All Courses Forums Course Discussion Forums Spiritual Care in Long Term Care: Best Practices Long term care spiritual care seminar week 3

10 replies, 5 voices Last updated by llawhon 2 years, 1 month ago
Viewing 10 reply threads
  • Author
    Posts
    • #5283

      Rick Underwood
      Moderator
      @RickUnderwood

      Greetings all,

      We are into our third week. I have searched the literature high and low for relevant articles and you all have added valuable resources as well.

      For this last week, we have posted two videos: a YouTube video exploring issues related to memory care and a video from our resource library conducted by my friend and colleague at the University of Louisville, Dr. Meer Alaragaja and discussed by the lead administrators at Signature Healthcare. They are a bit unusual in LTC in that one of their business pillars is spirituality and they are for profit. The data they collected and conclusions drawn could be helpful in talking with administrators about the value of spiritual care in LTC. Will be interested in hearing your reflections on the two videos.

      Rick

    • #5295

      Mark Pedersen
      Participant
      @markpedersen

      Hi Rick,

      One of the first slides that asks us….. What statement best fits our perceptions of spiritual care in long term care?…..easy for ME to answer but was harder for the staff and nurses of the long term care facility to answer.  Yes, I had to do some research in the long term care facilities in my town to see what their responses would be.

      Their physical and emotional reactions were fascinating!  Some didn’t want to answer…..some got very nervous and kept looking at the paper with the question on it……some answered with the response they think I wanted……others answered very truthfully according to their own beliefs.

      I finally told them that I wasn’t doing this for the manager of the facility.  It was just a question I was asked in one of my continuing education classes.  I asked them to be honest with me and I would not share their answers with anyone at their workplace.  Guess what the percentages were on their responses?????

      Pastor Mark

       

    • #5309

      Jennifer Gingerich
      Member
      @JenniferGingerich

      As you all view the videos, here are a couple more questions to consider:

      Kuepfer refers to a study she did with spiritual resources among baby boomers.  What do you all notice being distinct in the spiritual resources or needs of baby boomers in your communities vs. older generations?

      With the Signature webinar, how do you react to their focus on measurement and outcomes for chaplain interventions?  Do you do anything similar, even on a small scale, in your department?  If so, what have you tracked?

    • #5313

      Orlow
      Member
      @Orlow

      Hi

      I’ll answer Jennifer’s questions first before I reflect and respond to the two excellent videos.

      In one of my sites we minister to Baby boomers and younger.  Average age in 60 residents is 38 years old.  The other site is 200 residents with only a few boomers and all the others older; including two ladies who will turn 105 in December.  I notice that the older ones are often more interested in personal relationships with the chaplain, they love their visit.  They like being hospitable and are thankful when you mention how enjoyable the visit was.  Boomers may be very unused to having other than family or close friends visit them; but they can often be surprised how a visit and interacting can seem helpful to them in their circumstances.  The younger clients are not hospitable, don’t want you in their room, are usually distrustful of people in general and wonder what the chaplains purpose is because it isn’t practical or beneficial to them in their world view.  Some of the latter reflection needs sot take in that these younger residents are often very sick with multiple things wrong with them and even when they have a break from their degenerative disease have to deal with issues like bladder infections, bed sores, and what they see as really poor care by staff.  The staff in our places are largely Philipino or East Indian who bring with them their culture, perspectives and biases.

      Older residents desire to talk about themselves, their lives, jobs, holidays, kids, grandkids etc.  Younger residents don’t open up much and in some cases almost seem incapable of doing so, because its just not done in their experience.  Asking them questions even with great intent and desire to help often seems to them as an intrusion and they question why you would possibly want to know these things.

      I am 66 and want to declare my own struggle to communicate with residents that begin with distrust and set opinions about values, morals, issues, and religion and spirituality.   I have experienced really liking a number of our residents who were younger and yet always feeling I am distrusted for what I represent in their mind.

       

      On the second question.

      I have quoted the findings of articles over the years to my inter disciplinary team, colleagues and general public on the value of chaplaincy.  These have become anecdotes I guess. But I have talked about how prayers helped some people get better quicker, deal with heart attacks and have less problems, how clients took fewer pain meds when visited by the chaplain, or the role of a chaplain helped nurses with fewer calls from patients who were consistently visited by the chaplain.

      But I was really wide eyed and overwhelmed with the number of things the Signature group was keeping tabs on, measuring and documenting, for the purpose solely it seemed to justify chaplaincy, but also to fund it, turn it into research articles and seminars to push their brand and corporate identity.

      I kept stopping the video to be able to give myself time.  I repeatedly thought to myself, “this is interesting” BUT what would it be like to be a chaplain in this system?

