The spiritual care of older people approaching the end of their lives in residential care - a personal view by Keith Albans

Revd Dr Keith Albans (Director of Chaplaincy & Spirituality at MHA, 2001-17) 

The area of dying and death was a hugely significant feature of my work with MHA, both from the perspective of working with, and understanding the experience for, our residents and through developing training resources for Care Staff and Chaplains to help them offer meaningful support. I summarise very briefly here my thoughts and reflections from that experience.

Death has increasingly become a feature of older age. The last 40 years has seen the proportion of deaths in the UK accounted for by the 85+ age group leap from 16% to almost 40%. Those becoming residents in care homes expect to die there, and good spiritual care addressing this should be part of the everyday care that they receive.

Linked to this, three of my key principles in working with older people are that death be seen as part of life, that the narrative of ‘completion’ is usually more appropriate than that of ‘tragedy’ when we speak of death, and that openness, before and after death, is healthy and wanted by older people themselves. The conspiracy of silence is usually for our benefit, not theirs!

Dame Cecily Saunders wrote, “How people die remains in the memory of those who live on”, and this has a particular poignancy in residential elder care. The tasks that belong to the final lap of a long life can be addressed, to mutual benefit. However, all too often the task is beyond low-paid and often inexperienced and poorly trained care staff. This means that when the ‘how people die’ issue is handled poorly, the memory is not simply distressing to family, but also to those residents whose own end of life is approaching and to the staff who will support them.

There are two main parts to most people’s needs as life nears its end, namely to hand over the baton to the next generation and to die well. Integral to the first of these is the notion of life review and spiritual reminiscence, whereby the construction and narration of a life story can help to bring about an understanding of its meaning and purpose. For some, this process can be a religiously significant one – akin to that described at several points in the Old Testament (E.g. Genesis 48-50, Exodus 28-31, Deuteronomy 26:1-11) – but for everyone it is something which can go deep to the heart of what it is to be human. It is also something which is as significant for those left behind as it is for the one approaching death; developing the confidence to initiate and sustain these kinds of conversations is therefore of mutual benefit.

Finding ways to ask the question, ‘What is it important for you to do before you die?’ can open up the important area of ‘unfinished business’ which for many is a deep spiritual need. Similarly, funeral planning and expressing funeral wishes is part of the same area. This can be hard for family members to listen to when they are struggling to come to terms with the impending loss, but friends, carers and clergy can play an important part.

Seeing death as part of life means that it is never too early to start thinking about our own spiritual needs around end of life. Learning to speak naturally about death is something which both the church and wider society have failed to take seriously for too long. A change in that culture has been recognisable over the past 20 years, and my hope is that the church can be a catalyst in moving that process forwards.


MHA is a charity providing care, accommodation and support services for more than 17,000 older people throughout Britain. It was founded by Methodists in 1943. For more information visit mha.org.uk.