Spiritual Care in Long Term Care: Best Practices
“APC Standards of Practice for Professional Chaplains in Long-Term Care”
Reflection 1: One of my first responses to this document is excitement. It is not the first time I have seen this. I would like to know is there any long-term care facility where this has been put into practice? How long has it been used and what have been the positive outcomes along with the challenges of implementation?
My next reflection is how is it possible to move forward in these directions if you are a department of one and the facility doesn’t follow these standards. I observe that I can at least initiate the implementation a few of these principles. A chaplain benefits from being a “self-starter.”
Section 1, Standard 1 speaks of Assessment. After reading the following article I wonder if “assessment” is the proper term to be used in this place at the beginning of the list of Standards. I am referring to the Drummond, Carey article, page 377 on screening, history-taking and assessment. In this article it is recognized that ‘assessment is the correct nomenclature having to do with analysis of relevant information. I believe the article was suggesting that spiritual assessment culminate in a specific plan of spiritual care.
I have always used “assessment” in a very general way describing all the task of initial screening, learning history, and analyzing information for a care plan. Is this the broad meaning of the word in the Standards of Practice?
In my seven years of working full time in a continuing care facility as the only staff chaplain, I have used several assessment tools: S.P.I.R.I.T, F.A.I.T.H, H.O.P.E, F.I.C.A, and F.A.C.T. Over time, I have gotten away from strictly following a form and have gather the needed information in a conversational manner over several visits. On the whole, the one I have used the most has been FACT.
“Do you think assessment in your setting is important or not?” Yes…but! I practice spiritual assessment of all residents in the facility. I understand the value of initial screen and initial assessment. In a long-term facility, a resident’s condition often changes. Therefore, I see the need for ongoing spiritual assessment as a basic care which I offer. The challenge is staying current in this regard with 250+ residents. As a result, I practice a kind of spiritual care triage. I try to visit each newly admitted resident within the first three days. This visit is at least a screen. Next I note those who are struggling or having spiritual distress or having a status change and visit these as follow up contacts. Finally, I rely on staff to alert me spiritual crisis needs, such as end of life concerns.
While I see holes in this approach it seems to work most of the time, especially since I have built up a long term relationship with long term residents. A place for improving this approach is to train and enlist the help of volunteer chaplains in the work of initial spiritual screening. This is a goal I am currently working on for this year, I now have trained two volunteers as chaplains. I think nursing staff could do a spiritual screen-in theory. However, I find that they feel over worked, with too many tasks and unrealistic expectations already laid upon them. Therefore, I don’t really expect nurses to screen for spiritual concerns. Similarly, out Social Worker asks a few spiritual affiliation / practice questions during intake. However, my company does not allow me to see this information in the social worker’s electronic record and this colleague does not transfer this info to the face sheet of the resident.
I believe that a best practice for spiritual care in long-term care is exemplified by the APC Standards of Practice. Unfortunately, in the non-profit CCRC I work for, HR has determined that I may not have access to the clinical electronic health record. Therefor, I can’t effectively document or communicate a spiritual plan of care in a collaborative way with the interdisciplinary team. I struggle with this.
“Assessing Spiritual Well-Being in Residential Aged Care”
Reflection 2: I resonated with the first sentence: “there is a need for a clear and validated process of spiritual review that can be understood across multidisciplinary teams.” I have encountered other staff who don’t understand what I do as a chaplain; likewise, I have struggled to communicate spiritual needs of residents to the staff. Often, I find staff believing all I do for residents are religious things, like prayer and read the Bible.
I have an affinity with the broad task of working with residents to build a plan to help each person continue on their own spiritual journey. Assessment in this sense involves finding out how they cope, what their religious/spiritual practice may be, learning about their struggles, resources, support, goals and hope. These are foundations for building a spiritual care plan which allows a resident to continue on the journey.
This article was helpful in clarifying the distinctions between the activities of screening, history-taking, and assessment. In practice I admit that I often move back and forth between these activities as new information or experiences emerge.
The information about spiritual care taxonomy was very interesting. Previously I have known about the taxonomy described in the white paper by Spiritual Care Association: https://spiritualcareassociation.org/docs/resources/taxonomy_white_paper/chaplaincy_taxonomy_standardizing_spiritual_care_terminology_r1.pdf While helpful this document is also complex and cumbersome for me.
Page 380 of our document seemed much more practical, warranting further thought and practical use:
Loss of identity, fear/dread, anger/depression, existential concerns, abandonment by God, anger at God, relationship with God, conflicted belief system, despair/hopelessness, grief/loss, guilt/shame, reconciliation, isolation, religious/spiritual struggle.
I have also found the list of pastoral diagnosis a possible source for a taxonomy to communicate the spiritual care needs in a care plan and with the staff:
Connection with God, Searching for the Holy, Questions about why God has done this to me, or what has God promised, Expressions of gratitude, Concerns about death/afterlife, Repentance, Sense of identity or purpose, Hope, Search for meaning, Isolation, Faith, Conflict of religious beliefs and recommended treatments, Ritual needs, Spiritual practices, Grief, Loss.
List is drawn from Paul W. Pruyser, Minister as Diagnostician. Philadelphia: Westminster Press, 1976
Also, this article FACT, A Chaplain’s Tool for Assessing Spiritual Needs in an Acute Care SettingMark LaRocca-Pitts BCC, Chaplaincy Today. e-Journal of the Association of Professional Chaplains • Volume 28 Number 1 • Spring/Summer 201225 may be helpful in this discussion: http://www.professionalchaplains.org/files/publications/chaplaincy_today_online/volume_28_number_1/28_1laroccapitts.pdf
I appreciate the listing of various assessment tools. It confirms to me that there is not one approach in this task. It also shows the common concerns and general focus of attention in spiritual assessment care. It was reassuring to see many that I was familiar with and have used. I would like to know from my colleagues:
1) Do you only use one assessment approach, tool?
2) How do you communicate assessment and spiritual care plan to the interdisciplinary team? If so how?
3) How do you practice assessment with memory care / cognitively challenged residents?
David Brinker, 8/14/19