Donna Smith was a newly admitted resident at a skilled nursing center in Memphis, Tenn. Frail upon admission, she was not happy. Every day, she received a visit from the center’s pastor, Pastor Scott Payne, who made his rounds to all residents. At Smith’s door, he would knock and say hello, and she would turn her head and wave him away. The next day the same thing happened: He would knock on her door, say hello, and she would wave him away.This kept going on for three weeks. Then, Smith’s condition worsened, and she was admitted to the hospital. Pastor Payne received a call saying that Smith wanted to see him. Shocked, he went to see her: He knocked on her door, said hello, and she waved him in. He spent the next two hours there as she unpacked her life, her childhood, and the bitterness she carried within her. At the end, Pastor Payne asked why she had called him. Smith responded, “Because you just didn’t give up.”
The long term and post-acute care (LT/PAC) profession is filled with stories like Smith’s. The providers that care for residents and patients aim to heal their bodies and, if necessary, their minds. But what often goes
hand in hand with that mission, they say, is healing of the spirit.
“In order to really help the body heal, we need to look at all aspects of a person, and spirituality is a big component of that,” says Pat Giorgio, president of Evergreen Estates, a residential care center in Cedar Rapids, Iowa. “Whether it’s expressed in a specific, defined religion or whether it’s a matter of just faith. The needs are still there for most people.”
Defining Spirituality
Spirituality, says Giorgio, is a big part of caregiving, which focuses on all aspects of the mind, body, and spirit. A person does not just have a broken hip or a diagnosis of depression. It’s more than that, she says.
“Spirit is part of the essence of who we are. And that’s the root of spirituality, so it is simply part of our essence,” she says. “Rather than trying to define spirituality in religious terms, it helps to realize that everybody who believes in the human spirit has spirituality, they just might express it differently.”
Dave Baumgartner, vice president of spirituality and the Sacred Six at Signature HealthCARE, agrees. He cites the teachings of the book, “Man’s Search for Meaning,” written by Viktor Frankl. “It doesn’t matter what your faith tradition is or if you have a faith tradition,” he says. “All people have a longing for a purpose in life.”
A Pillar of Care
Spirituality is integral to the foundation of SignatureHealthCARE, says Baumgartner. It’s one of three pillars: Spirituality, Intra-preneurship (or Innovation), and Learning. More than just ideologies, he says, all three are departments with their own staff and programs.
Within the spirituality department, there are six missions, including stakeholder ministry, which is focused on employees; bedside ministry, for residents and families; a compassion fund, designed to help support people in time of need; volunteerism that aims to increase the number of Signature volunteers; interfaith understanding; and faith in works. An example of the last mission is Signature’s recent work of mobilizing staff and volunteers to send food and supplies to those recently impacted by Hurricane Harvey in the state of Texas, where Signature does not have centers.
Signature operates 120 centers across the country and has approximately 80 chaplains, with some serving several centers in some locations. The religious makeup of the residents is mostly Christian, but that depends on the demographics of the local market, says Baumgartner.
A typical center will have about 70 percent Christian with the rest being Jewish, Muslim, Hindi, New Age, or agnostic. In south Florida, for example, more residents will be of the Jewish faith.
The role of the chaplain is broad. Chaplains offer spiritual services typically seen in most care centers, such as Bible study, church services, funerals, memorials, weddings, and more. But that’s just one part of spiritual care, says Baumgartner.
“A lot of the time it’s a one-on-one check in,” he says. He recalls one resident who was not interested in the religious services. After some research, the chaplain found out the resident liked history. He approached him and said, “I hear you’re a history buff, so am I.” After that, they started talking about history and developed a bond, never mentioning religion. “That helped the resident feel more comfortable,” Baumgartner says.
Staff Need Services, Too
Another role of the chaplain is delivering spiritual services for staff.
“A lot of the time, those of us in long term care say to employees: ‘Leave your personal problems at home,’” says Baumgartner. “‘I know your kids are sick, but when you walk in the door you’re a nurses’ aide, and you have to give 100 percent.’ How realistic is that?” he asks. “We have to keep our staff in mind, too.”
Signature staff take advantage of services offered through the company’s stakeholder ministry and will request services from the chaplain.
Prayer is a powerful component, says Baumgartner. In several centers during shift change, he says, nurses huddle around the nurses station to touch base. At the end, someone will ask, “Does anyone have any prayer requests?”
“We hear all kinds of things,” says Baumgartner. “‘Let’s pray for our staff, or for Mrs. Jones, let’s pray for my son who’s not feeling well.’ Then, it’s us saying that prayer together. It’s a 15 second deal, and we’re done.”
After praying with staff at a center in Memphis, Baumgartner says a certified nurse assistant approached him and said, “I love it when we do that.”
“They are wearing burdens of people and life,” he says. Letting staff come together and lift each other up makes a difference, and if people do not want to participate, that’s fine too.
