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    • #5193

      David
      Participant
      @Chaplain Brinker

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      <p class=”MsoNormal”><b><span style=”font-size: 12.0pt; line-height: 107%; font-family: ‘Georgia’,serif;”>Spiritual Care in Long Term Care: Best Practices</span></b></p>
      <p class=”MsoNormal”><b><span style=”font-size: 12.0pt; line-height: 107%; font-family: ‘Georgia’,serif;”>Week 1</span></b></p>
      <p class=”MsoNormal”><b><span style=”font-size: 12.0pt; line-height: 107%; font-family: ‘Georgia’,serif;”>“APC Standards of Practice for Professional Chaplains in Long-Term Care”</span></b></p>
      <p class=”MsoNormal”><span style=”font-size: 12.0pt; line-height: 107%; font-family: ‘Georgia’,serif;”>Reflection 1:<span style=”mso-spacerun: yes;”>   </span>One of my first responses to this document is excitement.<span style=”mso-spacerun: yes;”>  </span>It is not the first time I have seen this.<span style=”mso-spacerun: yes;”>   </span>I would like to know is there any long-term care facility where this has been put into practice?<span style=”mso-spacerun: yes;”>   </span>How long has it been used and what have been the positive outcomes along with the challenges of implementation?</span></p>
      <p class=”MsoNormal”><span style=”font-size: 12.0pt; line-height: 107%; font-family: ‘Georgia’,serif;”>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.<span style=”mso-spacerun: yes;”>    </span>I observe that I can at least initiate the implementation a few of these principles.<span style=”mso-spacerun: yes;”>  </span>A chaplain benefits from being a “self-starter.”<span style=”mso-spacerun: yes;”>  </span></span></p>
      <p class=”MsoNormal”><span style=”font-size: 12.0pt; line-height: 107%; font-family: ‘Georgia’,serif;”>Section 1, Standard 1 speaks of Assessment.<span style=”mso-spacerun: yes;”>  </span>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.<span style=”mso-spacerun: yes;”>    </span>I am referring to the Drummond, Carey article, page 377 on screening, history-taking and assessment.<span style=”mso-spacerun: yes;”>  </span>In this article it is recognized that ‘assessment is the correct nomenclature’ having to do with analysis of relevant information.<span style=”mso-spacerun: yes;”>  </span>I believe the article was suggesting that spiritual assessment culminate in a specific plan of spiritual care.<span style=”mso-spacerun: yes;”>  </span></span></p>
      <p class=”MsoNormal”><span style=”font-size: 12.0pt; line-height: 107%; font-family: ‘Georgia’,serif;”>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.<span style=”mso-spacerun: yes;”>   </span>Is this the broad meaning of the word in the Standards of Practice?</span></p>
      <p class=”MsoNormal”><span style=”font-size: 12.0pt; line-height: 107%; font-family: ‘Georgia’,serif;”>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.<span style=”mso-spacerun: yes;”>   </span>Over time, I have <span style=”mso-spacerun: yes;”> </span>gotten away from strictly following a form and have gather the needed information in a conversational manner over several visits.<span style=”mso-spacerun: yes;”>  </span>On the whole, the one I have used the most has been FACT. </span></p>
      <p class=”MsoNormal”><u><span style=”font-size: 12.0pt; line-height: 107%; font-family: ‘Georgia’,serif;”>“Do you think assessment in your setting is important or not?”</span></u><span style=”font-size: 12.0pt; line-height: 107%; font-family: ‘Georgia’,serif;”><span style=”mso-spacerun: yes;”>     </span>Yes…but!<span style=”mso-spacerun: yes;”>    </span>I practice spiritual assessment of all residents in the facility.<span style=”mso-spacerun: yes;”>  </span>I understand the value of initial screen and initial assessment.<span style=”mso-spacerun: yes;”>   </span>In a long-term facility, a resident’s condition often changes.<span style=”mso-spacerun: yes;”>  </span>Therefore, I see the need for ongoing spiritual assessment as a basic care which I offer.