      I also noted they had talked on several occasions about what I would call the specific protocol the chaplain was to use in response to a particular type of illness.  I am sure this was in large part due to the replicability of the intervention and its improvement over time.  I wondered if there was a lot of woodeness in the ressonse due to this standardization of response by the chaplain.  A just say this kind of boxing in of the creativity, even though they talked a lot about how creative they were.

      My response to both of these videos was surprising to me.  I thought I would really like to be able to spend a week with each of them.  The spiritual assessments and responses that would lead to know what the resident needed to bolster their ability to have faith, hope, joy and peace was really interesting to me and I would love to see it work in action.  It really has helped me think of how the questions I ask might be brought into a tighter framework of goals: aiming at what brings the resident these four things.  We have three questions at the bottom of our initial spiritual assessment.  Who is important to the resident?  What do they look forward to?  What issue are they working on at this time?  I can see the possible list of questions, when aimed at faith, hope, joy and peace being very productive with certain populatons; particularly many boomers and the older generation.  I’d also like to ask younger residents questions which would elicit answers they felt comfortable sharing on these topics.

      What I need to do is ask of myself is the questions too of what today would bring me deeper faith, greater hope, more joy and lasting peace.

      I recorded for my own purposes the three minute section from Dr. Kuepfer when she opened up and let flow her passion about finding the answers to the questions.  This was really inspiring; to hear her voice and the result of her work turn into such flowing prose.  She really encapsulated the passion she feels and I resonated with it.  This video I thought went really well with the articles on spiritual assessment.  This course has had great materials to study and for further working with.  Thank you.

      The Signature video presentation was also very interesting.  As I said above I would love to be able to get a chance to get fully immersed for about a week in the system and be able to learn in their presence what really all that talk means in the interpersonal relationships to the clients.  I’d love to give their systems and interventions a try, just to see if I would be as wide eyed and wound up and enthused as they are.  On a side note I had a fair bit of trouble understanding Joe. Whether it was skips in the video or his speech or accent, sometimes I just did not get what he said.

      Thank you

       

       

       

    • #5315

      llawhon
      Member
      @llawhon

      Comments on the video from the folks at Signature Healthcare, I felt like it was more of a promotional video on who they are and what they do.  To me, it was more of a business presentation than an actual ministry presentation.  Any material they presented that may have been helpful to this course was passed over rather quickly.   Healthcare, long term and otherwise, has become so business oriented in this country and that has implications for chaplains and the work we do.  Is the model presented in this video the best answer to how the value and worth of chaplaincy care can be determined?  Is chaplaincy care really about improving the bottom line for the business?  This presentation has raised more concerns for me than help with understanding my work in a LTC setting.

    • #5316

      llawhon
      Member
      @llawhon

      Comments on the Meaning, Memory, and Mystery video…

      I really appreciate what she said about making spiritual care foundational to all of the care that is offered.  Here questions about what has helped in the past, what makes you feel hopeful, etc. are very good questions to use.  I wonder from you all what questions have you found useful in helping to build an understanding of a given resident/patient’s personal spiritual resources?  Information that I find useful to know include their experiences of handling loss or transitions in life, what is there support network like, and when they are connected, or have been connected to a specific religious groups or practice I like to discover what significance that connect plays in their life at the current moment in time.  She made the statement that “meaning is often connected to memory.”  I’m going to be pondering this statement but it seems to say to me that meaningful people, experiences, places, etc. of the pst  are important to the current spiritual foundation of the present.  This speaks to the need of building a strong base of information for each resident so we can help tap into those resources.  This may be very important for those who experience cognitive decline and have trouble recalling those meaningful memories.  I appreciate her work on defining spirituality.  As she noted this can be a challenging task as evidenced by the different ways that spirituality can be defined.

    • #5317

      llawhon
      Member
      @llawhon

      Jennifer asked the following questions…

      Kuepfer refers to a study she did with spiritual resources among baby boomers.  What do you all notice being distinct in the spiritual resources or needs of baby boomers in your communities vs. older generations?

      Speaking as a baby boomer my very first reaction to this question is that baby boomers may well have a strong need for connections.   I don’t know how typical I am but I think of things like baby boomers no longer living in their home towns, perhaps living in several different cities or states over the years so we’ve not done so well at maintaining long term friendships. Much of our generation did not work in the same factory for 30 or 40 years as our parents so those long term friendships did not develop. Siblings may well live in several different places and not be together so much.  A significant divorce rate is, I believe, a factor in the needs of my generation and it seems that many of my generation are no longer connected to the church of their youth, that is if they were connected at that time.   This raises the question of where they find their spiritual grounding.   Again, my experience my not be typical of my generation but these are some of the concerns of which I am aware from my own experiences or experiences of those I know of my generation.

