At present, there are about 850,000 people in the United Kingdom with dementia. This number is expected to rise to one million people by the year 2025. Two-thirds of people with dementia live in the community and are supported by 670,000 family carers. One in 14 people over 65 years of age has dementia, while the figure for people aged over 80 is one in six. Over 40,000 people are under the age of 65 with dementia. Concern exists about whether society will be able to address the future health and social needs of people with dementia. Within social policy, this has led to an increased reliance upon indigenous family and community resources.
Many people with dementia find that their local community is unfriendly towards them. They find many people do not make the effort to listen to them and make it difficult for them to have an active role in the community. Conversely, a dementia-friendly community is a ‘city, town or village where people with dementia are understood, respected and supported, and con dent they can contribute to community life. In a dementia-friendly community people will be aware of and understand dementia, and people with dementia will feel included and involved, and have choice and control over their day-to-day lives.’ The aim is to improve the quality of life for people with dementia wherever they live in the community.
Thus the latest Grove Pastoral booklet sets the scene for the challenge and opportunities of ministry with people who have dementia. In Developing Dementia-Friendly Churches, Trevor Adams explores the whole range of issues involved, engaging with a theology of mission, looking at assumptions in government policy and the philosophies that underpin them, and including many practical examples of churches engaging in this ministry. He begins by exploring possible understandings of mission that will lead us to engage with people who have dementia and their carers.
The first approach challenges the view that local communities can be changed without knowing much about their culture, needs and experience. It highlights indigenous resources that are available in the local community that can support people with dementia and their family carers, and reframes Christian mission as a ‘two-way exchange of gifts and includes listening and sharing with others.’ This approach sees Christian mission as a reciprocal dialogue between churches and the local community through the creation of relationships and alliances that respect and value people of difference. Moreover, it positions churches as vulnerable and dependent on the hospitality of others in the local community. The approach highlights churches and local communities displaying justice and righteousness, and facilitating ‘the recovery or development of places which are humanizing, through the fostering of independent community relationships within an identifiable geographical location whose scale is defined in terms of walkable distances.’
The second approach towards Christian mission draws on the work of Tom Wright. This approach states that Christian mission is concerned with building for the kingdom of God that occurs on earth now, as the church looks forward to God’s future restoration of creation. Churches are seen as bringing hope and healing to the world and responding to the love poured out in Jesus’ death that is not only directed towards Jesus but also to others, especially those in particular need. Wright calls upon the church to take places seriously as ‘sacred space’, not as a retreat from the world but rather as a bridgehead into it. In this way, Wright argues that the church must not rest as long as the world remains spoilt and defaced. This defacement is seen throughout creation and includes social and political structures, such as those that disadvantage and marginalize people with dementia.
This is followed with some practical examples of churches taking seriously this missional challenge. Adams then explores the ‘person-centred care’ narrative which shapes current government policy, and both the positive and negative impact of this approach.
The person-centred account of dementia firmly established the pre-eminence of secular humanism in dementia-care policy, practice and research. But, as Jenkins notes, this is a double-edged sword and, while recognizing that people with dementia are sentient beings with inalienable human rights, humanism also relies upon normative understandings of what it means to be human, which serve to position people with dementia as deficient. This secular approach extends to recent empirical studies that make little account of the presence and potential of churches as social capital, and their potential to contribute towards the creation of dementia-friendly communities.
The big question for Christians and churches is: does Scripture and theology offer an alternative narrative that might shape our thinking? Adams believes so, and sees it as including issues of spirituality, justice, the relationality of God, victory over evil in Jesus’ death, hospitality, and the church as eschatological community.
The narrative begins by affirming that God is just and that God’s expectation is that people should display justice. The Old Testament calls on people to ‘Do justly and to love mercy.’ Keller notes in Mic 6.8 that the difference between love [Hebrew: chesedh] and justice [Hebrew: mishpat] is that while chesedh focuses on the attitude (or motivation) behind the action, mishpat puts the emphasis on the action itself. He argues that the meaning of mishpat is wider than simply punishment for wrongdoing and includes ensuring that people have their rights. The Bible identifies four groups of people who should receive justice: widows, orphans, immigrants and the poor. Keller comments that today this group would include older people, and I personally would also include people with dementia, as they also need justice.
The narrative continues by drawing on Wright’s idea of the ‘covenant of vocation.’ As already noted, Wright argues that God’s calling on humans is to reflect the praises of creation back to the creator and to reflect the creator’s wise and loving stewardship into the world and that this is what it means to be and live as a genuine human being. According to Wright, this calling extends to all people and is not dependent on their cognitive ability. Moreover, the calling not only includes people with dementia but also affirms their identity and role as humans within creation. People with dementia are therefore just as much part of the church as any other person and have a shared calling to fulfil. Together with people of full cognitive ability, people with dementia are a ‘royal priesthood’ that stands between God and the rest of creation and reflects ‘the creator’s wise and loving stewardship into the world.’ Their calling is to be redeemed human beings and justified justice-bringers who are thus called to act as stewards of God’s redeeming love and justice, to help restore creation now in the expectation of its full restoration when Jesus returns, at which time ‘There will be no more death or mourning or crying or pain, for the old order of things has passed away’ and that in everything God will have the supremacy (Rev 21.4).
Adams then explores how to engage with the needs of the local community and from that develop and strategy of engagement and ministry, which will include training those who will be involved. The final chapter of the booklet includes a wide range of practical advice, addressing general communication, the impact of church buildings, how to make our worship and prayer dementia-friendly, putting on ‘memory cafés’, and engaging with carers of those with dementia. The comments on prayer are typical of the practical orientation here.
Prayer is an important part of the life of a church and so it is with dementia-friendly churches. Churches should seek to help people with dementia to engage with God through prayer and enable others to pray for them in church services or at home.
When praying with someone who has dementia, take them to a quiet and safe place where there are few distractions. Remember to turn o your mobile phone. Be aware of the church’s safeguarding policy so that the person with dementia is always safe, treated with respect, and not put at risk. Introduce yourself and ask them what they would like to pray about. Keep prayers short and simple. Always use short sentences and easy-to-understand language that will help people with dementia follow the prayers. Use familiar prayers like the Lord’s Prayer, which people with dementia are more likely to remember from their past. Try writing prayers with people who have dementia, as they may find this helpful. It will increase the relevance of the prayers to them and help them express their thoughts and feelings. When I take services in day centres for older people, I pray for people who attend that are presently in hospital. When you are praying with people who have dementia, tell them that you are starting to pray. Let the person with dementia know when you start and finish praying with them. Think about asking someone with dementia, or a carer, to pray during a time of church prayer or at a prayer meeting.
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