<span style=”mso-spacerun: yes;”>   </span>The challenge is staying current in this regard with 250+ residents.<span style=”mso-spacerun: yes;”>  </span>As a result, I practice a kind of spiritual care triage.<span style=”mso-spacerun: yes;”>  </span>I try to visit each newly admitted resident within the first three days.<span style=”mso-spacerun: yes;”>   </span>This visit is at least a screen.<span style=”mso-spacerun: yes;”>   </span>Next I note those who are struggling or having spiritual distress or having a status change and visit these as follow up contacts.<span style=”mso-spacerun: yes;”>   </span>Finally, I rely on staff to alert me spiritual crisis needs, such as end of life concerns.</span></p>
      <p class=”MsoNormal”><span style=”font-size: 12.0pt; line-height: 107%; font-family: ‘Georgia’,serif;”>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.<span style=”mso-spacerun: yes;”>   </span>A place for improving this approach is to train and enlist the help of volunteer chaplains in the work of initial spiritual screening.<span style=”mso-spacerun: yes;”>  </span>This is a goal I am currently working on for this year, I now have trained two volunteers as chaplains.<span style=”mso-spacerun: yes;”>   </span>I think nursing staff could do a spiritual screen-in theory.<span style=”mso-spacerun: yes;”>   </span>However, I find that they feel over worked, with too many tasks and unrealistic expectations already laid upon them.<span style=”mso-spacerun: yes;”>  </span>Therefore, I don’t really expect nurses to screen for spiritual concerns.<span style=”mso-spacerun: yes;”>   </span>Similarly, out Social Worker asks a few spiritual affiliation / practice questions during intake.<span style=”mso-spacerun: yes;”>   </span>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.</span></p>
      <p class=”MsoNormal”><span style=”font-size: 12.0pt; line-height: 107%; font-family: ‘Georgia’,serif;”>I believe that a best practice for spiritual care in long-term care is exemplified by the APC Standards of Practice.<span style=”mso-spacerun: yes;”>   </span>Unfortunately, in the non-profit CCRC I work for, HR has determined that I may not have access to the clinical electronic health record.<span style=”mso-spacerun: yes;”>  </span>Therefor, I can’t effectively document or communicate a spiritual plan of care in a collaborative way with the interdisciplinary team.<span style=”mso-spacerun: yes;”>  </span>I struggle with this.</span></p>
      <p class=”MsoNormal”><b><span style=”font-size: 12.0pt; line-height: 107%; font-family: ‘Georgia’,serif;”>“Assessing Spiritual Well-Being in Residential Aged Care”</span></b></p>
      <p class=”MsoNormal”><span style=”font-size: 12.0pt; line-height: 107%; font-family: ‘Georgia’,serif;”>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.”<span style=”mso-spacerun: yes;”>  </span>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.<span style=”mso-spacerun: yes;”>  </span>Often, I find staff believing all I do for residents are religious things, like prayer and read the Bible.</span></p>
      <p class=”MsoNormal”><span style=”font-size: 12.0pt; line-height: 107%; font-family: ‘Georgia’,serif;”>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.<span style=”mso-spacerun: yes;”>  </span>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.<span style=”mso-spacerun: yes;”>  </span>These are foundations for building a spiritual care plan which allows a resident to continue on the journey.</span></p>
      <p class=”MsoNormal”><span style=”font-size: 12.0pt; line-height: 107%; font-family: ‘Georgia’,serif;”>This article was helpful in clarifying the distinctions between the activities of screening, history-taking, and assessment.<span style=”mso-spacerun: yes;”>  </span>In practice I admit that I often move back and forth between these activities as new information or experiences emerge. </span></p>
      <p class=”MsoNormal”><span style=”font-size: 12.0pt; line-height: 107%; font-family: ‘Georgia’,serif;”>The information about spiritual care taxonomy was very interesting.<span style=”mso-spacerun: yes;”>   </span>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<span style=”mso-spacerun: yes;”>   </span>While helpful this document is also complex and cumbersome for me.</span></p>
