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8/3/2005 Vol. 2, No. 13

Professional Practice
 

Kenneth Dale on a unique pastoral care program

No Shortage of Chaplains Here!

Pilgrim Place, a retirement community in Claremont, California, has no shortage of chaplains. What is our secret for having no shortage of chaplains here? The secret lies in our pool of over 100 clergy from which to draw! Our retirement community is unique in that residents must have spent at least 20 years in active professional work in the church is order to be eligible for admission.

We are a three-level community with independent, assisted and full nursing care facilities all on the same campus. Chaplains serve the full nursing care facility which we call the Health Services Center. This Center has 60 beds, half of which are reserved for Pilgrims (the name we give ourselves as residents here) and half of which are open for the wider community of Claremont. In our pastoral care for the residents, no distinction is made between Pilgrims and patients from outside Pilgrim Place.

Since we have so many Pilgrims who have had long experience in calling on and caring for the elderly through their pastoral work, it is not hard to find persons to serve as chaplains in the Health Services Center. Aren’t we blessed! We have a fairly well structured system for utilizing this clergy-power in a way that gives the best service to the residents of the Health Services Center and is least burdensome to the chaplains.

A Coordinator of Chaplaincy Services a volunteer, as all the other chaplains are recruits 12 different chaplains each year, both men and women, not necessarily ordained. These 12 serve in teams of two, each team serving for a two-month period. This system allows scheduling flexibility within the team, which is necessary inasmuch as Pilgrims volunteer in many community activities and travel a great deal, so they don’t like to be confined to a daily schedule for a long period of time. The turnover in chaplains, although it has the disadvantage of lacking continuity in relationships, seems to be generally appreciated by the Center residents also. They get to know a diversity of men and women from the Pilgrim Place campus, and experience various types of pastoral care.

As for services provided by the chaplains, when on duty we spend at least two hours each day, seven days a week, in the Health Services Center. There is no paper work or administrative responsibility, so our entire time is focused on personal care. Although some residents are unable to carry on meaningful conversation, many are able to converse and respond gratefully to the time and attention the chaplains can pay them. The focus is always on the resident’s needs, not on formal procedures. We read Scripture and pray when the resident appears to desire that, not as a routine.

In addition to calling on residents, chaplains plan Sunday worship services. Here again we are blessed with an ample pool of ministers on whom we can call for leadership and preaching. The worship services are limited to 30 minutes, and always include special music. We are also blessed with many musicians within the Pilgrim community.

When death draws near for a patient, the chaplains are on call 24 hours a day and accompany the patient on his/her journey to the “next level.”If the patient lingers for a long time, we have a list of Pilgrims who volunteer to sit by dying patients during their last hours. When a Pilgrim dies, the chaplain on duty informs all the other Pilgrims in the Health Services Center of that death.

We are proud of the high quality of care at our Health Services Center and believe that the chaplaincy program is one significant factor in that quality care.


Kenneth Dale was a professor of pastoral care and counseling at the Lutheran College and Seminary in Tokyo, Japan, for 35 years. During that time he established the "Personal Growth and Counseling Center" in Tokyo, which still carries on a significant ministry of counseling and counselor training. He retired from there in 1996 and came to Pilgrim Place in Claremont, where he is involved in various volunteer activities: preaching, mostly in Lutheran churches, serving as docent in the local botanic garden, assisting at local food bank, and volunteering as chaplain in the Pilgrim Place Health Services Center.

 

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Advocacy
   

Chaplain Richard Lopez on pastoral care as a budget line item

Office Space: Profit or Presence

“Now before this, Eliashib the priest, having authority over the storerooms of the house of our God, was allied with Tobiah. And he had prepared for him a large room, where previously they had stored the grain offerings, the frankincense, the articles, the tithes of grain, the new wine and oil, which were commanded to be given to the Levites and singers and gatekeepers, and the offerings for the priests.” Nehemiah 13:4-5

We have finally done it! We have caught the eye of the accountant’s consultants, forged our place in the professional world and everyone sees it…including those who have the difficult task of balancing the yearly budget. We have spent decades tidying up our standards for accreditation. We’ve journeyed to the highest heights of hospital administration. JCAHO has finally agreed to our appeal for recognition as a legitimate, professional element in the hospital. We’ve arrived! We have more abbreviations behind our names, higher salaries and an office area of our own. And yet, has our climb up the mountain range of professional recognition really helped us? In the pursuit to have our 15 minutes of fame in the clinical arena we suddenly find ourselves as line-items in the industry. As we make our way forward in this battle of medicine and budgeting, we have quite of variety of our own fruit to taste in front of us.

The hospital industry is looking ahead. It doesn’t look good. Costs for malpractice insurance are rising exponentially, equipment and medication are costly and expenses for employee health benefits are unacceptably high. Hospital administrators are looking at every detail, searching for areas where employees must bear the burden of “making adjustments”to help hospitals stay barely in the profit margin. Finally, after all the pressure to accept recommendations from expensive hospital consultants, the final formula for budgeting has been reduced to this: office space and profit margin. Each square foot of the hospital must produce a certain percentage of profit in order to survive the next budget cut. Where we used to fasten core values like Respect, Excellence, Justice and Compassion to patient satisfaction and good hospital business, Stewardship and profitable Office Space has become the ultimate bottom line for ensuring the future survival of the hospital.

How does this management philosophy for balancing the books affect the spiritual care department? Accountants must place a price not on the work of the chaplain, but on the profit margin of the space the chaplain occupies. Sacred elements of our work like Ministry of Presence, Grief Support and Prayer are not discernable factors on the balance sheet. Rather, our office space is measured in comparison to other departments of the hospital. The news is not good: our office space may receive a thank you card now and then or even a package of chocolates, but rarely can an accountant’s audit detect any beneficial revenue for the hospital’s bottom line. Lately patient satisfaction has been casually ignored for managing costs in the business of medicine and for the accountant’s objective; in this light, chaplaincy should not even be on the map. While our difficult climb up academia has won us our “clinical”office space, our distinguished presence is tragically on the chopping block. What’s next for us in this desperate industry?

For the sake of our presence in the industry, our striving to validate our goal for supreme accreditation must end. With the undercurrents of budget-balancing and the writing on the wall, we must change our focus to reevaluate our goals for survival –and we are in survival mode. We are suffering the consequences of accrediting ourselves right out of a job. Enjoying our professional recognition and erecting lofty clinical standards affords the right for administrators to place a price on the spiritual elements of our service. Today we try to legitimize our position in the clinical arena by developing patient tracking forms and satisfaction cards, but in the end gauging profit margins with spiritual qualities are two elements that will never meet.

Directors of Spiritual Care Departments must overcome the implementing of trendy deficit-reducing strategies by educating hospital administrators about what exactly they’re paying for: Chaplains provide Presence, not Pr