The Million Dollar Survey

Chaplains will have an impact on Medicare reimbursements with their provision of spiritual care. Since CMS is placing a high degree of importance on the new Hospice CAHPS Survey, it behooves every hospice Chaplain to look at the Survey to find out what is being evaluated by the surviving family member(s) who complete the Survey. If the results of the Surveys are not good, it could cost a hospice of our size (1,000+ patients) a 2% decrease in reimbursements or over 1 million dollars. So, what’s in that Survey that a Chaplain should be concerned about? The primary question the family will answer is #36: Support for religious or spiritual beliefs, including talking, praying, quiet time, or other ways of meeting your religious or spiritual needs. While your family member was in hospice care, how much support for your religious and spiritual beliefs did you get from the hospice team? The family will answer one of three ways: Too Little, Right Amount, Too Much. Please do not think that because the final 3 words in the question #36 end with “the hospice team” that it excuses the Chaplain from responsibility. As the Chaplain the family will be looking you for direction and effective spiritual support during their loved one’s and their journey in the hospice experience. Other than providing spiritual support for the patient that is loving, encouraging, and compassionate, how can a Chaplain positively impact the family? Particularly for facility patients (LTC, hospital, and hospice house), the family members are not always present when a Chaplain visits. However, the Chaplain has access to the Primary Care Giver’s telephone numbers. After each visit with the patient, the Chaplain will place a phone call to the PCG informing that person of the visit and will express sincere concern for the PCG by asking, “And how are you?” Chaplains, this is a million dollar survey. While we have a small part in it, it is a vital part. Do your hospice ministry and by all means, be sure to include a phone call to the PCG and document it.

Our biggest day!

Yesterday was our biggest day. Hundreds of guests logged onto Embraced. Welcome! Please use this site to enhance your understanding of hospice chaplaincy and use the concepts and best practice principles to grow professionally. Your comments are also welcome and are a source of encouragement. Blessings!

3 Pitfalls of Value Judgments--Leadership Tips

Before I attempt to assign the 3 pitfalls, let me define what a value judgment is. A value judgment is an assessment that reveals more about the values of the person making the assessment than about the reality of what is assessed. In any value judgment there is the assumption that the person making the judgment knows all the facts, which they don’t. Yet, when a person with a title makes the judgment, the person who was assessed as deficient is pigeon-holed with a reputation he or she cannot shake. That is a shame, but it is the reality. This happens for some reason a lot in hospice work as leaders and team members work through their day to day challenges. The 3 pitfalls include: 1. An unfair assessment of an IDT member’s worth based upon a snapshot of time in an IDT meeting. When a value judgment is made about that person, it is quick like the cutting of a vegetable with a razor sharp knife. A value judgment disregards what the person is going through at the time and disregards one of the key elements of an IDT meeting. That element is safety. In an IDT the Team comes to work but a team also comes to care for its own. Value judgments take that aspect of the Team off the table and relegate people to robots. Not a good thing. 2. Value judgments cultivate a shallow view of people. It takes no time at all to decide whether someone is good or bad at their field work based on a Team member having a bad day. Shallow leadership is unhealthy leadership and unhealthy leadership is damaging to the organization and leads to recurring employee turnover. 3. Value judgments create instability on the IDT. It doesn’t take long for Team members to pick up on the fact that their leader thinks little of them. Again, a value judgment neglects the outstanding work a Team member may do in the field with patients and families and focuses on a small portion of time with that worker. Morale suffers when workers believe their leader think so little of them. A key value of leadership is to know one’s Team, to know the individuals on the Team, to know the issues they face at work and elsewhere. If the worker was hired because of excellent skills then that worker must be given the opportunity to be human from time to time. To pigeon hole a worker without knowing that person is exceptionally unwise. Beware then of falling into the trap of making quick, unfounded value judgments.