      <p class=”MsoNormal”><span style=”font-size: 12.0pt; line-height: 107%; font-family: ‘Georgia’,serif;”>Page 380 of our document seemed much more practical, warranting further thought and practical use:</span></p>
      <p class=”MsoNormal” style=”margin-left: .25in;”><span style=”font-size: 12.0pt; line-height: 107%; font-family: ‘Georgia’,serif;”>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.</span></p>
      <p class=”MsoNormal”><span style=”font-size: 12.0pt; line-height: 107%; font-family: ‘Georgia’,serif;”>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:</span></p>
      <p class=”MsoNormal” style=”margin-left: .25in;”><span style=”font-size: 12.0pt; line-height: 107%; font-family: ‘Georgia’,serif;”>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. </span></p>
      <p class=”MsoNormal” style=”margin-left: .25in;”><span style=”font-size: 12.0pt; line-height: 107%; font-family: ‘Georgia’,serif;”>List is drawn from Paul W. Pruyser, Minister as Diagnostician. Philadelphia: Westminster Press, 1976</span></p>
      <p class=”MsoNormal”><span style=”font-size: 12.0pt; line-height: 107%; font-family: ‘Georgia’,serif;”>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 <span style=”mso-spacerun: yes;”> </span>may be helpful in this discussion:<span style=”mso-spacerun: yes;”>  </span>http://www.professionalchaplains.org/files/publications/chaplaincy_today_online/volume_28_number_1/28_1laroccapitts.pdf </span></p>
      <p class=”MsoNormal”><span style=”font-size: 12.0pt; line-height: 107%; font-family: ‘Georgia’,serif;”>I appreciate the listing of various assessment tools.<span style=”mso-spacerun: yes;”>  </span>It confirms to me that there is not one approach in this task.<span style=”mso-spacerun: yes;”>  </span>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.<span style=”mso-spacerun: yes;”>  </span>I would like to know from my colleagues:</span></p>
      <p class=”MsoListParagraphCxSpFirst” style=”text-indent: -.25in; mso-list: l0 level1 lfo1;”><span style=”font-size: 12.0pt; line-height: 107%; font-family: ‘Georgia’,serif; mso-fareast-font-family: Georgia; mso-bidi-font-family: Georgia;”><span style=”mso-list: Ignore;”>1)<span style=”font: 7.0pt ‘Times New Roman’;”>     </span></span></span><span style=”font-size: 12.0pt; line-height: 107%; font-family: ‘Georgia’,serif;”>Do you only use one assessment approach, tool?</span></p>
      <p class=”MsoListParagraphCxSpMiddle” style=”text-indent: -.25in; mso-list: l0 level1 lfo1;”><span style=”font-size: 12.0pt; line-height: 107%; font-family: ‘Georgia’,serif; mso-fareast-font-family: Georgia; mso-bidi-font-family: Georgia;”><span style=”mso-list: Ignore;”>2)<span style=”font: 7.0pt ‘Times New Roman’;”>    </span></span></span><span style=”font-size: 12.0pt; line-height: 107%; font-family: ‘Georgia’,serif;”>How do you communicate assessment and spiritual care plan to the interdisciplinary team?<span style=”mso-spacerun: yes;”>   </span>If so how?</span></p>
      <p class=”MsoListParagraphCxSpLast” style=”text-indent: -.25in; mso-list: l0 level1 lfo1;”><span style=”font-size: 12.0pt; line-height: 107%; font-family: ‘Georgia’,serif; mso-fareast-font-family: Georgia; mso-bidi-font-family: Georgia;”><span style=”mso-list: Ignore;”>3)<span style=”font: 7.0pt ‘Times New Roman’;”>    </span></span></span><span style=”font-size: 12.0pt; line-height: 107%; font-family: ‘Georgia’,serif;”>How do you practice assessment with memory care / cognitively challenged residents?</span></p>
      <p class=”MsoNormal”><span style=”font-size: 12.0pt; line-height: 107%; font-family: ‘Georgia’,serif;”>David Brinker, 8/14/19</span></p>
      <p class=”MsoNormal”><span style=”font-size: 12.0pt; line-height: 107%; font-family: ‘Georgia’,serif;”> </span></p>
      <p class=”MsoNormal”><span style=”font-size: 12.0pt; line-height: 107%; font-family: ‘Georgia’,serif;”> </span></p>

