The Changing Role of Chaplains at Long-Term Care Facilities
The need for spiritual support and a compassionate ear is more important than ever
The circle of life has rituals. There are ones people look forward to, like births, weddings and milestones along the way, and ones that mark less joyous occasions, notably those surrounding the failing health and death of loved ones.
During the COVID-19 pandemic, methods of meeting the spiritual and emotional needs of older adults in assisted living, long-term care and rehabilitation facilities have changed dramatically. The overwhelming nature of the pandemic has also pushed staff members in such facilities to seek guidance while grieving those deaths.
Chaplains of all faiths have always been on the frontlines of reaching out to older adults in these facilities, and to their families. It has been routine for them to visit patients, listen to their stories, lead prayers and provide support. But social-distancing restrictions that accompany COVID-19 protocols have derailed what they do, forcing many rituals to reach a complete stop.
What Makes Someone a Chaplain?
Most people who are chaplains must complete an accredited clinical pastoral education program and become board certified. In such places as hospitals, assisted living facilities or prisons, they often concentrate on care that touches on emotional, spiritual, religious, pastoral, ethical and existential subjects. They are trained to work with people of faith or of no faith.
Chaplains of all faiths have always been on the frontlines of reaching out to older adults in these facilities, and to their families.
Chaplains who serve facilities for older adults often focus on helping people move to a different phase of life with their faith and spiritual practices intact. Residents may come from a variety of faiths, but many have participated in some form of worship throughout life. A chaplain may aid that faith by coordinating and leading group meetings, conducting one-to-one ministry, staying on-call during end-of-life care and providing support to grieving families.
Chaplains may counsel people of any devotion, but if they choose to minister to followers of a specific religion, most must complete coursework required by that faith. They have a goal to help people find meaning in their lives, and many see their role as complementary to that of a doctor who treats physical ailments.
How the Chaplain's Routine Has Changed
The Reverend Sharon Johnson, a chaplain and administrator for the Somerset Chaplaincy to the Elderly, an ecumenical organization in Somerville, NJ, recalls when chaplains were part of the daily fabric of elder care facilities.
"We used to lead weekly worship services and activities," says Johnson. "We'd visit people one-to-one, especially residents with no family. That may have been their only opportunity to talk to someone other than staff or residents for the entire week. We just know the impact of losing that regular contact during the pandemic has been significant, especially for those with memory loss."
Rabbi Lynn Liberman, vice president of Neshama: Association of Jewish Chaplains, is a chaplain in the Minneapolis/St. Paul area. Lieberman says COVID-19 has exacerbated some problems, but loneliness remains the greatest disease.
"When someone is sick, that's often the time when others pull away," she says. "It's also the time when people need help the most. Whether it is dealing with COVID or other conditions, humanity (comes in the form of) speaking to someone as a treasured soul while they search for meaning in their lives."
What Are Chaplains Doing Now?
Long-term care residents, especially those who have had life-long rituals of attending religious services, are feeling the loss of routine. Residents, who aren't overly religious but just want to talk, are missing opportunities to find someone with a sympathetic ear.
Long-term care residents, especially those who have had life-long rituals of attending religious services, are feeling the loss of routine.
To counter the loss of routine, chaplains with the Somerset Chaplaincy are recording audio/video religious services. They are conducting services and having one-on-one conversations with patients via Zoom or Skype video platforms.
But they find some facilities don't have the Wi-Fi necessary to reach all residents. Many lack the staff and enough computers, and not all patients have the technical or cognitive ability to view presentations on phones or laptops.
Recognizing these limitations, one of Somerset's chaplains got creative by arranging a "celebration of life" service (during warmer weather) with a small, socially distanced group in a facility's courtyard. Other chaplains have performed celebrations of life via Zoom or by phone.
Chaplains are brainstorming to combat loneliness and determine each facility's ability to host chats and virtual presentations. Such efforts may require staff assistance, though some chaplains feel guilty for enlisting help from people who are already stretched thin.
"We had an instance when facility administrators took the time to help with connectivity issues that were preventing families from reaching patients," Liberman says. "They dropped everything to figure things out. It's in those moments you realize people really care deeply for those they serve."
Some chaplains are also returning to older ways of staying in touch, like giving residents and staff their personal phone numbers, distributing flyers with prayers and creating videos that can be played at holidays and times of need.
Still others are emphasizing the use of phones instead of video while patients are on their deathbeds. This is being done so family members don't have a jarring picture of their loved one near death as a final memory.
Making Connections Through Writing
Yuseff Salaam, a board-certified chaplain clinician, works with older adults and families at the Harlem Center for Nursing and Rehabilitation, and serves as a chaplain at the Mosque of Islamic Brotherhood, both in New York. He misses the ability to visit those in need.
"I'm used to being face-to-face," Salaam says. "I can't hear aural cues accompanied by body language now. I can talk to clients over the phone, though, and if I know the person is a Muslim, I may mention a religious term to see how they respond. I might have the person repeat what I've said as a sign that they understand me. That helps me feel their presence and gain a sense of who they are."
"I'm used to being face-to-face," Salaam says.
Salaam also taps on his background as a writer to help people cope with the spectre of COVID-19, as well as medical and emotional issues, by asking them to capture their thoughts on paper. He is a former English professor who has led healing writing workshops.
One of the clients Salaam keeps in touch with is a woman who lost two brothers and an ex-husband to the coronavirus. He encouraged her to write poems about how she was feeling and reviewed her work as both an editor and a chaplain. The process has helped her figure out her feelings, what might be at the root of them and how that work may lead to great understanding.
Sometimes Staff and Chaplains Need Help
Stressed staff members have approached some chaplains to seek prayer or just talk. Chaplains also speak to health care professionals who forge relationships with patients who die while in their care. Liberman recalls working with a colleague who had lost a patient to COVID-19 and just started crying.
"I asked her to tell me about the patient and the relationship they'd built," Liberman says. "Sometimes we all need to take a moment in that space, place and time to reflect on how many souls we've touched and the difference each has made."
Johnson says the pandemic has led chaplains in her group to increase their support of one another. They have monthly discussions with spiritual advisers who can help reinvigorate their coping skills.
Given the heightened stress chaplains may feel alongside senior living and medical facilities staff during the pandemic, do they wish they'd chosen a different path? Given that most see what they do as a calling rather than a job, many would answer 'no.'
"I adore working with seniors," says Liberman. "They have so much to teach me. I haven't met someone who hasn't taught me something, even from those who can no longer communicate well. You may have a degree that shows you're an expert at something, but does that degree mean more than the wisdom gained through life? That wisdom is wonderful to be around."