Demographic changes, political, social, and migration trends are changing the care demand in the United Kingdom. This is reflected in residential care for older people, especially regarding the spiritual needs of residents. Attention to spiritual and religious diversity is limited in residential care for older people and the implementation of diverse spiritual care is under-explored. Furthermore, knowledge and education regarding spirituality is limited among staff members in residential care. This study aimed to understand the ethical implications of ‘spirituality’ in residential care for older people. Qualitative research with an ethnographic approach was conducted in four care homes each with a different cultural or spiritual background. This comprised participant observation, semi-structured interviews with residents with capacity and focus groups with staff. Prior to the interviews, residents were asked to bring an artefact which had to give or represent a sense of wellbeing. It functioned as a conversation starter and gave insight into older people’s ideas of spirituality. Finally, an e-Delphi process was conducted with an expert panel to explore knowledge and advice relating to spirituality in residential care for older people.

Spiritual needs are the needs that resonate to someone’s ‘core being’. Barriers to good spiritual care were assumptions made by care home staff regarding residents’ spiritual needs, moral dissonance relating to fears of taking risks, and a lack of advocacy for residents. Spiritual wellbeing was enhanced by creating a care home culture of intimacy, hospitality and intersectional awareness. This study raises awareness of the importance and diversity of spiritual needs of older people in residential care. The findings of this study inform care home managements, care home staff, nursing students and policy makers on how to improve spiritual care for older people in residential care. A reflective toolkit was produced to help care home staff think about the space for spirituality in their care home. This is the first of its kind and has the potential to help support care home staff and management to reflect upon how spirituality can be best incorporated into the care home culture through enhancing connectedness and understanding individual residents.