Worshiping in the moment: A special service for people with dementia

The Rev. Blaik Westhoff prepared recently to lead a religious service for a tough audience: seven elderly women with dementia.

He had a stack of colorful shawls, because these worshipers often find the chapel in the facility where they live, Phoebe Richland near Quakertown, to be too chilly. An ornate cloth – blue on one side and gold on the other – would turn a plain table into an altar.  To illustrate God's creation of the world, Westhoff had a globe you blow up like a beach ball, an electric candle, plastic fruit, stuffed animals, and a hand mirror.

About four years ago, leaders at Phoebe Ministries, an Allentown-based organization that provides services and housing for seniors, realized that traditional services were literally putting residents with dementia to sleep, even those who were deeply religious. They couldn't follow all those words, but the staff knew they still loved the hymns they'd sung for a lifetime.  Phoebe, which is affiliated with the United Church of Christ, created Spirit Alive, using Montessori educational methods to craft services that are small, personal, and aimed at awakening the senses with touch, sound, and smell, rather than relying so much on language.

So Westhoff would not be delivering a traditional, structured sermon.  Spirit Alive called for him to tell a much-simplified Bible story, respond to the spiritual moment, and let the memories and insights of his wounded flock lead to sacred spaces that dementia had spared. It was religion stripped to its emotional core, and Westhoff was fairly bursting with admiration for it.

"It is such an honor and privilege to do this," said Westhoff, who is pastor of Tabor United Methodist Church, near Harleysville, and has been leading Spirit Alive services for a year and a half.  "I truly sense the presence of God. … To me, this is true, real worship."

The program was developed by the Rev. Scott Brooks-Cope, director of pastoral care for Phoebe; Elizabeth Buss, a chaplaincy student, and Kelly Carney, a psychologist who was until recently director of Phoebe's Center for Excellence in Dementia Care.  Brooks-Cope had experience with Godly Play, a Montessori-based religious program for children.  Buss helped write and design lessons.  Carney brought her knowledge of dementia and evidence-based treatments.

Three years after it was rolled out in Allentown, there are now nine Spirit Alive groups in four Phoebe facilities. A small pilot study found that it was more effective than traditional services at improving resident engagement, mood, and spiritual well-being.

"There has never been a time that I have sat in Spirit Alive that I haven't gotten tears in my eyes," Carney said. She was moved by the kindness residents showed one another and the wisdom they shared.  "When you strip away all of those conscious cognitive processes that we all use every day, it removes the facade. … The veil is just a little bit thinner, the veil between this world and the spiritual world."

Profound declarations from residents thought to be almost nonverbal are so common that Phoebe created  a report listing 17 of them.  "What does it feel like to forgive?" a facilitator asked one resident.  "Everything that hurts here goes away," she replied, moving her hand to her heart. "You love."  Another resident felt God walking nearby. "What is that like?" the facilitator asked.  "It is wonderful. He stays longer now."

Westhoff had a similar experience with a woman who seemed unreachable until she spoke up about dogs, faithfulness, and God.  "What I've learned is you never assume nobody is home," he said.

He began the recent service by personally greeting each of his worshipers, who ranged in age from 79 to 94.  All but the youngest sat in wheelchairs.  Westhoff, 56, kneeled to talk to each one because he knows people usually tower over them.  "Good morning, Shirley," he said to Shirley Derstine, 82.  "I'm so excited about being with you."

He pulled out the altar cloth and presented it to each woman. They touched it and examined its patterns. That got them to talk about favorite colors, flowers, paisley fabric they had known, sewing, and softness.  Sometimes, Westhoff said, they spend the whole service talking about that cloth and the memories it draws forth.

"Have you ever felt anything that soft?" he asked Jeanette Schmauder.

"No, not even my husband's [backside]," she blurted. Everyone laughed. "Well, what happens in Spirit Alive stays in Spirit Alive," Westhoff said with a smile.  Last, he brought the cloth to Ruth Beer, who is 94 and rarely speaks.  He wrapped the fabric around her shoulders.  "When I think about God's love, I think about this altar cloth," he told her.  "It's beautiful and it's soft and it wraps around me and it brings God into my life."  Beer said nothing, but her good eye was open, bright, and trained on Westhoff's face.  He felt a connection strong enough to make his own eyes tear up.  "I can tell by your eyes it's a good thought for you," he told her, his voice cracking a little.

The group sang "He's Got the Whole World in His Hands." Westhoff passed the inflated globe and they sang a verse for each woman. "Jane's got the whole world in her hands" and so on.  Westhoff said he imagines God hugging the earth in a loving embrace.

They talked about things they had created and Westhoff learned why Schmauder's husband was on her mind. He was in the hospital and she was worried.  She cried.  "Can I say a prayer for you?" he asked.  "Certainly," she said.  "Thank you so much." Later, she said these services "bring back life to me."

The talk turned to what they would create first if they were God. Derstine said she would create a "perfect partner." Then she talked about how her husband had gone to sleep next to her and died. He looked so peaceful. "How did you feel when you saw him at peace?" Westhoff said.  "It took the sting out of it," she said.  "So God created the perfect partner for you when he created your husband," he said.

They talked about light, their favorite fruits, dead goldfish. Beer dozed and Westhoff stroked her hand. "God is granting you a wonderful time of rest right now," he told her.  "God always knows what we need."

The hour passed quickly and Westhoff sped to an ending.  "As a special treat," he told the women, "I'm going to show you God's most amazing creation."  Out came the hand mirror.  He held it so each woman could see her own face.