Monday, April 12, 2012
Plenary: “Accelerating Change: The Emerging Future of Spiritual Care"
Rev. Kevin Massey
Vice President, Mission and Spiritual Care, Advocate Lutheran General Hospital
The provision of spiritual care needs to be examined along with all other areas of healthcare. The field of chaplaincy must study itself to learn what measureable outcomes of its work can be found.
- Surfing through a Sea Change: The Coming Transformation of Chaplaincy Training.
- Massey K. Reflective Practice: Formation and Supervision in Ministry. 2014.
- “The field of chaplaincy must study itself to learn what measurable outcomes can be found.”
Trends Underway at Advocate Aurora Health
- Fee for Service -> Fee for Value • Remote work
- Evidence-based medicine
- Alignment of care with values
COVID Changed Everything:
- System Discharges were -14.5% of budgeted for 2020
- That includes patients with COVID.
- Unknown what percent of those would have had a different hospitalization in 2020.
- If you take out patients with COVID the number changes to -30.6%
- 999,491 virtual visits in AAH in 2020.
Where do spiritual care providers do what they do?
- Doesn’t line up precisely with urban vs. rural.
- Shows care provided far outside the organization’s primary and secondary service areas.
- Illustrates the inequities of those who don’t have access to internet access
Chaplain Connect (current State) – Advocate’s Telechaplaincy
- 24/7 Chaplain Service of AAH
- Originally envisioned to pilot in Q4 2020
- Launched March 29th, 2020
- Envisioned for 24/7 back up coverage for rural places, ambulatory advance care planning, and team member support
Purposeful Rounding – Identifying achievable outcomes that contribute to the larger work of the organization
- Focuses chaplain care in the acute care hospital into clearer areas with achievable outcomes
- Supporting patient/family coping to enhance compliance with treatment plan
- Identifying inequities to be addressed with interdisciplinary team
- Identifying misaligned care to be addressed with interdisciplinary team, increasingly planning to follow up about that in the post-acute stage.
- Supporting emotional and spiritual needs of team members
What would it take to re-engineer a whole field?
- Recognition that the operating model has become obsolete
- Develop customer focused requesting model
- Focus attention outside the acute care hospital to pursue outcomes once person has been discharged
- Objectify the process of training and certifying spiritual care providers, and training and certifying spiritual care providers for the new present, not the obsolete past. Includes training in outpatient settings
- Re-envision the spiritual care delivery team (spiritual care providers includes inter-disciplinary team members as generalists, and chaplains and faith community nurses and ethicists and others as specialists)
- Codify a normative language and practice model
Keynote Address: Has COVID Made Us Better Caregivers?
Donna E. Shalala, PhD President Emeritus, University of Miam
Trustee Professor, Herbert Business School and Dept. of Political Science
The impact of COVID has led to rethinking the health care system, which was already known to be fragmented with issues of disparities, lack of access, etc. There have been serious issues due to COVID including mental health and loneliness. There are those who have stepped up within the pandemic to “care for the human spirit”. COVID has brought us closer together; it has also identified our gaps. Now is the time to knit together the health care pieces to create a new paradigm of compassion.
We have a generation of children who have issues of anxiety and parents who don’t know how to support them and are more concerned about the future.
Biden administration has proposed several increases:
- Mental health
- Child care
- Support to people who work in the health care system in terms of their mental health
- Senior care, particularly mental health
- Support to all those who work in health care
COVID will fundamentally change the ways in which we provide services, not only health-related but the social issues that surround it. Spirituality must be an essential part of all aspects of it.
Dialogue: Facilitated by George Handzo, APBCC with Questions from Attendees
HANDZO: Chaplains have not traditionally been involved in lobbying. If you were to say a few words to the public about spirituality, what would that be?
SHALALA: There are 2 asks: 1) Be at the table and integrated into the decision-making processes and systems, both health and social care. 2) Talk about how your work is integral to people’s health and wellness. It’s not simply expanding Medicare and Medicaid as filling in the gap – you are the gap. What do you provide? Speak up at the table.
HANDZO: If I were to write to one of my congressional reps, what would I write about?
SHALALA: Address salaries of those working the low-paid yet essential jobs in health care and ask for a broader role for those who provide care for the spirit.
HANDZO: What is in Congress now?
SHALALA: The real play is in the budget, so pay attention to the Appropriations Committee and their members who believe in social justice. The budget has been sent; the chair for the Infrastructure Bill budget is Rosa DeLauro (CT)
What supports the patient and the public? Think about fragmentation; the current health care system isn’t integrated. While one can talk about programs and salaries, look at meal programs, childcare, and all the programs that can lift people out of poverty and care for their needs. Learn about the programs that are in place and are being recommended
Nurses, pharmacists, and nursing assistants’ roles and scope of practice are being expanded. Expanding the role of health care professionals is happening – that is a state issue.
