Memorial Services

Memorial services are a good way for the elderly to share their grief, consider their lives and consider how they would like to be remembered when it is time for their memorial service. If you are providing a memorial service, you need to be sensitive to this. It should be dignified, special without detracting from the focus on those being memorialized and meet the needs of the attendees and the expectations of those who are being memorialized.

Friends of residents may go to the hospital and either not return for a long time or pass at the hospital. Often this is kept "confidential" by staff concerned about HIPAA. Memorial services allow for a time and place for residents ti find out who has passed. Those who do not wish to know these things, need not attend the service. The memorial service offers a community ritual for the transition from friends being a part of lives creating new memories and that time when all we have of our passed friends is the memories created in the past. This chance to say goodbye and recognize that our friends live on in our shared memories helps in grieving normally. Being informed of the passing of hospitalized friends and having a memorial service brings a sense of normalcy and agency in the world to residents who otherwise may feel left out of important parts of life.  It helps residents to know that their friends will be informed and they will be remembered in this way after they have passed. To bring these benefits, regularity is important in scheduling.

For those who are not trained as pastors or preachers, the next challenge may be to develop a service that has the proper tone. These do not need to be varied from service to sevice much, nor do they need to be particularly entertaining. Familiar formats and elements actually help mourners to focus as they will normally do on the internal processes of grieving. Consistency will make it easier for those who may attend many of these services. Assertions that the deceased will be remembered with examples of how this is so will help. References to the after-life and pleasant visions of being embraced by the Holy Spirit and the ending of earthly suffering are traditional.  Avoid crosses, stars of David, Buddhist wheels, Sikhist daggers, redstone pipes, eagle feathers, or other particular religious symbols unless you can present all of those that might apply to those deceased and present at the service.  However, indications of the Spirit's presence such as candles, incense or water is general enough to focus attendees of all faiths on their particular version of that Spirit and their understanding of the Spirit's role in this transition.

For those interested in this kind of service and do not want to create an original one, a sample service might be:

MEMORIAL SERVICE

Welcome with appropriate music (Faure's Pavane for example)

Opening Hymn: “Amazing Grace” (In the Garden, or some other hymn that many know well if not by heart)
1. Amazing Grace how sweet the sound, that saved a wretch like me!
I once was lost, but now I am found, was blind but now I see.
3. Through many dangers, toils and snares, I have already come.
'Tis grace has brought me safe thus far, and grace will lead me home.

4. Yes, when this flesh and heart shall fail, and mortal life shall cease,
I shall possess, within the vail, a life of joy and peace.
Meditation (read by the leader)
Today we gather to remember those who no longer live and breath among us. However, they were here, they touched our world and our lives in so many ways that they never leave us...

Reading: We Remember Them (Pastor or Resident Reading)
At the rising of the sun and at its going down We remember them.
At the blowing of the wind and the chill of winter We remember them.
At the opening of the buds and in the rebirth of spring We remember them.
At the blueness of the skies and in the warmth of summer We remember them.
At the rustling of the leaves and in the beauty of autumn We remember them.
At the beginning of the year and when it ends We remember them.
As long as we live, they too will live; for they are now a part of us, as we remember them.

When we are weary and in need of strength We remember them.
When we are lost and sick at heart We remember them.
When we have joy we crave to share We remember them.
When we have decisions that are difficult to make We remember them.
When we have achievements that are based on theirs We remember them.
As long as we live, they too will live; for they are now a part of us, as we remember them.
(from the Jewish Book of Prayer)

Lighting the candle  (or some other symbolic act of invoking the Spirit)

Reading of the names (of those who have passed)

A Prayer for Souls
Eternal light,shine into our hearts.
Eternal goodness, deliver us from evil.
Eternal power, be our support.
Eternal wisdom. Scatter the darkness of our ignorance.

Eternal Pity, have mercy upon us,
that with all of our hear and mind and soul and strength
we may seek your face
and be brought be infinite mercy
to your holy presence,
at the end of your gift called life.

Hymn “Children of the Heavenly Father” (or other hymn that is more well known such as In the Garden)
1. Children of the heavenly Father safely in his bosom gather.
Nestling bird nor star in heaven suc a refuge e'er was given

2. God his own doth tend and nourish, in his holy courts they flourish.
From all evil things he spares them, in his mighty arms he bears them.