A No Brainer
“It’s really a no brainer when it comes to caring for staff,” says Woodbury Senior Living Campus Director of Spiritual Services Basil Owen. The campus, based in Woodbury, Minn., consists of a 75-apartment community offering senior living with services and assisted living; a 64-apartment community offering assisted living and memory care; and a 142-bed community for transitional care, skilled nursing, and memory care. With a focus on integrative therapy, the campus also offers wellness programs, spiritual services, and recreational therapies.
Early on, Owen says, Woodbury recognized that staff needed support when residents they had cared for suddenly passed on. This led to the creation of the Eternal Butterfly Program, an end-of-life program that takes into account the spiritual and emotional needs of staff, families, and other residents. For staff, he says, it was really about giving them permission to grieve.
“We let them know that it’s okay to take additional time and share stories with the families and other residents,” he says. “When a resident passes, we have a public send-off ceremony, and that’s healing for all involved.” It’s a way to honor them and a way for everyone else to say goodbye.
And for those involved, including staff, it’s about dealing with issues like denial, anger, and grief, which can be elevated in times of loss. If more than one death has occurred on a floor, says Owen, another service
will be offered, in addition to memorial services, to help staff process what they’ve just gone through.
Sometimes his role as a chaplain is a buffer, and sometimes it’s a sounding board. His presence, he says, is key to show support for everyone. Church services taking place throughout the week are open to staff who may have missed their own spiritual services while caring for residents, he says.
“These are all powerful rituals, and we’ll do anything to help our staff. They take care of our people.”
Changing Needs
LT/PAC providers have already seen how the aging baby boomer demographic is changing the demand for spiritual services. Just starting to move into LT/PAC settings, they are starting to make a presence, according to Giorgio.
“Their need for expressed religion is significantly different than 20, 25 years ago,” she says.
While many boomers have an association with a church, many do not. And still others feel strongly that they don’t want an association with a church.
“It doesn’t mean that they don’t have spiritual needs or a belief in a higher being, but it’s almost 50/50 with boomers, whereas it was probably 90 percent of people before them who related to a church.”
The changing demographic calls for a change in addressing the topic of spirituality with residents today.
“I am finding that our younger residents often don’t even express their spiritual needs in the same terms,” says Giorgio. “The old standard was: ‘Would you like us to call your minister?’ or ‘Is there someone from your church you would like to talk to?’” she says.
“Now, you have to say: ‘Is there something weighing on your mind? What do you think about that? Who is God to you?’ These are the kinds of questions that need to be asked.”
Where this can be a challenge, says Giorgio, is at end of life. Earlier, a typical resident usually found it comforting when a pastor or priest from a church community would visit regularly. Issues of concern were
often being addressed directly by their minister during those visits.
“Today, our staff have to be much more attuned to ask things like: ‘Do you have needs or concerns? Would you like to talk to somebody? Can we meet your needs?’ A hospice chaplain will take that role automatically, but for many people who are with us long term who may have some mental health issues or some chronic pain issues, we have to be willing to open that line of inquiry and see if there is something there that we can help them with,” Giorgio says.
Living Their Mission
Delivering on the spiritual needs of residents, families, and staff is alive and well at The Evangelical Lutheran Good Samaritan Society, which ties spiritual work to a long-standing mission. “Part of what makes us different is that we were born of the Lutheran church, which has a legacy of caring for those in need,” says Greg Wilcox, vice president of mission integration and senior pastor. Those in need have always been people with disabilities or elderly, widows, orphans, and people who live on the fringes of society, he says.
Good Samaritan has 240 centers across the country offering multiple lines of service in LT/PAC. Wilcox says that the organization employs about 25 full-time chaplains, and a large number of chaplains are also part-time or sharing these duties with others.
Similar to other LT/PAC centers, Good Samaritan will conduct a spiritual needs assessment to tailor services for each person. “We ask if they have a faith tradition, if they had any particular providers of spiritual, religious, or faith care, and what they want to have during their time with us,” says Wilcox. “That gives us a baseline to know how we can meet their spiritual needs.”
A Spiritual Framework
Spiritual ministry expectations make up the framework for skilled nursing settings, and others like assisted living and home- and community-based care. This includes the provision for pastoral care for residents, weekly worship services, daily devotions (readings from the Bible), and prayer before meals and meetings.
If the center has an individual of another faith and wants services from a religious figure, such as the Islamic faith, the chaplain will seek out an imam from the community to perform the service with authenticity.
The organization also integrates its values into caregiving via its values program, which includes treating their residents with humility, joy, acceptance, perseverance, and love. “All of these are at the heart of caregiving,” says Wilcox.
These values are universal, and they extend into every position in the organization, he says. Even business leaders are required to be spiritual leaders. “All administrators and anyone who oversees business lines must be active in the church and go through training to ensure that they are responsible for the overall spiritual programming of their locations, as well as being encouraged to share in the work of providing pastoral care,” he says.
