In the Catholic tradition, the month of November is a special time to remember those who have passed away. It is also a time to acknowledge and give thanks to those who accompany our loved ones as they enter their older years and palliative care. In this story, pastoral care practitioners Helen Treuel and Genevieve Malone share why they feel called to accompany those who enter residential aged care and end-of-life care, describing it as both a blessing and a challenge.

We walk gently with others in their real world as they carry hearts full of love
and sometimes broken hearts.
We walk gently with others in their real world as they hang onto their inner strength
and, also as their strength diminishes.
We walk gently with others in their real world as they approach change
with hope, courage, and vulnerability.
We walk gently with others in their real world to affirm that they are loved.
We walk gently with others in their real world to nurture and nourish
their unique lived experience
We walk gently with others in their real world to honour the sacredness of lives lived.

These are some of the words expressed by Helen Treuel in her ‘personal creed’ as a pastoral care practitioner at VMCH’s Star of the Sea aged care residence in Torquay, on Victoria’s surf coast. These words speak to the essence of Helen’s call to accompany people, being a gentle and calm presence of support and care, as they approach the later stages of life, and ultimately, death.

It's a role that Helen shares with Genevieve Malone – both work three days a week, with a shared day in the middle – as part of a broader team of practitioners who care for around 80 residents aged anywhere from 60-100 years old. It is a role that both say is ‘a privilege and honour’ and one that brings deep meaning to their own lives, and hopefully those whom they serve.

‘There is so much to our role,’ said Helen. ‘Our role involves companioning residents throughout their personal journey and their spiritual journey. We spend a lot of time with residents one-on-one talking with them, listening, and providing whatever support is needed for them and their families, particularly in the space of end-of-life or palliative pathway. We’re present for residents and families there.

It’s also about companioning people at a time in their life where there’s a lot of change happening for them. People can sometimes say, “There’s no purpose in my life anymore” so we try to help them find meaning and hope in their life, whether in a personal or spiritual capacity, or both.

Genevieve explained that the spiritual aspect of people’s lives is important, but that they ‘take the lead’ from the resident. ‘We’re very conscious of letting the resident lead. If faith is important to them, we’ll support them in that. If faith is not, we will support them in other areas. We’re conscious of not intruding in people’s own beliefs.

‘Essentially, we are present to people, we take the time to be with them, to allow them to be seen and heard, to let them speak about their experiences and to acknowledge the importance of their lives. We’re so lucky because we have the time, we’re not rushing, our role is really to let people know you are seen, you are heard, you are important, you're valuable just as you are.

The residents naturally have been through so much in their life, they have so much life experience, so often our role is also to reflect back to them how we see them, to reflect back to them how beautiful they are and the gifts that they possess: “You’ve got that inner resource and strength to deal with things. You’re so strong and you seem to get through every difficulty. That’s how I see you, you’re incredibly strong and resilient, you have all these jewels, your life is a treasure”.’

Helping others to remember that they are brave and courageous and shining the light on their positive attributes, attitudes, actions, and achievements is key, according to Genevieve who penned some reflections in her own “Pastoral and Palliative Care Creed”.

There is an on-site chapel for residents and staff at Star of the Sea with the local Catholic priest and Anglican minister able to offer Mass for those who’d like to attend. Together with the clergy, Helen and Genevieve can facilitate services for residents in the chapel as well as helping to create and facilitate rituals for residents, particularly when it comes to palliative and end-of-life care.

For Catholic residents, the anointing of the sick by a priest is important and often brings much comfort and peace to the resident.

‘Helping to facilitate a ritual, particularly at the end-of-life-stage, can be very healing,’ said Helen. ‘We may use some holy water, or plain water, and we just model a little blessing on the person’s hand or head and suggest some words of peace acknowledging that they’re moving onto a resting place. The family might then take the water and do the same blessing on their loved one.

‘And whether they’re coming from a religious or spiritual point of view, there’s something very powerful in that ritual. We see people really melt into the moment as they impart their farewell.’

Genevieve added, ‘That sense of ritual, particularly for someone who is dying, is important – their family telling them how much they love them, perhaps having a blessing-type prayer that can be religious or not, depending on what people prefer. It’s about creating a lovely space that is sacred for everybody.

It’s like the birth of a baby, it’s sacred, and end of life is sacred and whether you believe in God or not, it is a sacred time.’

Genevieve explained that the past 18 months, during the COVID-19 restrictions and lockdowns in Victoria, had been particularly difficult for residents and their families who were unable to see each other in person.

‘Over that period, we facilitated countless phone calls – both video and regular phone calls – and window visits between residents and their family members,’ said Genevieve. ‘Some family members were incredibly skilled at leading the conversation to bring out the most participation from their loved one. Other residents, just by hearing their loved one’s voice or seeing them on the screen had a reduction in confusion and appeared far more relaxed and calmer after the call.’

Helen shared a particularly moving example: ‘Last year during all of the COVID restrictions, we had a resident who was end-of-life. At the time only one family member could be in the room at a time, all in personal protective equipment “PPE”.

‘The resident was on the ground floor here and the family would come and do window visits with her over a long period of time, particularly at the end-of-life stage. I remember sitting in the room with the resident for long periods just holding her hand or rubbing her forearm and the family would look in through the window. That was hard. After the resident passed away, one of the family members wrote a card, which acknowledged that they couldn’t be there in-person with their loved one, but that we were there for that person. I’ll never quite forget that.’

Both Genevieve and Helen feel deeply ‘honoured and privileged’ that they can care for the residents in their older years and as they progress toward needing end-of-life-care.

‘People say “thank you for all the care you’ve given our mum or dad” or whoever, but we both always say what a privilege it is to be able to care for them, and to be trusted so deeply. It’s an honour and privilege.

‘The relationship with our residents is at the centre of everything,’ said Helen. ‘Their life stories enrich me so much.’

Genevieve added, ‘I really admire our older residents – I think they have so much life experience, wisdom, humility and courage. They’re just beautiful. And we’re around at those times where they just know they can be honest. They know they can be themselves. You can just go straight to the point, heart-to-heart, this is how I am, these are my worries, these are my fears. This is what’s going on. And together, sharing the load for what can sometimes be years.’

Genevieve reflected that this too presents one of the deepest challenges in the role: ‘The longer you’re here, the deeper some of those relationships are, and the more likely someone’s going to be entering end-of-life,’ she said. ‘By then you’re quite connected to them, so it can be really difficult – it’s a blessing and a challenge as well.’

In those difficult times, Genevieve draws on her own personal faith, as well as the support of her work colleagues, who share her deep commitment to care and nurture those in the later years of their life, as they progress to end-of-life.

At times I go through moments where I just feel like I don't know how I am going to do this,’ said Genevieve. ‘But while it can be hard, I know that God is here in every moment and every situation.’

Helen added: ‘We also work in an environment that is of itself a pastoral environment. We’re the pastoral care practitioners here but everyone is a pastoral carer in who they are and the way that they work. We’re not here on the weekend, and there is a lot of things that happen on a weekend that require a pastoral care approach, and I’d say with confidence that that happens for people here. We have a culture of care here and we’re well supported.

‘And I have a great partner that I work with,’ said Helen. ‘We often say how grateful we are to share this role and to have each other so that we can talk through things and support each other. It’s not for everybody, but we love what we do.’