Rabbi Nathan Goldberg on the next great frontier of chaplaincy

Community Chaplaincy:
Evolving Health Care Challenges

As the pressure to decrease inpatient length of stay increases, our healthcare culture confronts new challenges. Modern medicine has responded with a greater emphasis on outpatient treatment and specialized rehabilitation programs outside the confines of the traditional hospital.

Spiritual caregivers confront this problem as well. How can we serve this elusive community? Inpatient care has become more compact. Inpatient pastoral relationships are often limited to one visit – not based on need but time constraints.

One response has been reframing the chaplaincy model to a community based chaplain. This model has the potential to offer ongoing pastoral relationships where the traditional model cannot. This model also comes with numerous challenges that need to be met as the position evolves.

The strength of this model lies in its fluidity. Community chaplains have mobility. They can follow patients before and beyond the limited inpatient stay, can help design, provide, and sustain a network of community support to help care for patients in a more holistic fashion and can work with local schools to educate and support teachers and peers of the patient’s children. The chaplain can serve as a liaison to local clergy and other support professionals as changes in the patient’s condition may provide or preclude opportunities for strategic visitation.

The community chaplain may be in a better position to link the family with community resources for counseling support during and after sickness. For example, community chaplains ideally have more connections to various support and grief groups than their typical hospital based colleagues.

(Please note that as I list some of the advantages of the community based model, I come not to bury inpatient chaplaincy but to “praise”/advocate that spiritual care and concern continue beyond the confines of the medical center environment.)

While community based chaplaincy provides supplements to traditional models of chaplaincy, there are also significant challenges. While community chaplains have the potential to be “everywhere” on paper, they will be dependent on a network of other professionals for referrals. These relationships take time to build and cultivate. Additionally, these chaplains must become one of the “chosen,” so to speak, allowed access to appropriate and relevant medical records. As HIPPA becomes more prevalent and far reaching, this task becomes more time consuming. Negotiating each different community medical center’s HIPPA interpretations can become a Herculean task.

There are two other major concerns. First, who supervises the community chaplain and how? The community may provide experts from local congregations, social agencies, and medical centers to help support and supervise the chaplain. This model has the potential to help inform a greater ministerial experience as the chaplain receives input from a number of areas of expertise. However, community chaplains may find themselves in awkward situations as the various supervisors maintain a parochial vision in supervision of a community position. How can a many-voiced community give a clear message when supervising an individual community chaplain?

But the biggest challenge will be to answer the question, “Where’s the money?” Who finances community based chaplaincy?

Community chaplaincy has the potential to be the next great frontier in healthcare ministry. Its evolution is dependent on a community working together to fund and supervise such a model. As professionals caring for the spirit, I believe we need to be on the front lines of community chaplain advocacy. We must articulate our unique perspective to congregational leaders, ordained clergy, medical and administrative professionals, helping them embrace and further innovate this change in clinical spiritual ministry that is beyond the bedside.

Do you have thoughts about advocacy you’d like to share with your colleagues? Send an e-mail to info@PlainViews.org.