As A Pastoral Care Provider and As A Consumer of Pastoral Care Services in Hospitals and Nursing Homes We Have An Obligation to Be More Critical and Ask More Questions. We Must Have A Voice.
Over the years I have done a great deal of reading, research, and critical thinking about pastoral care, spiritual support, chaplaincy and have come to some conclusions. Some of these conclusions are disturbing, others are illuminating, some are constructive, others are serious wake-up calls. So let me throw a couple of them out and get some feedback from my pastoral care colleagues and from some of our readers who may be on the receiving end of our well-meant efforts.
Pastoral care used to be the ministry of the clergy or at least the pious religious, usually in monasteries or in hospitals run by religious orders. The theory was basically to perform acts of mercy, to provide spiritual encouragement and guidance, to attempt to alleviate suffering, and to make the transition from life here to life in the hereafter somewhat easier. Not much has changed from say the 13th century to the 21st century, despite the fact that we’ve had more than 800 years to re-evaluate and update our operations.
From my perspective, pastoral care continues to be a ministry but more than that it is a vocation, a calling. True, we in professional chaplaincy have professional degrees in theological studies, pastoral studies or have even gone through studies leading to the advanced degrees of master of divinity or a doctorate in ministry. Some have succumbed to the lobbying and the arrogance of the 20th century’s panacaea, its answer to everything: certification. But this notion of lobbying and influence peddling, of certification, though well-intentioned enough, has gone awry and has become merely another MBA scheme. Far from its original intention of benefitting the recipient of pastoral care it has become yet another way to promote questionable ideologies, to form cliques, to push political agendas, to become esclusive in too many ways. In fact, by virtue of the numbers, the whole system of certification of pastoral care providers has become almost fraudulent; indeed, many of those certified have forgotten the humility and discipleship that underscores the authentic pastoral care provider and have become mini-celebs, or the divine’s personal liaison to the suffering.
This problem, and a problem it is, is not primally that of the novice who enters the tutelage of a so-called “certified supervisor” in a “certified clinical pastoral education” program, but is created and perpetuated by individuals with an agenda and a mission: that of notoriety and recognition, of being the one who has made pastoral care a bonum fides entity in holistic healthcare delivery. Half-baked didactics, half-hearted supervision, checking the text messages and emails, rushing off to this or that committee meeting, Oops! off to a conference, politicking for that grant or those funds, prettying up the place for the site visit, etc. forms the day-to-day routine of the “certified supervisor.” The intern is left pretty much on his or her own after having paid up to about $700 just to be an intern! What’s worse, the hospital gets reimbursed for the services performed!
In this entire process, however, something is missing. Sure there’s structure. Of course there’s “standards.” And yes, there is the opportunity to learn a great deal on the floors and about one’s self but little thought is actually given to the effects on the recipients of the pastoral care being delivered–and that pastoral care, if we can throw that term about somewhat carelessly, does vary enormously depending on the intern’s background, faith tradition, education, and experience.
All too frequently, as in any hierarchical, corporate organization you’ll go far in terms of the certification process if you don’t buck the supervisor, if you don’t question his or her doctrines and dogmas, if you don’t have any thoughts of your own, if you prostrate yourself before the supervisor, and your don’t ask too many questions–and you’ll fare much, much better if you keep your mouth shut and play stupid. Just be corporate and know your “boundaries.”
Hospitals and nursing homes, despite what we read in the professional journals, play loosey-goosey with pastoral care. Most have no clue what a professional pastoral care minister is and they’re happy in their ignorance. Ask around, if you’re curious or looking for placement or even looking for a care facility for yourself or a loved one and you’ll be shocked to find that pastoral, religious, spiritual care is tucked away between personal laundry services and janitorial services, or is included in the activities department with ballroom limping and paper flower making, or is simply relegated to the volunteer department. In other words, one of the most important aspects of the suffering person’s pilgrimage through bereavement, pain, illness, his or her anxiety and existential questions are largely ignored in favor of things to pass the time and beautician services. In other words, much of what is done takes on a cold technical-scientific aspect or is window-dressing to make the facility as marketable and pretty as possible, not for the patient-resident, but to sell the place to the family and keep the bottom line in the black. That’s at the administrative level, of course.
We cannot do enough justice to the dedicated and committed souls on the floors, in the trenches as it were, those with direct patient-resident contact, the living saints: the nursing staff and the nursing aids and therapists who serve in a vocation on a par with that of the professional chaplain. But we must be clear that the spiritual, the religious, the emotional aspect of the patient-resident, an eminently important part of the healing of the wounds of the suffering, is largely treated with a bandaid.
There are turf and territory concerns, too. I know of no so-called director of pastoral care or a director of volunteer services who would admit that he or she is unqualified for the job of overseeing and coordinating pastoral care to patients and residents. Regrettably, most are ignorant and most take advantage of their position to be self-important in the institution. The standard is generally “good enough” to get under the wire.
Pastoral care is a healthcare specialty and the professional chaplain is a healthcare profession who makes valuable contributions to patient-resident care on the inter- and multi-disciplinary healthcare team. A local clergy person plucked from the community and providing monthly liturgy or worship ritual or popping in to visit patients or residents affiliated with his or her faith tradition is not a chaplain. Most local volunteer clergy have little or no training in clinical pastoral care, little or no knowledge of hospital or medical technology or procedures, many have their own issues, and most are pitifully overworked and distracted by the demands of their parish or congregation. Local volunteer clergy are poor substitutes for dedicated pastoral care professionals.
Most volunteer coordinators and most directors of pastoral care in our hospitals and nursing homes are unaware of the fact that federal and state laws apply to pastoral care and the Joint Commission for Accreditaion of Hospital Organizations, the people who inspect and accredit hospitals and other healthcare facilities, require pastoral care services, and have scoring categories that apply to how the pastoral care is delivered. Do most hospitals and nursing homes comply? Absolutely not!
In fact, the era of the denominational hospital is past! There will be no more “Catholic,” “Lutheran,” etc. hospitals run by denominations and adhering to the denomination’s philosophies, ethical tenets, doctrines, etc. Not if they want to continue receiving federal and state administered funds! The age of the interfaith institution is nigh. No more bedside evangelization and proselytizing is out. You even have to ask permission to pray now! Sure we have some prehistoric remnants, fossils remaining on the staffs and boards, even running the pastoral care departments. These are mostly nuns who are making money for their communities and who defend their turf with a religious fervor. There are also priests and ministers who serve part time as pastors and play pastoral care director or chaplain the rest of the time. In an age when parishes and congregations are starving for pastoral leadership, I cannot understand why religious and clergy are allowed to take secular jobs but Hey! there’s hypocrisy everywhere. But this is definitely a conflict of interests considering the constraints and needs, not to mention competency questions.
Most hospitals and nursing homes drag their feet, put up smoke screens, lie on their websites and in their marketing literature, or do just enough to make an impression, and fail in most of the more critical aspects of pastoral care services to their patients and residents.
This article will be continued…