Good Samaritan Society – Fort Collins Village in Fort Collins, Colo., is one place to see the organization’s values working. The life plan community offers independent living, assisted living, long term care, and short-term rehabilitation. In addition to having a full-time chaplain on staff, the 140-bed center has a chapel on site.
“Spirituality is definitely important to people, especially as they age,” says Fred Pitzl, administrator. “I’ve heard people liken it to the fourth quarter of a game. You’re nearing the end, you take time out, you reflect more, you listen to the coach more, and you have more time to take things maybe more seriously. I think people are very open to that. We have seen nothing but good come of it here.”
Values in Action
Pitzl recalls a story of one family that was touched by one of the policies at Good Samaritan: that no one passes on from life alone.
A resident was getting toward the end of her life. Staff contacted the resident’s son, who was out of state, and encouraged him to start making his way over to visit his mother. The son booked the next flight and arrived there the next evening, afraid his mother would be there by herself. When he arrived he was surprised to see three staff members with his mother, who was still living. One staff member was on each side, holding her hand. Another staff member was at the foot of the bed, talking with her. The staff members were all there off the clock.
“At that point, it was just the son with his mother until she passed the next day,” says Pitzl. The son shared later at her memorial service that since his mom had been there, her faith had been renewed, and so had his. “Many people were impacted by that,” says Pitzl.
Pitzl says he has observed the spiritual needs of residents, staff, and families change and grow during his tenure. “Staff have mentioned to me that working here has made them want to pray more, as they have seen prayers answered in the work we do. Sometimes, staff will call me from home saying that they have something that happened there, and they ask us to pray for them, which we do.”
Accessibility a Priority
In Sioux Falls, S.D., Chaplain Deb Hippen Schultz has a busy week, offering services to over 300 residents at Good Samaritan – Sioux Falls Village. The center offers skilled nursing and rehab, independent and assisted living, and home- and community-based care. A majority of individuals in the skilled nursing center are of the Lutheran faith. For those of the Catholic faith, lay leaders of the local Catholic church offer communion, a rosary prayer, and other Catholic services every week. Schultz leads Protestant services on Sunday and daily devotions, Bible study, and special events throughout the year.
With much activity in the onsite chapel, which has a camera, residents may choose to watch the goings on from their room on television.
When asked about residents’ spiritual needs, Schultz points to a common need for most people.
“As the residents do get older and maybe sicker, depending on their situation, and they might know their time is coming, they want to know what everyone wants to know,” she says. “That there is peace at the end. Families want to know this, too.”
Answering specific spiritual needs may involve one-on-one visits with the resident and/or family members and fulfilling special requests.
Schultz also takes care to visually demonstrate to other staff and residents when a resident is in the process of passing on from life. “We put up a paper in the copy room to show staff that they are on their journey,” she says. “And everyone knows that and can say goodbye if they like.”
A bedside service is a common staple in most centers, including Good Samaritan – Sioux Falls Village. It’s held immediately, and staff, residents, and families are welcome to attend to honor the resident who has passed. “The families always appreciate hearing stories, and the staff appreciate that too,” she says.
“There is plenty of laughter and tears.”
Schultz and her team place an embroidered white quilt over the bed and announce to all in the building via intercom to show their respect. After memorial services are completed, each family is given a rose with a note thanking them for letting the staff care for their loved one.
Families continue to stay connected, Schultz says, through the community gatherings at the center. “It could be a summer picnic or a soup and pie supper,” she says. “We see a lot of them at holidays like Christmas, when we have a live nativity, go caroling around the building, and share Christmas cookies. A lot of families come to that.”
Meeting Them Where They Are
What delivering spiritual services is most about, providers say, is meeting people where they are.
“Spiritualty is expressed very differently for different people,” says Giorgio. All three of Evergreen’s communities have nondenominational church services on Sunday. The attendance is very high, and people greatly appreciate the music.
“I think that music is a very important aspect of spirituality for our residents,” says Giorgio. “We have some residents who don’t want to go in the chapel to participate, but they always sit in the lounge to hear the music.”
Respecting preferences is important, too. “A couple of times we had to intervene when we’ve had different church groups come in that wanted to get a little too preachy,” she says. “We have to monitor that because it’s extremely important that everyone be made to feel welcome, and never excluded.” Giorgio says she encourages residents and faith leaders to remember that every person is coming from a different place at a different time, and to grow and try new experiences.
Sometimes, making a difference can be just helping someone write a letter. In one Signature HealthCARE center, a resident who had a double amputation shared that he was estranged from all his family. No one would come to visit him, and he had a terminal illness.
The chaplain sat down and helped him put together a letter to his children. “Eventually, he started to get some calls and letters from the family,” says Baumgartner. “The chaplain was a stand-in for the family during his passing, which was a blessing for both the resident and himself. Whether it’s history, or faith traditions, or coming to terms with who they are and where they’ve been in life, we just meet people where they are.”