3. Neither life nor death shall ever from the Lord his children sever.
Unto them his grace he showeth, and their sorrows all he knoweth

4. Though he giveth or he taketh, God his children ne'er forsaketh.
His the love purpose solely to preserve them pure and holy
Benediction (leader )
Go with the memories of those who are now safe in the embrace of God! Go in wholeness, with the love of those gone, and in peace.

Elements of a Spiritual Assessment

Most spiritual assessments provided by Med-Pass, Briggs or others are demographic and deal primarily with questions of religious practice for which accommodations might be required. Jewish Kosher, Muslim Halal or Hindu proscriptions against beef concerns are the most often addressed. [1] The strengths perspective, currently popular in social work, would suggest some investigation of spirituality as a strength and resource for a client. Studies of resilience support this, showing a remarkable correlation between coping and healing, both physical and psychological, and participation in spiritual practice. [2]

What is provided in this post is based on Pargament's work in Spiritually-integrated Psychotherapy. This is an untested instrument designed to offer a profile the client's subjective relationship with spirituality and at least some elements of their personal theology in a systematic way that offer indications of both supportive and unsupportive spiritual contexts. A fairly complete profile may be required for clients with hyper-religiosity, command or persecutorial hallucinations with a religious character as this will be key to developing behavior management plans. For the more typical geriatric client, you may wish to develop this spiritual profile over time and in the context of various crises as deeply or completely as might be required to address the issues at hand.

To develop the context of spirituality and its practice by the client, it is important to start with simple probing questions that establish the knowledge of the client in this area and the level of participation and reliance on spirituality for support. [3]

1. Would you call yourself a religious or spiritual person?

2. Are you a member or do you affiliate with a particular spiritual community? If so, which one?

3. Would you say that this current situation affects you spiritually (or religiously)? If so, would you tell me more about that?

4. Does your spirituality help you in any way with this situation? If so, how?


Given the answers to the above questions it will be possible to determine whether further questions will be helpful. If the client has a strength in the spiritual arena, it would be appropriate to begin looking systematically at the resources and spiritual challenges that most clients face. The resources will give the care provider some spiritual tools for helping and noting the spiritual challenges will help place the client in their spiritual journey. Knowing what spiritual challenges the client faces will allow you to gauge your use of spiritual tools for the spiritual maturity and spiritual directions that will be most helpful.

KNOWING
[These questions may be answered by the client without directly asking them. Not all may be applicable. In some cases, the spiritual maturity of the client will make some of the questions redundant or unnecessary.]

1. What spiritual or religious sources do you find help you to go on? [Bible, sermons, prayer, rituals such as saying the rosary / counting decades / daily prayers / reflection / devotionals, lighting candles, meditation, attending to a shrine...]

2. Where do you find peace? [In prayer, in church, in communion with God/ ancestors / Spirit(s), in special place, in nature...]

3. Who truly understands you situation? [Jesus, God, Allah, ancestors, Angel(s), Spirit...]

4. When you are afraid or in pain, how do you find comfort and solace? [Pray, rituals, Bible,

5. What might you be deeply grateful for?

DESTINATIONS
1. What might you be striving for in your life?

2. Why, would you say, is it important for you to be here in this world?

3. What legacy would you like to leave behind in your life?

4. How would you like people to remember you when you are gone?

5. To whom or to what are you most devoted?

6. What is your true self?

7. Who or what do you put your faith and hope in?

8. To whom or what do you most freely express love?

9. When have you felt most deeply and fully alive?

CHALLENGES AND TRANSFORMATION
1. Are there any deep questions that this situation has raised for you? Would you tell me about them?

2. What causes you the greatest despair and suffering, do you think?

3. How has this situation changed you at your deepest levels?

4. What have you discovered about yourself that you find most disturbing?

5. How has this situation shaken your faith?

6. Is there anything you have learned from this situation that you wish you had never discovered? Tell me about that, if you will.

7. Do you have regrets? What might your deepest regrets be?

8. If you could let go of somethings in your life, what would they be?

9. Have you experienced forgiveness in your life? When was that? What was happening? How did that affect you?

These questions provide a rough set of questions to start conversations about spirituality. You will be looking to develop a spirituality profile of the client. To develop a plan for therapy and deal with spiritual challenges, you will require an evaluative framework to identify issues and approaches. For those wishing to understand spiritual strengths for the client and not necessarily deal with spiritual issues directly, a mapping of these answers to a strengths inventory will be required. These will be offered in the next blogs.