    • #5199

      Jennifer Gingerich
      Member
      @JenniferGingerich

      Hi David,

      Unfortunately what you posted is coming through with lots of gobbledy-gook – for example:

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      I’ll see if Lindsay, the course administrator, can give some guidance on what might have gone wrong.  I don’t know if you have to type directly in the forum page rather than copying from a Word document?

      I look forward to reading it when it comes through as you intended!

      Jennifer

    • #5200

      Lindsay Spencer
      Keymaster
      @LindsaySpencer

      David, Jennifer is correct. Unfortunately your post looks like code. This forum doesn’t do well when you copy and paste from Word for example. You will need to manually retype your message in the box.

    • #5201

      Jennifer Gingerich
      Member
      @JenniferGingerich

      I am seeing now that you have posted in the Introductions theme as well – I’m guessing that is the same text you posted here, so I’ll respond to you there!

    • #5220

      llawhon
      Member
      @llawhon

      I was out of town over the weekend some I’m just getting caught up with you all today. In reading the week one material I would like to reflect a moment on material from the “Context” section of the SOP for chaplains in LTC. It is very unique work we do in at least two ways. One is because of the residential nature of the setting, we are basically working in their homes, or at least in the neighborhood so there are frequent opportunities to check in with folks, or for them to stop us for whatever reason. To have this regular contact with folks often lends itself to doing a bit of a spiritual screening. There may not be time to assess a situation but we do, or at least I feel that we do, get to see, talk to, and hear from folks regularly so we might gain ongoing insight from their journey through grief, just as an example. The other unique aspect is that we sometimes work with people for years, walking with them through all sorts of situations, good and bad. In some ways we’re like a congregation’s pastor who does, as Dr. Oates would say, walks with people through the “crises of their lives.” One thing that may not be captured so well in the SOP for LTC chaplains is how our work may require us to do screenings, assessments, plans of care, etc. related to a variety of times and events of our residents’ lives.

      Where I work there has been an effort several years in the making to bring Culture Change to reality with a very clearly stated goal of moving away from the medical model of care noted in the context section of our reading material and moving to person centered care. In our setting the residents who advocate for this talk about it this way saying that the goal is to move away from the staff being the experts telling or directing the residents and moving to the residents being their own experts telling the staff what they want or need. Those differing perspectives will be an interesting thing to look in light of the standards which call for a certain level of expertise from the chaplains. Of course we chaplains do have our own gifts, insights and expertise which we bring to the table so trying to find the right balance between offering what we bring to table to meet the residents at the point of their need/desires is an interesting opportunity.

      Our interdisciplinary team (IDT) is currently involved in looking at how Aging in Place fits into our setting of delivering care on any and all of the multiple layers of care involved in a CCRC. The tension seems to be around the view held by some residents that aging in place means they never have to leave their independent living apartment no matter how much they decline versus the practice of the IDT reviewing needs and recommending or actually facilitating a move to a higher level of care. I share what I have about aging in place and culture change because they are such a part the culture where I provide chaplaincy care it will interesting to me to look closer at the SOP in light of these parts of our culture.

    • #5224

      Jennifer Gingerich
      Member
      @JenniferGingerich

      Hi Larry, I’m glad that you brought the topics of culture change and aging-in-place into conversation with the articles.  These are not a big focus in my current setting, so I had not yet thought about how they relate to the standards of practice.

      It seems like encouraging the residents to express their own needs and wants could provide a good opportunity for spiritual care, encouraging them to name aloud ways in which they would like to grow spiritually, and what provides them support and comfort.  I think here the skill/expertise of the chaplain comes in as you guide that conversation with language and options, even helping them understand what you mean when you ask about their spiritual needs or preferences.  The basic screening or history may lead them to tell you that they are Baptist and like to attend worship services.  But then assessment happens as you get to know them better and learn about themes in their life or about how they respond to loss.

      As residents have to move between levels of care, you may be one of a couple staff members who might follow them and help their new care/service team get to know them.  And you are there to help them adjust to that change or loss.  As you point out, a big piece of the LTC chaplain’s role is being in community with the residents and staff, so you may also be helping to soften the lines between the levels in different ways.

      Do others have thoughts about how culture change in LTC or the chaplain’s role in community relate to the Week 1 readings?

    • #5228

      llawhon
      Member
      @llawhon

      It will be very important in the process to learn from the residents how they define spirituality and what religious or spiritual practices help them on the journey.  Jennifer you are right, that would come in the screening process.  The way I see it and experience it there is a challenge with finding the time to do a good early screening on which to build from.  Because our LTC work is, well, long term we may get multiple opportunities to have follow up conversations so learning to be more intentional in taking advantage of those times is key.  The more emergent situations will provide some opportunity for assessment of deeper needs and issues but even in these ripe opportunities time crunches can hinder that process.   As I go into a situation I’m learning to be more open to letting the resident or their family guide me and inform as to what they prefer in the situation rather than my assuming what is needed.  What a difference it makes when you have a good baseline from which to build.

