Best Practice for Providing Care for Patients in Long-term Care Facilities at Thanksgiving

The patients we serve in LTC facilities include: memory care patients, ALF patients, and independent living patients.  Usually, at Thanksgiving the memory care patients go home for the holiday or the family comes to the facility to be with their loved one.  The facility provides the meal which his pureed.  In the ALF and independent, we follow the protocols for providing care for home patients.  (see below)

Collaboration between the Chaplain and Social Worker is the key to serving the patients who will be alone.  Use the IDT for initiating planning sometime in October and finalize early in November so effort is focused on the patient and not the plan prior to Thanksgiving.

 

Patients at Home—(Going the extra mile for them)

For patients still living at home Thanksgiving can be anything but a happy holiday.  The circumstances of the patient and why they are alone at this holiday come into play in your pastoral care.

v  Are they alienated from their family members?

v  Are they separated due to distance from family members?

v  You probably have broached the subject of family issues with them.  Thanksgiving will bring emotions to the surface weeks before the actual holiday.  Employ listening skills.  They are not looking for you to fix things.  Provide the spiritual and existential support they need.  Your winsome and wise counsel will help them through the emotional pain.

v  If they cannot provide a meal for themselves and would be open to it, collaborate with the Social Worker as they have a concurrent program to provide meals for patients.

v  Provide a card, if possible.  Some faith communities make cards for “shut-ins” and if appropriate ask for as many as needed.

v  A phone call on Thanksgiving from you or the on call Chaplain would provide support.

 

Best Practice for Providing Care for Hospice House Patients at Thanksgiving

The Chaplain will support patients and families at this holiday recognizing that all may be suffering emotionally not being together at home.  There are at least two scenarios:  the patient with a family and a patient with no family.  Each scenario requires that the Chaplain be aware of these circumstances and provides a compassionate and gracious presence.

The patient with family present for them

The following will serve as guidelines for Chaplains, even though, the experienced Chaplain may find these to be second nature.

v Employ inter-active listening

v Provide an empathetic pastoral presence

v Facilitate the actions the family would like to take for Thanksgiving. 

v Work with the Hospice House staff to ensure they are aware of what the plan is so they can assist.

v Bear in mind this will most likely be the last Thanksgiving the family and patient will celebrate together and let that truth dictate all you do.

 The patient who is alone with no family

o   Recognize we can’t fix circumstances, but we will do what we do best in providing a loving and encouraging presence for the patient.

o   Should the patient want to discuss the issue that he or she will be alone for Thanksgiving, provide an empathetic pastoral presence and use your best listening skills.

o   Plan for what you will do on Thanksgiving for these patients.  Most HH patients cannot enjoy eating anymore, but they do enjoy the presence of the Chaplain.  Be sure you see the patient to provide support.

 

 

Best Practice for Providing Care for Patients at Thanksgiving (general statement)

Patients at Home—(Going the extra mile for them)

For patients still living at home Thanksgiving can be anything but a happy holiday.  The circumstances of the patient and why they are alone at this holiday come into play in your pastoral care.

v  Are they alienated from their family members?

v  Are they separated due to distance from family members?

v  You probably have broached the subject of family issues with them.  Thanksgiving will bring emotions to the surface weeks before the actual holiday.  Employ listening skills.  They are not looking for you to fix things.  Provide the spiritual and existential support they need.  Your winsome and wise counsel will help them through the emotional pain.

v  If they cannot provide a meal for themselves and would be open to it, collaborate with the Social Worker as they have a concurrent program to provide meals for patients.

v  Provide a card, if possible.  Some faith communities make cards for “shut-ins” and if appropriate ask for as many as needed.

v  A phone call on Thanksgiving from you or the on call Chaplain would provide support.

I’ve been doing some thinking…

It’s been a while since I last wrote here.  Lots of reasons why—large staff to work with to train to be the best Chaplain corps in the nation; final prep for CPE launch (more work than I imagined, but have a great Senior Leadership Team to lean on); Connie’s surgery; actual launch of CPE, to name a few.

As I have been planning this unit of CPE, the topic of genograms popped to the surface.  What a revealing exercise for any of us!  I am literally looking at each descriptor of relationship mentioned.  The ‘fused relationship’ was one I wanted to explore more fully.  Some say it describes people who can’t live with or without someone else.  Man, what a conflicted relationship.  I came across some really insightful material that speaks to this.  Read on for your own edification.

