of Caregiving
JANUARY 14, 2023
BY ONOME HENRY OSOKPO, PHD, MSc., MSN, RN
In most religious traditions, Rabbi Richard Address and Reverend Tyrone Pitts explained, faith and caregiving are deeply connected, and caregiving can be considered “a sacred act”. Faith-based communities are a central part of any community’s infrastructure and are natural partners for supporting caregivers.
The webinar, part of the Caregiving NOW! series hosted by Penn Nursing’s NewCourtland Center for Transitions and Health, focused on the spiritual dimension of caregiving and the search for meaning within the caregiving experience. The conversation was moderated by Mary Naylor, who noted that this dimension is rarely discussed among health care professionals and researchers, even as we recognize the importance of faith-based organizations in caregiver support.
Rabbi Address and Reverend Pitts both consider caregiving as central to their mission and their work. Rabbi Address is the founder and director of Jewish Sacred Aging®, an initiative that promotes awareness of aging issues and resources for Jewish congregations across the U.S. Reverend Pitts is General Secretary Emeritus of the Progressive National Baptist Convention. He is also President and CEO of Bridges International, an organization committed to peace with justice. Both Rabbi Address and Reverend Pitts serve as members of the Interfaith Action Council of the Coalition to Transform Advanced Care (C-TAC). As faith leaders, they shared insights on how they have translated the tenets of their faith into programs that support caregivers and families during serious illness and at the end of life.
First, they shared how they came to focus on caregiving issues. Rabbi Address became involved in caregiving after rabbinical college, when he helped start a hospice in his local community in Thousand Oaks, California. Caregiving issues were central to his training in a Doctor of Ministry program. As a rabbi in a synagogue, he worked with congregations to help establish committees that would take care of congregants, informed by a Jewish textual perspective. He noted that a big transition for him came after his dad died very suddenly. “My mom lingered for two years with dementia and Alzheimer’s. So, the caregiving issue went from the academic and institutional to the very, very personal.”
Reverend Pitts, an American African, said his stance on caregiving was nurtured and developed as he grew up in a one-room church in rural Bailey’s Crossroads, Virginia, just seven miles from Washington, D.C. “We were a community that was surrounded by Jim Crow and by segregation, and so the community itself learned to deal with issues of family and support systems.” Caregiving was at the core of the church ministry, he said, noting that “within the American African Baptist Church and church family, caregiving is essential.” Growing up, Reverend Pitts saw his great-aunt care for his great-grandmother, and subsequently, he provided care to his great-aunt and his own mother. These humble beginnings, he said, showed him that, “if you were not a caregiver, you were really not a Christian.”
Both Rabbi Address and Reverend Pitts highlighted caregiving as a basic component of their faith, rooted in the Talmud and the Gospel, as well as in other faith traditions including Islam, Hinduism, and Buddhism. Reverend Pitts noted that churches within the American African tradition operate based on a love ethic revealed in the gospel and that caregiving is a biblical mandate in scripture.
Reverend Pitts described the connection between faith and caregiving from one of his favorite Gospel stories, Mark 2:1-4. As he told it, four men carry a lame man to see Jesus, who is in a house surrounded by a crowd. But they cannot get through the crowd to see him. Finally, they decide to cut a hole in the roof, and lift the man from the roof down to see Jesus. And then Jesus says to the caregivers, “Your faith has made you whole.” Jesus then tells the man to get up and walk, and the man does, and he is cured. Reverend Pitts described the lessons this story offers for caregivers:
“People who are struggling with caregiving and the principle of spirituality sometimes get stuck in the institutions and the structures that prohibit them from really getting to the kind of support systems that they need. And our biblical mandate is to really be individuals that go beyond what is expected of us. And sometimes it means to take off the roof and do the extraordinary, do the impossible, do the unimaginable. And our faith system tells us that.”
In the Jewish faith, Rabbi Address said, caregiving flows from the fifth commandment in the Torah—to honor and respect one’s father and mother. Through Talmud conversation several centuries later, these concepts are elucidated to focus on dignity. As Rabbi Address explained, “You are not allowed to take away any person’s sense of dignity, and who they are, because, according to the tradition, they are created…in the image and likeness of the sacred.”
