Dear Patti,

I’m widowed and my divorced sister, Mary, has been living with me for the last four years. Our arrangement has been working very nicely. Mary has a serious chronic illness which has recently grown worse and she’ll soon need 24-hour home care. We can afford for her to stay with me and have the room to accommodate a live-in caregiver.

We were discussing how to find and interview caregivers. I emphasized that it’s important that Mary likes the person(s) more than I do since she’ll be dependent and with this person the majority of the time. I’m pretty easygoing and can live comfortably with all kinds of different people as long as they take good care of my sister.

We were raised in a very strict Christian home where the fear of God was put before us daily. We were often shamed into believing we were sinful and that our sexuality was dirty and bad. As an adult, I’ve shied away from structured religion and I don’t want anyone putting their views on me ever again. I still feel a strong resentment and bitterness toward our parents’ overly zealous doctrine.

Mary has recently found a renewed interest in religion and expressed a desire in finding a female caretaker who could appreciate her newfound faith. Mary admits she’s afraid to die and understandably wants someone to talk to about God and an afterlife. I, however, am extremely uncomfortable about having a religious or “spiritual” person in my home. I don’t care to hear someone else’s opinions on abortion, premarital sex, infidelity, drinking or how our grandchildren should be disciplined based on the caregiver’s own religiosity. At the same time, I’m sincerely devoted to meeting Mary’s needs and requests, especially at this time in her life.

  — Jan

Dear Jan,

I appreciate your dilemma, as you don’t want to interfere with Mary having meaningful help to support her sacred right to explore her personal spiritual feelings and beliefs and yet, at the same time, don’t want to reenact your unhealthy, traumatic childhood experiences. You have clearly expressed both Mary’s needs as well as your own and it’s crucial that the chosen caregiver can make the distinction between the two of you and incorporate a religious and/or spiritual component into Mary’s caregiving and simultaneously respect your need for boundaries.

What does Mary want in her caregiver? Is it a perceived closeness or connection to God or higher power? Is she looking for a spirituality or religiosity that provides direction and internal guidance, often referred to as a sustaining force?

Some nurses, attendants and caregivers — in the endeavor of fulfilling their patient’s needs — include religious and spiritual areas when requested, since not doing so could lead to insensitive assessment and treatment. Spirituality and religion are often considered important aspects of care for patients with chronic illnesses and are used as an inner resource to overcome the challenges associated with their health problems.

In order to facilitate finding the right person, Mary might want to answer the following questions and communicate her answers to potential caregivers:

What type of spiritual or religious support do you desire?    

What provides you with strength and hope?

Do you use prayer in your life?

What does dying mean to you?

How does faith help you cope with illness?

Having the caretaker answer the following questions may be helpful as well:

Are you a spiritual or religious person?

Do you have ethical concerns about incorporating spirituality or religion in your caregiving? If so, what are they?

How knowledgeable are you about different spiritual and religious belief systems outside of your own?

How do you feel about using prayer with patients?

What were your most painful experience with religion or spirituality both while growing up and as an adult? How have they affected you?

What are your reactions when you meet someone with a set of spiritual or religious belief systems different from yours?

This could also be a wonderful opportunity for you to work through feelings of anger and pain from your childhood trauma which rigidly limits your tolerance for other’s theological beliefs.

Even if you decide to bring in a caregiver who isn’t necessarily religious and have a spiritual leader of Mary’s choice frequently visit her, you might still want to work through your unprocessed emotions toward your parents and your religious childhood experiences with professional counseling. 

Patti Carmalt-Vener, a faculty member with the Southern California Society for Intensive Short Term Psychotherapy, is a psychotherapist in private practice with offices in Pasadena, Santa Monica and Canoga Park. Contact her at (626) 584-8582 or email Visit her website,