    • #5236

      llawhon
      Member
      @llawhon

      In reading the paper on assessing spiritual well-being I have to admit it started slowly but did get some better for me as I read on.  I agree with the need for some kind of common language across the various disciplines in health care.  I appreciate the work that many are doing to help develop tools and resources to help with the need for better cross communication.   In this paper I appreciate the reviews of just what spirituality means.  As noted in the paper our field has changed, or is changing, from more religious based work to the more broadly based emphasis on spirituality.  I find it important for me to keep in focus that I am a Christian who is a chaplain and not so much a chaplain who is a Christian.  Perhaps subtle in some ways this distinction is still important to me.  What I have to be careful of is to not let this focus cause me to put my beliefs as a Christian ahead of the views, needs, and concerns of the resident.  One of the tools reviewed here which may be helpful to me particularly with screening is the FACT/Four Facts material.  I like that it is brief yet inclusive enough to gather helpful insight that can be built on.  Now the FACITsp material is brand new to me.  I like that it covers a bit broad scope of things and agree with the paper that even though it is set up for chronic illness situations it could adapted otherwise and because it covers 7 days it would a good tool to come back too in a about a week after an initial screening.  As usual, there is more learning to do when given a new tool to use but I like the idea that in a LTC setting where we do have more chances to build over a period of time its good to the various tools which can be used to do the building.

    • #5246

      llawhon
      Member
      @llawhon

      I found the article on the spiritual needs model article and the accompanying assessment tool to be interesting.  It is acknowledged quite early in the article that it is broadly understood that a consensus definition of spirituality is needed.  To me, the task of defining spirituality in a broad sense is daunting because the various beliefs and practices that are found in most communities have their own particular sense of spirituality.  These differences reflect broader views of spirituality, such as Christian vs Jewish vs Muslim, as well as differing views within those broader views such Baptist vs Catholic views.  Besides these various differing views you have to also account for the individual, personal differences or nuances that each person may hold.   The assessment tool holds some potential for helping to move our interventions closer to understanding what the individual wants, needs, believes, or practices.  Of course it starts with the individual and they can help move the conversation into those broader areas and how they influence the individual or what the individual needs from those sources.  If I’m not careful I will start with where the individual comes from  and assume that that background might influencing their situation today so this tool will help to get things better focused on where the individual is today, right now rather than on what from their background may not be so important now.

      One thing I question in the assessment tool is the placement of “The need to maintain control” under the “Values” heading.  I just had a conversation yesterday with a gentleman who is about turn 100 and he is really grieving all that he has lost or has had to give up or curtail in his life due to aging limitations and particularly due to a stroke at 98 years.  He feels that life has lost much of its meaning and as we talked it seemed helpful to him to be reminded that he still can make some very important decisions, dietary for example.   He has given up or lost so much that the ability to make the decisions he can make will seemingly be a source of meaning for him.  Yes, his decisions will reflect his values but perhaps values that is what is important to him at 99 years, need to be understood first as a way of helping him to find meaning.  At any rate, I do think that the tool has some potential value and I will be looking at how it might be utilized in my current LTC setting.

    • #5251

      Jennifer Gingerich
      Member
      @JenniferGingerich

      I appreciation your thoughts on the SDAT, Larry.  You make a good point that maintaining control can be a reflection of where we find meaning.

      I might not have thought about including a sense of control within a definition of spirituality/spiritual needs myself, but I like that including this aspect reflects what is really a concern among older adults and others who find themselves within the healthcare system.

    • #5263

      Orlow
      Member
      @Orlow

      Hi

      Thanks so much to all of you for jumping right in and engaging with the material.

       

      I am sorry I did not get this out earlier.  I have been really intrigued by the material and making notes, and

      stopping to have a lot of thoughts about my practice and perspectives on chaplaincy through the lens of these readings.

       

      Lets start with I really have appreciated the stimulus.  I have been at this one position for 23 years.  I thought this was a

      good time to take a course from Oates; and what better one at age 66 than Spiritual Care in Long Term Care: Best Practices

       

      I will start with a few facts.  We have the electronic health record, EHR, and I have full access to it.  This really helps me get a

      full picture from what my colleagues are writing about the resident; involvements, struggles, challenges, responses, etc. In addition

      we have three times a week a Leadership meeting where the care of the residents is the major focus; questions and plans are discussed

      there.  We also have after admission of the resident an initial care conferences with the full IDT and doctor.  This is six weeks in.  As well

      we can hold a conference anytime and especially if the resident has been moved to Palliative; the EHR prompts each of us to respond to

      this change by standard responses specific to our profession.  In my case this means a mandated meeting with the decision maker, the resident

      or other to discuss what this change means to them, how they are responding to it, what support they need, how this challenges or informs their

      spirituality.  This is also the time to discuss final plans and continued constant support for the resident and family and staff during this time.