These Talmudic teachings are powerful, he added, not only because they unpack the concept of dignity, but also because, in the modern world, they reflect upon the concept of quality of life and caregiving issues at the end of life. He noted, “The Talmud says, there is a time that you can allow the flame of life to flicker out in dignity and in sanctity. That’s why every single case is unique, and every single situation has to be dealt with on its own terms and levels.” He added that the teachings are also relevant to modern-day issues in caregiving, such as the role of money and the obligation to take care of parents who have abused or neglected their own children.
The tenets of these faiths have translated into different programming on caregiving. According to Rabbi Address, programs in Jewish Sacred Aging® are based on a theology that through prayer and service, the community can help spiritually heal caregivers and their loved ones, even if there is no cure. For example, congregations hold Friday night services to honor caregivers, with liturgy that honors their work as part of doing the fifth commandment. During high holiday services, caregivers are invited to come up as a group to say the blessings before the Torah is read. Rabbi Address said that the reactions are phenomenal. “People look around, and all of a sudden you realize you’re part of this community. You’re not alone.” On a practical level, caring communities provide support to older adults and their caregivers, such as providing transportation to doctors’ appointments. Wellness programs that incorporate ritual are also offered to caregivers. Rabbi Address shared a prayer for caregivers, written by Rabbi Michelle Medwin, a former student:
Sustainer of the Universe, help me to care for my loved one, with hope, courage, and sensitivity.
Grant me insight, resourcefulness and the ability to ask for help and to accept help when it is needed.
May I find the patience to overcome difficult moments and to find meaning and purpose in the smallest task. O Eternal God, help me to remember to take of myself so that I may have the strength to help others.
Be with me and my loved one, as we journey on this path together. May the One who makes peace in the heavens, bring peace to me, to my family and loved ones, and to us all.
Revered Pitts noted that the African American church’s whole positionality and programs center around caregiving, caring for the elderly, the sick, and other members of the community. He pointed out that caregiving is rooted in the South African concept of relationship, “I am because you are. You are because I am,” and the “church is really a part of an African village concept.” These concepts have translated into programs with C-TAC to address the caregiving needs of the poor and oppressed, developed with the active participation of the people most in need. For example, the Alameda County Care Alliance pulled together six churches to launch a program with navigators and training to support family caregivers. Importantly, pastors and church members controlled the process of identifying the needs and designing the program, not the organizations that are part of the health system and structure. The alliance now includes more than 40 groups. In Detroit, the Southeast Michigan Care Alliance created “Caregiver Sundays” in which the pastors preach sermons on caregiving, and invite caregivers to come to the front to receive a certificate and be honored. Pastors have lunch with the caregivers after the church meetings and serve them meals. Seminars and workshops are being organized on caregiving.
Revered Pitts also highlighted work in Louisville, Kentucky in one of the poorest communities in the state. Church elders began by addressing the immediate needs of the community, which were housing and food. As Reverend Pitts described it, “We need to focus on where the people are hurting.” Thus they started with immediate needs, and then centered the issue of advanced illness and care in that context. As another example, Reverend Pitts cited the Ward 7 Caregiving Project, which serves one of the poorest areas in Washington, D.C. The Caregiver Coalition of Ward 7 has conducted “listening sessions” to identify the needs and concerns of caregivers. They are developing a strategic plan, “by the community, for the community, with folks outside of the community…listening to see how they can help support it,” he explained.
Reverend Pitts did not shy away from calling out what is needed to sustain these programs, namely by changing the system and the structures that create these problems in the first place.
“We need to rethink the whole issue of health care within this nation. And we need to think about how we support the poor and the needy and the oppressed, and how we deal with the issue of inequity. Because each one of these communities that we’re engaged in, and that Rabbi Richard Address is engaged in, really suffer from the same thing: an inequity in the health care system.”
He advocated for legislation to establish a universal health care plan, as well as partnerships with other professional organizations, area agencies on aging, the government, and faith-based organizations to address community caregiving needs.
It is clear that health professionals and researchers can learn a great deal about supporting caregivers from the tenets and programs of faith-based organizations. In meeting the caregiving needs of numerous and diverse communities, these organizations have taken a bottom-up approach, as opposed to the top-down approach often used in the current health care landscape. The community perspective should be at the center of all faith-based caregiving programs.