One of the best tests of whether a couple is emotionally fused or not is how they handle conflict. Emotionally fused relationships often struggle to live in any sort of disagreement. Because individuals in emotionally fused couples define intimacy as “getting what I want” they will often listen only to those messages that make them feel loved. But as therapist David Schnarch puts it,

"Communication is no assurance of intimacy if you can’t stand the message. “Good communication” is often mistaken for your partner perceiving you the way you want to be seen or understood. “We don’t communicate” is code for “I refuse to accept that message—send me a different one! How dare you see me [or the issue] that way!” (from fire by fire, by Matt Anderson, http://www.conversantlife.com/relationships/when-emotional-fusion-happens)

As a Chaplain explores his or her most valued relationship, this concept has to be examined in some fashion.  Modeling healthy relationships goes a long way to validating our message of hope and comfort delivered with a non-anxious presence.

 

 

Vigils, Doulas, Saints and Angels

Vigils, Doulas, Saints and Angels...it’s hard for me to distinguish among these. 

A few weeks ago I had the privilege of leading part of a training event for our Vigil Volunteers (as we call them…others call them doulas).  I think saints and angels might be better.

 

What a group…Willing to go to the bedside of the dying at all hours of the day and dark hours of the midnight shift…soul-shaking commitment.

 

Who was I to try to tell them how to do their work?  It’s either in your heart or it isn’t. I have sat by the bed of many a person dying, no family, no friends, no one.  Dying alone doesn’t remotely sound inviting.  Heart cries out to heart, soul reaches out for soul…we need each other, particularly at life’s final moment. “I’m afraid.” “I feel cold.” “Does God really love me?” “Where am I going when I close my eyes?”  “Can you hold my hand, please?”  Then, silence…  Death is approaching.

 

Providing vigils with readings, methods, boundaries, and the like are necessary.  Heart is more necessary.  I can’t teach that.  I sat in awe as I read the “Loss Exercise” and watched this group weep over what they were choosing to lose when it came to their own health (as they related to the story in the Loss Exercise).  If you don’t have that piece, ask and I’ll send it.  Tenderhearted group.  I urged each to be sure they took care of themselves as tenderhearted people sometimes get lost in the chaos of life.

 

So, these are my thoughts on vigils, doulas, saints and angels.  The ground I trod that training day was surely holy ground…

Reflections on hospice care …

A dying person said to Cicely Saunders, “I am a traveler on the journey from one life to the next, and I need a place where I can be welcomed and looked after and cared for and be myself on that journey.” No, we do not have the power to control their illness or make it go away, but as hospice people we reach out with an outstretched hand, a listening ear, an understanding mind. Our kindred spirit helps to share their feelings, thoughts, and fears. We are an essential part of the road map of their daunting journey.

What a privilege and blessing to be part of the hospice team! Patients and families openly and honestly express their inner emotions so that plans of care will meet their unique needs.

 

On one hand, when the unfortunate, dismissive words are uttered, “There is nothing more to be done,” hospice is both death accepting and life enhancing. Hospice is not disease centered but patient focused. When cure is no longer possible, giving our utmost in care becomes the ultimate concern. Often when asked, “How can you work with people that are dying?” you probably answer, “You get more out of it than you give working with a great interdisciplinary team.” You understand the words of Ecclesiastes 7, “It is better to be in a house of mourning, than a house of fasting.” Confronted with the finitude of life we rethink your priorities, refine our goals, and redefine our futures.  We become better people because of hospice.  How blessed we are.

 

Based on “In The Face of Insanity, How Do Caregivers Maintain Their Own Sanity” by Rabbi Earl A. Grollman

The tension to pray at every visit...

Many Chaplains feel a tension to pray at the close of every visit.  Is it necessary to pray at the close of every visit?  Where does the tension come from?  Could it be that prayer was the expectation of church members when you were a pastor and you carry that into chaplaincy? 


How do you pray for an atheist?
How do you pray for a Muslim?
How do you pray for a Jewish patient?
How do you pray for a Hindu?
How do you pray for a Sik?
How do you pray for ........?


The list goes on and on.  But, the question must be answered.  Is it ever ok to simply say that "in my prayers I will remember you"?


Would it then be in order to seek the patient's permission to invite local spiritual caregivers of their faith to provide spiritual support along with you? 


There is much to think about when it comes to prayer.  Our study on the Clinical Use of Prayer deals with these issues and many more.  Prayer makes for good discussion, but too often we are more interested in doing prayer than talking about the patient's understanding of prayer and the patient's experiences with prayer.


So...back to the question at the beginning of the article...Where does this tension come from that you experience when you are coming to close of a visit?  Must you offer to pray?  Why or why not?