Assuming the Burden…

What burden is the hospice Chaplain to assume? There are many burdens hospice Chaplains like every other type of Chaplain assumes. Most are personal and independent of chaplaincy. The topic to which I am referring is hospice oriented only. What burdens do patients carry when they are in hospice care? If they are lucid and able to communicate, we may learn they carry burdens related to relationships, the need for reconciliation, fear of dying, the afterlife, and concerns for the welfare of their loved one after they die, to name just a few. They come to us with these burdens. Best practice in chaplaincy means the Chaplain is able to listen and identify these burdens and be a part of the healing ministry that supports the patient through the hospice journey. What burdens do the patients’ loved ones bear? Their burdens can relate to anger with God, wrestling with the “why” of it all, the need for reconciliation with their loved one, it might mean reconciliation with a clergy person or faith community as a funeral looms in the immediate future. How do these burdens find relief and lifting and what role does the Chaplain play in all of this? Let me answer this question by providing a bulleted list that hopefully gives a starting point for the Chaplain to begin. • When providing care for a patient who is lucid, the Chaplain uses the power of active and reflective listening. Giving the patient a Safe Haven, as Bowlby suggests, is a great starting place. It may be that the patient before the Chaplain has never unburdened his or her soul to anyone and now that death is near, the time may be ripe for this to occur. • When providing care for a patient who is minimally or non-responsive, the Chaplain may find him/herself in a quandary as to what to do next. Best practice answers the quandary. After the Chaplain provides spiritual care for the patient, the Primary Caregiver is contacted by phone and a brief summary of the Chaplain’s visit is provided. The Chaplain always thanks the PCG for the privilege they have given said hospice organization to provide care for this patient. Leaving a business card and not contacting the PCG after the visit adds an additional burden to the PCG to contact the Chaplain. If you think about it, why would you even think for a moment of adding an additional burden to an already burdened person? Is that not a form of arrogance rather than servant-hood that suggests that if they want to speak to me, then they can just call me? The Chaplain is to exude a servant-mindedness. Expecting a burdened family member to contact him or her is just not a good mindset. And, really, that is the point of this article. The Chaplain communicates his or her attitude with body language and tone of voice. The Chaplain’s attitude conveys all the family member(s) need to hear. If you leave a card, great. But, make the phone call. It’s just Best Practice, plain and simple.

3 Ways to Take Initiative

A Hospice Chaplain is a difference-maker. Being a difference-maker, however, doesn’t happen all by itself. Difference-making takes place when there is activity involved. In reading Forbes: Entrepreneurs I came across this article: “How 'Difference Makers' Think -- The Single Greatest Secret to Personal and Business Success”. (http://www.forbes.com/sites/groupthink/2013/06/04/how-difference-makers-think-the-single-greatest-secret-to-personal-and-business-success/) A portion of the article reads: A comprehensive set of new studies from OC Tanner Institute (including research we’ve conducted with Forbes Insight that we’ll be issuing shortly) shows a fundamental shift in the mindset of people who achieve groundbreaking results. The mindset is this: Great difference makers shift from seeing themselves as workers with an assignment to crank out, to seeing themselves as people with a difference to make. You, Hospice Chaplain, have a difference to make in the life of each of your patients and their family members. It is your calling. It is your destiny! Here are 3 ways you can make a difference by taking the initiative. I am sure you can think of many more, but consider these thought-starters. 1. Make a difference in the life of the patient. a. By actively listening. b. By a non-anxious presence. c. By advocating for them and their needs in a long-term care facility, home setting, or hospital. d. By assisting them to finish life well. 2. Make a difference on your IDT a. With your encouraging words and positive presence b. By helping without being asked to do so c. By working with your leadership to solve problems 3. Make a difference in your Inpatient Units. a. Do not wait to be told to do something. Take action: Meet, Greet, Move boxes, Do what is necessary, but do the unexpected. b. Support the staff with special seasonal rituals. c. Support the patients and families by giving extraordinary care. Chaplains who take existing job expectations—or job descriptions—and expand them to suit their desire to make a difference find great satisfaction and do great ministry for their patients/families and their company. Do what’s expected (because it’s required) and then find a way to add something new to their work. Do something that delights, something that benefits the souls on your caseload and those who work with.