      With the Signature webinar, how do you react to their focus on measurement and outcomes for chaplain interventions?  Do you do anything similar, even on a small scale, in your department?  If so, what have you tracked?

      Chaplaincy is something of a second career for me as I spent many of my younger years in youth ministry.  I’ve been in active chaplaincy work for 13 or so years now and was not in it very long when the hospital I worked as a per diem chaplain started talking about “measurements and outcomes for chaplain interventions.   Before that conversation went very far I moved into the current FT position where there has been, so far, no talk of measurements and outcomes.”  I personally am grateful that we don’t track measurements and outcomes.  It is my feeling that trying to quantify chaplaincy care in a life-care CCRC is almost like nailing jello to the wall.  An example is based on my experience which tells me that sometimes a brief conversation in the hall might have more impact on someone than a more lengthy visit elsewhere.  In a LTC setting we generally have the opportunity to build a pastoral relationship so many of our contacts, while important for building the relationship, may not in and of itself be very significant and hard to track other than as a small step in a process.  I think that providing spiritual care has a very fluid component to it so much of it would be hard to track with hard numbers.  What we can do, perhaps, is track how well we are doing at building the relationship and compiling the information needed to help us understand the spiritual resources and life stories of our residents.    In the Signature Healthcare presentation they talked about their work helping to provide good outcomes which sometimes help the bottom line.    If our interactions help benefit a person then well and good but I feel that it needs to be kept complete separate from the bottom line of our respective organizations.  I can’t image being a chaplain whose benefit to the organization is measured in any way by how he/she helped the bottom.  If the justification of our care is tied to the bottom line then it becomes to big of a temptation to let bottom line influence our efforts.  In the other video the emphasis was on building a culture in which spiritual care is seen as foundational to all of the work that goes on.  I like that emphasis very much a believe strongly that our building that foundation need not be tied to how we help the bottom line.  In fact, building that kind of foundation could have a big effect on how administrative decisions are made.

    • #5318

      Jennifer Gingerich
      Member
      @JenniferGingerich

      In response to the thoughts shared about the Signature video – I wonder how much of the bottom-line and protocol focus that you all pointed out is related to Signature being a for-profit company?  I have only worked in non-profits with faith-based roots, and the culture of spiritual care has been more like what Larry described in his own setting: we offer spiritual care because that’s part of who we are.  Not because it produces better outcomes.  However, I do see in the wider healthcare chaplaincy arena that there is a concern for chaplains needing to prove their worth to administration.  That seems to be a significant piece of the emerging realm of chaplaincy research.

      Signature’s unique tone may also come from being a big company with many locations – perhaps that leads to a desire to standardize practices more than smaller organizations need to.  I recall a song in which the singer sarcastically talked about the church becoming “just like IBM.”  Is this making spiritual care replicable like Target and McDonald’s make their practices standardized?  There is value in that in some ways: using best practices and ensuring high quality care, presumably.  And yet as we read in one of the week 2 articles, a big part of the care we give has to do with the person of the chaplain, and each one of us is different, as are our settings and our residents.

    • #5326

      Jennifer Gingerich
      Member
      @JenniferGingerich

      Thank you all for your thoughtful engagement in this course!  I have enjoyed hearing your experiences and insights and wish you all the best in your continued ministry.

    • #5327

      llawhon
      Member
      @llawhon

      As Orlow stated the Signature material is interesting in concept but I really am not comfortable with it as it seems to possibly go to far in trying to make the work of the chaplain overly structured and too heavily defined.  My experience tells me that that two different people, even people who are related, may face the same diagnosis or same issue in their respective lives and yet handle it very differently.    I shy away from a program such as what Signature does because it may not allow for working with each person on their own terms and with their own experiences in lieu of “marking off the checklist” of what to say and do when responding to this specific information.  It is more important in my view that we get to know the individual, their family dynamics, and other pertinent personal details and work from that perspective rather than trying to fit the situation to our predetermined response/questioning to a given situation.  I may be overstating things but the signature system seems to lend itself to something other than a personalized approach, not to mention lending itself to having to accomplish a certain number (quota?) of good outcomes.  Sometimes our most important work is being with folks in the midst of bad, very bad outcomes.

    • #5328

      llawhon
      Member
      @llawhon

      A final reflection from me is that I believe we have a unique situation by serving in LTC settings, particularly if the foundation of what we do is relational work grounded in trust.  There are some materials from this course which will be worth look back over.  I’m not great a spiritual assessments so that is one area for sure that I will look back at.  It is disappointing to realize that there is not much research out there for LTC chaplaincy.  I wonder what, from this course, might lead to some fresh ideas for research in this area.   Thank you all for sharing in this experience.  I wish you all well in the important work in which we share.  Peace to you all.

Viewing 10 reply threads
  • You must be logged in to reply to this topic.