By David Lewellen
Home healthcare and senior centers that want to serve the whole person are also beginning to include spiritual care in their services.
Chaplain Karen Nehls recently retired from Community Care, a PACE model organization in southeastern Wisconsin. Her spiritual care, whether at the group’s facilities or on the road in clients’ houses, was part of the integration of all aspects of care for the senior population who need some help to remain in their homes.
The organization runs a day care center during the week and offers medical service, meals, van transportation, laundry, and basically “everything but surgery,” Nehls said. And that long list, for the past nine years, has also included spiritual care. “We would see them before the hospital, when they’re in the hospital, after they’re discharged to the nursing home, and in hospice,” she said.
The care team meets in the morning to discuss the caseload, and after that Nehls was usually in her car, on her way to see her first patient. In addition to the morning or evening visit of a nurse assistant, a chaplain is in a position to offer some extra attention, and can also learn from the home environment and support family and caregivers, if needed.
Toni Kesler, the palliative care and ethics manager for Community Care, said that the organization did a study years ago that showed that “especially for the older population, spirituality is part of their life, and something they need to do their life’s business.” That was the impetus to create the position that Nehls filled; the organization now has two full-time chaplains, including one fluent in both English and Spanish.
Nehls’ caseload, largely losing mobility, was sometimes in danger of losing their connection to church, so in a sense she could bring church to them. Many patients form a relationship with both the chaplain and the pastor of their home church. In one case, Nehls said, she visited on Tuesday and the pastor of the patient’s Baptist church visited on Thursday, “and he said that we each gave him something different.”
Sometimes, patients who were unreligious or unchurched would request visits. “It’s awkward, because you can’t pray,” Nehls said, “but you look at what else gives them spiritual comfort.”
“I found it very fulfilling,” Nehls said. “I grieved more when they died. It was easier to do funerals and to console the family.” She had a typical ongoing caseload of about 100 people, seeing them anywhere from monthly for more casual relationships to twice a day for someone dying in hospice. “It was a lot of time in the car by myself,” she says. “I could reflect while I was driving and prepare ahead.” Sometimes, she’d have “someone dying in Racine and someone dying on the north side of Milwaukee, so there was a lot of going back and forth. … There was so much unexpected or surprising — you had no idea what direction the day was going to go.””
Nehls’ first career had been as a nurse, and working as a mobile chaplain became “an extension of what I would have liked to do more as a nurse.” She would encourage her spiritual care patients to do legacy work, to go through their life, ask what is important to them, write letters to important people in their lives.
While keeping herself busy in retirement, Nehls has been volunteering for the Red Cross and suggesting that that organization do more. Although the Red Cross values its neutrality, she pointed out, “We really don’t do religion. We ask questions and follow up.” Eventually, she hopes, even local Red Cross chapters might have a professional spiritual care component for small-scale disasters, such as working with families who have lost their homes to fire.
Kesler said the PACE model is spreading, but programs don’t always offer spiritual care at the start. But as they grow, they find that “spiritual needs are as important as physical, mental, and emotional needs.” A program that offers palliative care, she said, should automatically include a spiritual component: “If they’re going to die in the program, we have to have the means to meet their spiritual needs.”