Best Practice for Chaplains Serving in LTC Facilities (excerpt from the Handbook)

Basic Practice in Chaplaincy 1. Make contact with each new patient on your Team. You have a 5-day window to contact each new patient. Document each phone call in Allscripts. 2. Complete the Initial Spiritual Care Assessment. Document this in Allscripts. 3. Documentation of Initial and Routine visits will be completed the day of your visit. If the visit is late in the day, you have 24 hours to complete the documentation. 4. Synchronize in the morning and evening of each work day. 5. The following provides a primer on functioning with best practices in the facilities. Please keep in mind that each facility has its own nuances. Your professional presence will assist you to comply with the nuances of the facility. Checking In 1. Upon your arrival at the facility, check in at the front desk. Explain who you are, who you represent. Have your badge prominently placed on your blouse or shirt. 2. Ask for the room number of the patient(s). 3. Thank the person who assisted you. Entering the Patient’s Room 1. Remember that the patient’s room and bed are their personal space while they are in the facility. a. Knock before entering the room or, even, on the wall near the bed before crossing the line of a curtain that defines that patient’s particular area. b. If the curtain is completely drawn around the bed, speak outside the curtain and be sure you have the patient’s/family’s permission before stepping inside the curtained-off area. c. Announce yourself by name, with Cornerstone Hospice, and role and ask if it is OK to come in. For example, “Hello, my name is Rich; I am your Chaplain with Cornerstone Hospice. May I come in for a moment?” d. Respect for the humanity, privacy, and situation of each patient and the patient’s family are essential to what we do. Positioning Yourself in the Patient’s Room 1. Position yourself in a sensitive manner. a. Examples, depending upon patient and situation:  If the patient is at all physically exposed because of gown, equipment, etc., seek a facility staff member to cover patient. Do NOT do this yourself.  Perhaps the patient is hard of hearing; position yourself and speak clearly to maximize the patient’s ability to hear you and/or read your lips.  Perhaps the patient has a sight deficiency; position yourself accordingly and use your voice and/or touch to ensure the patient knows you are there and that you have identified yourself, as the patient may not otherwise be able to recognize you from a previous visit.  Sit in a chair, if possible, so that you are eye-level with the patient; however, do not immediately sit, because that might signal to the patient that you intend to stay for a while – make sure you have determined with the patient/family that an extended visit at that time is appropriate and welcomed. (Do not sit on the bed.) If the Patient Indicates He/She Does Not Wish a Visit 1. Do not stay if the patient does not desire a visit. We do take “no” for an answer! 2. Leave a Spiritual Care Services brochure with them for further information and later contact. Touch 1. Be cautious with physical touching. a. It is often natural for us to want to touch a patient: To hold hands or place a hand on the head, for example, while praying; b. To lay a hand on an arm or shoulder as an expression of comfort or reassurance. 2. However, touch can be a “touchy subject”. a. The patient may be in physical pain that even a little pressure might exacerbate. b. The patient’s personal history and/or personal temperament may make touch unwelcome or threatening. c. The patient may misunderstand the intent of the touch, especially if their condition in any way decreases their understanding and perception. d. Whenever possible, if you wish to touch a patient, ask the patient’s permission first. What We Do and Don’t Do 1. Remember, we emphasize listening. Our first concern, always, is simply TO BE WITH patients/families. o To listen. o To let them lead any conversation where they want/need it to go. o To be a quiet presence, if that is what is needed and possible. 2. We seldom or never:  Give advice.  Try to convince anyone of anything.  Proselytize (try to win converts to our religious beliefs and communities) – this one is a NEVER. Communicate with the patient’s faith community to provide a pastor, priest, Imam, Rabbi, or other religious leader to assist with your work with the patient. 3. We may pray with patients/families. a. We will pray:  If they request it.  If they agree to our suggestion/offer to pray.  After clarifying if they want us to pray with them, then and there, or for them, in our own time, perhaps back in the sanctuary.  After clarifying what prayer means to them and what style of prayer is appropriate for them. (We do not assume prayer using a particular religious form or language, unless it is clear from the patient/family that is what they want and expect and if we ourselves are comfortable with that kind of prayer.)

Commentary on Chaplain Qualifications

It is almost comical when I read qualifications for Hospice Chaplains. 1 Unit of CPE, Bachelors Degree, 1 year of experience in pastoral care...Seriously? What exactly are you expecting of this person you call Chaplain? Have you no idea what issues a Chaplain will encounter? Are you not aware that Hospice CAHPS will determine your reimbursement? Even with our high qualifications we spend time training our Chaplains to provide excellence in spiritual care. We assume nothing and seek to build a team of Chaplains that will make a difference in the life of the patient and their families. The issues hospice Chaplains face require experience and skill. Makes me wonder if the lack of qualifications is simply a financial issue rather than anything else. Something to think about when the results of the CAHPS come rolling in.