After Having Made More than 200 Written Inquiries to Healthcare Facilities in 4 counties in Central New York, My Conversations with Persons in Charge of Pastoral Care in Their Institutions Have Been…SHOCKING!
Since the late 80’s volumes have been published on the subject of the importance of spiritual and emotional care to patients in crisis, patients with chronic conditions, patients and residents in long-term care facilities. Much has been written about the positive effect of competent pastoral care and emotional/spiritual support palliative care and the hospice movement. Surveys, empirical and evidence-based studies and research have provided the methodological and statistical and scientific support showing that pastoral care, spiritual and emotional support is sought by patients, has positive effects on outcomes, complements the medical/technological/physical care and treatment provided, and is an integral part of multidisciplinary, interprofessional, holistic health care. The data’s there, the vangards are promoting the good news, but healthcare administrators, CEOs, COOs seem to be missing the bus on this issue. Where have they been for the past 20+ years, one has to ask?
Well, there are a number of reasons for the failure of administrators and executives to have missed the message. Yes, they claim to attend conferences and workshops and seminars on every conceivable subject, but they are worlds apart from the wards, the dramas that play out on a moment-to-moment basis, the writing and sealing of living, human documents. These executives rarely, if ever, seek the honest inputs from those in the trenches, and are highly unlikely to be aware of complaints when they are made. Seems they’re too important, too busy taking care of business and relegating human care to the foot soldiers.
That’s the impression I have gotten from two rounds of inquiry with almost 200 hospitals, nursing and rehabilitation centers, and funeral homes. Yes, funeral homes. You’d think that with the hospitals and nursing homes dropping the spiritual care ball, the funeral homes would pick up the pieces. But not at all. The funeral director is in the business of selling services, too, and once the remains are out of sight, Job’s done! Pay up and go forth and grieve!
The bottom line is: The preliminary findings is that most healthcare institutions do not have a pastoral care program or even anything close. They continue to bring in visiting clergy, questionably fit lay ministers, untrained inexperienced volunteers and put an untrained unqualified person in charge of the “pastoral care services.” It’s pitiable but it’s true!
The saying goes: “You can lead a horse to water but you can’t make it drink.” But what’s mind-boggling is that the horse knows it’s thirsty and when offered water still refuses to drink. Go figure!
An Illustrative Case
I received a call today from a large healthcare system and had the opportunity to discuss pastoral care, spiritual/emotional care with the VP, marketing and public relations. That may seem like a real opportunity but I found it a bit odd that the hospital administrator directed my letter regarding continuing quality improvement and pastoral care to marketing and public affairs. Nevertheless, I ran with it. I wanted to see where this was going to go.
What I learned from the conversation with the VP, a woman who admitted not only to being VP for marketing and public relations but also to being supervisor of volunteer services, including what she thought was the pastoral care program, as well as overseeing several other ancillary services. Red flags went up. These people don’t have a clue!
This was no small fish. CMH is a general medical and surgical hospital in central NY, with 258 beds. Survey data for the latest year available shows that 32,764 patients visited the hospital’s emergency room. The hospital had a total of 6,755 admissions. Its physicians performed 1,206 inpatient and 2,776 outpatient surgeries. Outpatient visits: 309,767, Births: 518. In fact, with its satellite outpatient and long-term care facilities it is likely one of the largest healthcare institutions in at least two central New York counties.
The conversation got off to a rather deplorable start when she assumed I was ignorant of the healthcare setting and commenced to describe how when a patient is registered s/he is asked about religious preference. “If the patient wants to give that information s/he can but if they don’t, well, they don’t.” (That’s the extent of their spiritual screening, assessment, etc.) She proceeded to tell me that the information they do harvest goes into a list … Here I had to interrupt her and tell her that I am familiar with the usual hospital routine and the hospital census as well as HIPAA provisions regarding access to the hospital directory. Shall we move on, please?
I’d rather not describe the entire discussion. Suffice it to say that it was rather typical for most institutions: abominable ignorance about what a pastoral care program is or should be, reliance on unqualified or poorly qualified, part-time staff who provide spiritual care (for example, the spiritual care coordinator is an English teacher, but she “does have a MA in English.” And her spiritual qualification? She’s married to a pastor. That’s like having my physician’s wife, who has a MA in Art, do my colonoscopy! Breathtaking!)
This organization also has a pastoral care coordinator who “contacts and follows up with commuity [visiting] providers.”
And what training or inservices to you provide to staff and providers? “Rabbi F. from the large local Hassidic community comes in and talks to staff about religion, diet, etc.” Well, that’s a comprehensive program if I ever heard of one!
I mention HIPAA, the Joint Commission scoring categories for pastoral care and spiritual and emotional support, and the Title 10 NY code regarding spiritual and emotional support to customers. “We’re not accredited; we do what NY law requires.” Appears that CMH is not JCAHO accredited and the VP, Public Relations & Marketing didn’t seem to think that incorporating or applying industry standards was important. Au contraire, mon amie!
This is where my conversation partner starts to get defensive: I ask whether any of these people have any training in theology, pastoral care, divinity. “No.”
But this raises not only the question of what on earth are these off-the-street amateurs offering to patients in spiritual and emotional crisis but also the question of the ethics of offering healthcare (Yes! Mabel, pastoral care is healtcare and the professional chaplain is considered to be a healthcare provider. Read the regs!) by untrained, incompetent persons. This question follows on the heels of my VP friend responding to my question about ethics training for pastoral care associates by telling me, “We have an ethicist on staff. And we have an Ethics Committee of about 20 people, I’m one of them.” Omigod! We’re doomed!
By this time I realize that this woman’s defensiveness is escalating and she’s not hearing, not listening, and is begging to get off the hook. Finally, I opt for mercy and suggest that I send her some extracts from my Continuing Quality Improvement and my Standards of Practice for Pastoral Care, and that she review them and get back to me when convenient. (The relief on the other end of the line is audible, almost palpable.) So, I thought I saved us both the agony on continuing the conversation in a language one of us didn’t understand.
My initial reaction was sadness that such ignorance would prevail in the institution and, by extension, to its satellite and affiliated healthcare facilities. (In fact, I did a year of supervised pastoral formation at one of their nursing homes and can attest that the problems are system-wide in this organization. There pastoral care (religious/spiritual/emotional support) was run by the activities department!)
As soon as I mention that I have observed that CMH is in the same boat as most other institutions in the area: No clue what pastoral care is nor the impact on quality that such a service deficit might have, I hear the tone and the mood change. I ask myself, “Why are you contacting me? Is it just to tell your CEO you spoke to me as requested? You’re not interested one iota in pastoral care nor in what your customers need!” Yes! That’s the impression that was made on me.
Do you have similar experiences? Please share them with us. In the meantime, I’ll keep pluggin’ on. Remember: We are sometimes the only advocates for those suffering and we have a sacred duty to be a voice for them. Peace!