The Rev.
Steve Rice on proposed reforms for
spiritual care
HOSPICE Spiritual Care Providers….This is for YOU!
The CMS (The Centers
for Medicare and Medicaid Services
- a Federal agency within the U.S.
Department of Health and Human Services)
recently issued proposed reforms
to the Medicare Benefit that will
affect how spiritual care is provided
in hospice organizations.
As Chaplains/Spiritual Care providers
in hospice we are invited to review
the new proposals to the Conditions
of Participation (COP) and make comments
to a federal committee by July 26,
2005.
Click HERE to
download a pdf file.
Highlights of Proposed Changes
for Spiritual Care:
1. I believe the most significant
proposed requirement in hospice will
be the inclusion of Spiritual Care
Counseling services as a CORE SERVICE
(Proposed 418.64, page 30850, 51).
Spiritual counseling joins the medical
and “medical social services”disciplines
as essential and required in
hospice assessment and delivery of
hospice/palliative care. What does
this mean? I serve a hospice with
a census of 200. Over one year ago
we provided spiritual care to those
patients and families based on the
referral of our nurses or social
workers. We followed 30-35% of the
caseload. In this past year we began
viewing spiritual care as a core
service and assumed an initial assessment
by a professional spiritual care
provider. As a result of this change
in philosophy, today we follow 85
to 90% of our patients and families.
That is the good news. The bad news
is we have not yet increased our
number of spiritual care providers.
Spiritual care is an essential part
of dying. Now Medicare is saying
we agree.
2. A second area to note is the
section preceding the Core Services
(pages 30844-30851) Basically, spiritual
care has to be part of the individualized
plan of care, assessment and outcome
measure. The assessment needs to
be completed in four calendar
days after the patient elects
the hospice benefit! (page 30845)
3. The weakest section has to do
with Personnel Qualifications for
Licensed Professionals (418.114,
page 30859). The Committee, working
with NHPCO, has a difficult time
defining the qualifications for a
professional spiritual care counselor/chaplain
for hospice. One sentence does state “these
[professionals] must be licensed,
or certified or registered to practice
by the State …”It is
easy to define a state licensed individual
(social worker or speech pathologist)
or a certified nurse. Here is an
area where we can educate the Committee
as well as hospice and palliative
care programs. If I interpret these
qualifications correctly, then a
salesperson friend, who, for fun,
bought an M.Div. for ten dollars
on-line and registered as a licensed
minister in this state, is as qualified
as I am to provide spiritual care
in hospice.
How To Contact:
The Federal Register gives reminders
throughout that you can electronically
(not fax) submit comments to httpp://www.cms.hhs.gov/regulations/ecomments by
July 26th, 2005. Mention the section
you are commenting on when making
your remarks.
There are significant changes for
hospice and palliative care (when
they become Medicare eligible). You
and your administrators need to be
aware of how these proposed changes,
if adopted, would affect what you
do and how you do what you do.
Thanks to Sue Wintz for bringing
this to our attention.
Note: These proposed rules are especially
important as CMS states in this document
that they are working to revise not
only the hospice requirements but
the requirements for other health
care providers, such as hospitals,
home health facilities, and others.
The APC Board is submitting written
comments to CMS regarding the proposed
changes. Those comments as well as
a model response for Board Certified
Chaplains to use in their own submissions
will be available on the APC website.
For more information, contact the
APC office at info@professionalchaplains.org or
Sue Wintz, Chair, APC Commission
on Quality Services at sue.wintz@chw.edu.
Steve Rice, a Lutheran minister,
is a chaplain and spiritual care coordinator
with HomeReach Hospice at Riverside
as well as a member of the Pastoral
Care Department at Riverside Methodist
Hospital. Steve has been providing
spiritual care in the hospice setting
for eighteen years. Steve is Board
Certified with the APC and currently
serves as a liaison for the APC with
the National Hospice and Palliative
Care Organization, Washington DC.
Do you have thoughts about advocacy
you’d like to share with your colleagues?
Send an e-mail to info@PlainViews.org.
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Education & Research |
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Rabbi Julia Neuberger
on answering the basic
questions
By
Books, By Writing
and By Listening…
It
is over twenty years
since I first wrote a
book about death and
dying. In those days,
as a pastoral rabbi in
south London, with two
of London’s most
famous hospices within
easy reach of my synagogue,
I was constantly being
called late at night
to give the ‘last
rites’to someone
Jewish dying in the hospice.
However many times I
explained that Jews did
not have last rites,
it was clear that the
level of ignorance –not
wilful, just a fact of
life –was huge.
At the same time, a
small charity –the
Lisa Sainsbury Foundation –was
set up to teach nurses
how to deal better with
dying. They asked me
to write a short book
about how to look after
dying people of whatever
faith. And so I began
to write. How do you
look after Muslims who
are dying? Sikhs? Jews?
Buddhists? And so on.
The first edition came
out in 1986. A simple
volume, it answered basic
questions. Every ward
in every hospital wanted
a copy on their reference
shelf. I was delighted.
I realised that the most
basic advice I had given
was bearing fruit. If
you do not know, ask.
The patients –or
their families–will
be only too delighted
to tell you. Time and
again, nurses have told
me that as a result they
have felt free to ask
a Muslim family, or Buddhist
patient, about their
desires and fears.
Later editions have
added Chinese customs,
and drawn distinctions
between different groups
of Muslims and Jews.
The book has also inspired
many better, more thorough,
books designed to help
caregivers support people
from backgrounds different
from theirs.
It has also had a powerful
effect on me personally.
Before this, I had only
written short pieces –this
made me enjoy writing
books. Since then, I
have written Dying
Well, a book designed
to help ordinary people
as well as healthcare
professionals think about
achieving a ‘good
death’. But I have
written about women,
too, research ethics,
and, most recently, a
book entitled The
Moral State We’re
In, looking at the
way we treat the most
disadvantaged in the
UK. I’m no longer
a pastoral rabbi, but
the desire to preach
and teach, to support
the weakest and to take
real care of those who
are dying, or those who
have severe mental illness,
has never left me. For
me, the most spiritual
moments are those intense
times with someone suffering,
or someone slipping away
from life, with a sense
that perhaps one can
help –just a little.
In our country, far
less religious than the
United States, people
are confused religiously
and seeking something
spiritually. In the healthcare
field, and particularly
when people are facing
their own death or that
of someone dear to them,
the desire for spiritual
care is still ever present.
We need professionals –healthcare
professionals and chaplains –to
help them come to terms
with what is happening
to them. By books, by
writing and by listening,
we have to learn to play
that role for everyone,
whoever they are, from
whatever background.
Rabbi Julia Neuberger
(Baroness Neuberger D.B.E.)
is a Liberal Democrat member
of the House of Lords,
front bench spokesperson
on health, an adviser to
the trustees of the Sainsbury
Centre for Mental Health
and consultant to the project
to establish a Jewish Community
Centre for London. She
is also a Trustee of the
Booker Prize Foundation
and writes widely on health,
women's and religious issues.
Her latest book is The
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7/6/2005
Vol. 2, No. 11
