By Lauren Marsh, MAR
What a gift I have been given! As a staff chaplain, I have had years of offering spiritual care for patients and families in many settings; acute care, home care and currently long-term care. Most of my time has been between home care (10 years) and long-term care (seven years). My intent here is to give some examples of advantages and disadvantages of ministry in these two settings as well as to surface some of the challenges chaplains and patients may face along the way.
Clearly, in long-term care, there is the advantage of more time to spend with patients and residents. This ultimately allows for deeper, more personal pastoral relationships between the chaplain, patient and family members. Usually there are many spiritual and emotional issues for long-term residents upon their arrival to the facility. Issues dealing with fear, loss and anxiety are prevalent. The good news, though, is that the chaplain can journey with the residents as they process these emotions and feelings. In this setting, chaplains get to know each resident rather well – their interests, hobbies, life work, values and beliefs. The chaplain can encourage residents to reflect on their lives and redefine meaning and purpose for their future living in a long-term care senior living community. For example, residents participate in joint activities to accomplish a common community mission, such as raising a community garden or organizing a welcome wagon committee for new residents. Some of these activities are instrumental in the patient’s adjustment to living in a new facility or senior living community.
The long-term care facility where I work also has a rehabilitation unit. Many patients are admitted for a short rehab stay, but sometimes they are admitted with terminal, chronic conditions that prohibit participation in the therapy required for rehab. Many insurance plans cover some or all cost associated with rehabilitation as long as the patient is making good progress. A good number of these patients are too sick to return home and yet too sick for rehab. This becomes a difficult situation as most patients and families do not have the funds to pay privately for their stay when insurance no longer covers the charges.
Many people receiving home care while living in their own homes have expressed to me their feelings of isolation and depression. Sometimes they exhibit anxiety if family members are not available to be present around the clock, especially as patients become more dependent on others. Of course, each patient’s home life is unique, some with lots of family and socialization and others with less. In comparison, a patient’s anxiety level in long-term care can be relatively high upon admission, but later subsides as they become familiar with staff members and come into a trusting relationship with them. It seems to me the social setting in which patients live has enormous impact upon the quality of their lives. In the long-term care setting, patients have many staff and other resources close at hand when needed, whereas in home care these resources are not as immediately available. Chaplains, social workers and other healthcare staff play significant roles in the spiritual and emotional well-being of patients and residents. Patients who find meaning and purpose in a safe environment, in the midst of their medical diagnosis, seem to have a relatively good quality of life and cope better with their illness.
In both settings, the consistent challenge I face with patients is that many do not seem to know or understand their diagnosis and prognosis. There may be various contributing causes. This lack of information creates challenges not only for chaplains, but for other healthcare staff members as well. The physician is the member of the healthcare team who gives patients their diagnosis; other healthcare staff members are prohibited from providing this information to the patient even though they have knowledge of the diagnosis via the medical record. Given this circumstance, the patients and families find themselves in quite a dilemma as they attempt to make future healthcare plans together with staff with rather limited medical information. My hope is that physicians will have better, easier access to chaplaincy services in the future, even as they deliver healthcare in their medical offices and practices.
Chaplains are patient and family advocates who can be helpful in guiding patients through the sometimes overwhelming processes in our healthcare facilities and systems. It is truly an honor to journey with patients, residents and families during these vulnerable times in their lives.
Lauren Marsh is a chaplain at Mercy Health Schroder in Hamilton, OH. Mercy Health Schroder is a part of the Mercy Health System and Catholic Health Partners in southwest Ohio.