NOTES:
[1] An example of such a form can be found at:

• https://shop.briggscorp.com/pdf/3887P.pdf
• http://www.med-pass.com/Docs/Products/samples/MP5455_sp.pdf
  

[2] These health claims are documented in:

• Koenig, H., McCullough, M., Larson, D. (2001) . Handbook of religion and health. Oxford, UK: Oxford University Press.

• McCullough, M., Hoyt, W.T. Larson, D. B., Thoresen, C. (2000). Religious involvement and mortality: A meta-analytic review. Health Psychology, 19, 211-222.

• Pargament, K., Koenig, H.G., Tarakeshwar, N., Hahn, J. (2004). Religious coping methods as predictors of psychological, physical, and spiritual outcomes among mentally ill elderly patients: A two-year longitudinal study. Journal of Health Psychology, 9, 713-730.
  
  
• Pargament K., McCarthy, S., Shah, P. Ano, G., Tarakeshwar, N., Wachholtz, A. B.. et al. (2004). Religion and HIVL A review of the literature and clinical implications. Southern Medical Journal, 97, 1201-1209.

• American Academy of Family Physicians has an article on a similar tool: http://www.aafp.org/afp/2001/0101/p81.html
  
  
• American Academy of Family Physicians has a patient handout on this topic at: http://www.aafp.org/afp/2001/0101/p89.html
  
  
• Puchalski, C., M.D. has developed a FICA form that is available at: http://www.lumetrasolutions.com/uploadedFiles/resource-center/tools/spiritual-assessment-tip-sheet.pdf
  
  
• American Cancer Society's brief is available at: http://www.cancer.org/docroot/ETO/content/ETO_5_3X_Spirituality_and_Prayer.asp?sitearea=ETO
  

[3] The subsequent questions are similar to the FICA assessment of Puchalski (see reference above). Pargament also uses some questions from the HOPE assessment. More on each of these in further blogs.

Resource: Spritiually Integrated Psychotherapy

Kenneth I. Pergament, in his book "Spiritually Integrated Psychotherapy" (published in 2007 by the Guilford Press of New York and London), describes the reluctance of practitioners to deal with the sacred. Pergament points out that some therapy traditions judge the spiritual or any reliance on it as a sign of illness. This he does not directly counter, but suggests that people have a spiritual dimension and to amputate this part of a person causes more damage than cure.

To choose to avoid spirituality rather than excise it, Pergament says, is not better. Spirituality, he maintains provides many powerful tools for healing. And because some psychosocial difficulties arise from the sacred domain, psychotherapists who avoid spirituality will not be able to reach some problems successfully.

In providing some insight for therapists on the nature of the sacred, Pargament recognizes that one can become lost in the domain of the spiritual. He offers "a map that can guide us through spiritual territory, pointing to landmarks along the way, the directions to pursue, and the barriers to avoid." [29] Pergament references earlier psychology theorists who offer definitions and insights into religion, spirituality and belief. He suggests that explaining spirituality in more basic human drives, as some theorists attempt, is to miss the chance to elevate this dimension of humanity. Spirituality, suggests Pargament, is to search for the sacred in life. To engage with spirituality in helping clients is to aid in their search for the transcendent realities, the meaning and purpose of their lives -- the find that which is sacred in their lives. Pargament offers case studies along the way that ably demonstrate his points.

Pargament also offers research that demonstrates that spirituality is correlated with:

• Well-being, happiness and life satisfaction
• Hope and optimism
• Purpose and meaning in life
• Higher self-esteem
• Greater social support and less loneliness
• Lower rates of depression
• Lower rates of suicide
• Less anxiety
• Less psychosis
• Lower rates of alcohol and drug use
• Less delinquency and criminal activity
• Greater marital stability and satisfaction

[90] This would be very good outcomes for most psycho-therapeutic interventions, but there are also medical benefits expressed in increased longevity.

Pargament offers several approaches to interventions in the spiritual dimension. He also offers several types and levels of spiritual assessments. We will discuss spiritual assessment tools developed by Pargament in the next blog.