       

      I have more comments, much of which will just reiterate what has been said.

       

      In the interest of self care I will head home now.  I’ll get back to you first thing tomorrow.  I have taken notes so I hope to be

      concise and helpful.

       

      Thank you so much for this first week.   Orlow

    • #5267

      Orlow
      Member
      @Orlow

      Hello

      I agree that the good part of the article is about the definitions.  I find that often, having 269 residents I can be lulled into doing the screening for a crises or for important information about the resident, and a decent history, invite them to those activities which they want to attend and then shift into neutral.  Part of this is because we have about 100 deaths a year and I am doing end of life care and then doing the above all over again.  As was said I think by David, having students involved can help bring a better spiritual assessment which we would do together plus involving the resident.

      I mentioned this to a colleague who knows me and my situation well and she was wanting to say the assessment and intervention are happening but are not as intentional, professional and documented as I would like.  This is probably a fair assessment of my situation.

      On page 174 of the Drummond article at the bottom is a listing of five ways in which religious spirituality contributes to the promotion of health and the patient care environment.  This list reminds me a lot of my daily reality in caring and providing support and care to the residents, families, staff and volunteers.

      For me over the years the challenge has b4een to not smoothly slide over the deep things, but to try and make the connections to what is going on in peoples lives and help them see, discover and explore what the paper quotes Larty listing as the dimensions of spirituality.  I like to find questions or observations which allow the resident to make those connections for themselves.  In the moment these interactions can feel kind of deep, allowing a type of rudimentary theological reflection.  Especially with my students (and anyone who will listen really) I like to brain storm ways we might ask a question or make a comment at a particular point in the visit which allows a focus on meaning, values, the experience of God, illumination of a sacred/secular text which will allow some focus; which the resident may find helpful.  As I see Larty, the word relationship comes up.  This is central I believe in all our connections; build on and grow in relationship–to self, others and the transcendant.

      I like re-reading the standards at least three of four times a year.  They keep me grounded, focused, and questioning how I would further develop an area of weakness or need in the ministry.  I often am inspired to do a search for more information on an area and have thus been able to grow in this way.  This is how I discovered Oates several years ago.

    • #5268

      David
      Participant
      @Chaplain Brinker

      You wrote: ” I like re-reading the standards at least three of four times a year. They keep me grounded, focused, and questioning how I would further develop an area of weakness or need in the ministry. ”

      What a great idea. I am going to start this practice as well. Do you have annual evaluations and written goals each year? I do and find this reveiw with a supervisor helpful, even though I am the one who makes the majority of the goals for myself.
      David

    • #5294

      Mark Pedersen
      Participant
      @markpedersen

      Hello Brothers and Sisters in ministry,

      After reading the minimum standards and the different types of spiritual assessments that are used in Nursing homes or long term care facilities I was interested to know what the three nursing homes in my small East Texas town use and the name of their chaplain.  The nursing homes rely on the community pastors (who come in on Sunday afternoons to lead worship) instead of having an actual chaplain!  I have been in ministry for 30 years and this is very common in small Texas towns.

      Each long term care facility has at least 40 residents.  I feel led to try to help create some type of standard in these facilities that every pastor that visits can use.  Does anyone have any suggestions on where to start?

      Pastor Mark

    • #5298

      Jennifer Gingerich
      Member
      @JenniferGingerich

      Hi Mark, if you would be willing to share  your email address (I think you can message me by clicking on my profile picture), I would be glad to share a couple outlines for presentations I gave in a ministerial association meeting and for one congregation’s pastoral care committee about visiting in a nursing facility.  These are more practical suggestions and some education about dementia rather than specifically geared toward spiritual care.  You could also develop a resource yourself using some of the suggestions in the Elledge-Volker article from Week 2 of this course.

      I do think that it is just as common for local pastors to share responsibility for a nursing facility’s services/pastoral care as it is to have a chaplain.  Here in Louisville, generally the church-related homes have chaplains, while the for-profits do not, with the exception of the Signature facilities.  Medicare and Medicaid, which provide the majority of the income for most nursing facilities, do not reimburse for spiritual care.  And usually budgets are very tight.  Organizations that provide chaplains have to make a strong commitment to spiritual care and often fund the positions through donations from churches and individuals.  That’s also why some of the participants here in this course are tasked with caring for 200+ residents.

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