Have to become storytellers; congressional reps are interested in the stories of the people they represent.
HANDZO: What is the role of faith community nurses; is this a place where connection can help with the fragmentation?
SHALALA: Yes, it can be the glue. Approach: Some is licensure however educating everybody is the most important. Focus not only on end of life, but wellness because spirituality encompasses both. The day-to-day of life needs to be supported.
This will be the golden age of telemedicine and telehealth. During COVID, there was limits on touching. However, the 1:1 connection is just as important and needs to be expanded whether by computer or phone. It will change the practice of health care. “Just our ability to talk to people 1:1, especially for those who don’t have access to computers. It’s a new skill set for all of us.”
Bandwidth issues: President Biden will insist on this in the Infrastructure Bill. This is a major issue being pushed and supported as a bipartisan one and has support.
Home health care: Part of the President’s Budget includes expansion of home health care, which is primarily funded by Medicaid. These positions are severely underfunded and often do not include insurance or other opportunities to advance.
Inequities and hesitation about vaccines are all symptoms of mistrust in the health system. What should we be doing to help overcome this?
- Listening, communicating, the compassion of the faith-based communities is key to getting people COVID vaccinated. “It’s only under emergency use by the FDA”. That doesn’t mean standards were lowered for approval; the same studies and requirements were followed. It was emergency-use approved to get it out quickly. The science had already been done.
- Listen to concerns, ensure they have the facts. Make sure there are people within communities that work in the health care system who can talk about it. The most credible people are those that people know; they need to be part of the education.
HANDZO: State licensure for chaplains has been a hot-topic within the profession for years. Is that a good idea?
SHALALA: State licensure is often dictated by politics, not to do with red/blue states, but the medical societies within them. If it will give more access, yes – but wouldn’t spend time on it. Instead, create models for spiritual care for implementation into health systems and work to get them integrated.
Reimbursement funding hasn’t caught up and has met a dead end. That is both a state and federal issue. It’s an issue of broadening the standard of care and integrating spiritual/faith-based practitioners into the health care system as a way of providing wellness. Until some big health care systems step up (and where they have it has been successful), convincing the government to include spiritual-based care integrated into Medicare and Medicaid system bills, it will be uneven.
HANDZO: What can we do to educate more about equity, justice, cultural diversity issues so that they can become leaders?
SHALALA: These are clear social justice issues that many faith leaders have known for a long time; there is a lot of material available. Until everyone has access to quality health care and we can lift a generation of people out of poverty, we will not have social justice.
HANDZO: What do we know now and what can be accomplished in the Biden administration regarding COVID and its variants?
SHALALA: We are on top of the science; these vaccines need to cover the variants although we may need a one-shot booster shot next year like the flu. Public policy moves slowly; to make giant steps to help the country there has to be agreement on the problem and on the solution. We can expect “big things” to be done in Biden’s first two years, i.e. the Jobs Bill, to help improve communities.
HANDZO: What should chaplains and spiritual care providers do to help bridge the gap, or should we simply move ahead?
SHALALA: Closing the gap requires both the government and the faith-based communities, they can’t been seen as separate but integrated.
HANDZO: What helped sustain and nurture you through the pandemic?
SHALALA: What kept me grounded was regularly passing out food in the community, delivering meals to health care workers, having conversations, having a dog, talking to religious leaders in the community about their challenges, music of the faith communities.
HANDZO: We know that because of the pandemic, there will be grief and anxiety; how will these be addressed?
SHALALA: The president is encouraging a large increase in mental health for all, mental health services for health care providers, and investment in the next generation for mental health providers. We have also created a new kind of chronic disease: the COVID long-haulers, which needs to be addressed. We must worry about the work force of the future (including chaplains) as much as expanding current mental health programs, which means funding and strategies from Congress as is related to the high cost/high debt of higher education.
HANDZO: What about billing for services by chaplains and faith community nurses?
SHALALA: that is not particularly a federal issue but rather state-based.
HANDZO: What are other top issues in health care?
SHALALA: Health care has been shifting to outpatient for a long time. Public health and population-based health will be integrated into the system in a new way that hasn’t been seen before. There will also be a larger role for pharmacies and other stores to deliver health care in a way never seen before. Telemedicine as has been mentioned along with technology. The primary health care and the social safety net . Affordability of health care for all with a sense of fairness embedded. Finally, health care regulations have been historically layered upon each other and need to be simplified. Medicare is already doing this, especially within Medicare Advantage, which offers a broad range of services, reduces complexity for providers, and makes access simpler for patients.