Learning from a Home Health Chaplaincy Research Project
Guest post by Rabbi Sara Paasche-Orlow BCC, and Mandi Rice, MDiv
At the beginning of 2020, Hebrew SeniorLife began a modest study in collaboration with the Chaplaincy Innovation Lab (CIL) and funded by Combined Jewish Philanthropies (CJP). We set out to measure the impact of in-person chaplaincy visits on the degree of isolation experienced by frail elders living in their own homes and receiving assistance from a home care service. In light of the COVID-19 pandemic, this project unfolded quite differently than we had imagined. Our experiences provide context for others looking to offer and/or research chaplaincy care during the pandemic.
Our initial plan was to offer chaplaincy care to HSL Home Care clients — elders living at home and receiving support with activities like cooking, cleaning, and bathing. Our model relied on referrals from Home Care aides who see these elders on a regular basis. A chaplain and chaplain educator would train Home Care aides in using a simple tablet screen to refer clients who might benefit from chaplaincy. Then the chaplain would use the Lubben scale to measure isolation before and after the chaplaincy intervention. We received IRB approval and completed the training with Home Care aides (two workshops explaining spiritual care and introducing the screening tool).
Then the COVID-19 pandemic hit.
Faced with new priorities and challenges, aides made very few referrals to us. We simultaneously needed to transition to telechaplaincy to lower exposure risk for patients and chaplains alike. Finally, the pandemic and associated protocols for social distancing and stay-at-home orders meant that a much wider group of elders faced extreme isolation.
We made the decision to discard use of the referral system and the isolation scale, and have the chaplain simply cold call a group of Home Care clients to offer spiritual care support. We were only able to call private pay clients due to the restrictions set by Aging Services Access Points (ASAPs) serving other clients (that were non-negotiable during the pandemic).
The impact extended to professional colleagues as well
Our chaplain’s calls to 29 Home Care clients resulted in ongoing tele-chaplaincy with 25 clients. It was important that the chaplain was affiliated with HSL, as that gave her credibility and gained client trust. Patients who participated in tele-chaplaincy also received a picture of the chaplain with some information about her so they would have a visual connection, as well. This chaplain concluded her work at the end of September and felt that her calls were helpful to people, providing another contact point and spiritual support during a stressful period. The impact extended to professional colleagues as well: based on the relationships forged during the initial trainings, the chaplain was also able to provide some support to the aides.
We made the decision to try again in the fall with a modified program, this time in our Home Health service which provides nursing and rehabilitative care to clients in their homes. Home Health leadership thought it would be a very welcome addition to the care, and a group of Home Health nurses and therapists agreed to offer this opportunity to their patients. These colleagues received a page of information about spiritual care and potential benefits to patients, and invited elders to participate in several weeks of conversations with a chaplain. The chaplain only received 5 referrals, two of which translated into patient cases. Because of our short timeline and the time needed to get an adjustment approved by our IRB, we did not pivot to recruiting via cold-calling.
Full relationships are possible in tele-chaplaincy
We learned from these experiences to keep the referral process simple. The best method for connecting with patients appears to be cold calling and not working with a screen – in particular during the pandemic. In addition, some patients/clients were wary of making a commitment, so the consent process for a multi-week study was a barrier to accepting care. For many patients, it appears that simply accepting one visit was easier.
We also learned that full relationships are possible in tele-chaplaincy, especially when the patient or client is able to verbally make their needs known, as there is not the usual opportunity to gather non- verbal and environmental clues. If the patient is verbally expressive of their needs it can lead to a very powerful chaplaincy experience.
A chaplain could provide additional psychosocial care to augment medical caregivers’ impact
As we concluded our grant, Home Health leadership reflected that although providers supported the idea of chaplaincy care, they did not act as if they understood that chaplaincy might aid and support their own efforts in patient care. In future outreach, we would also emphasize that chaplaincy could possibly save time for other members of the interdisciplinary team, as a chaplain could provide additional psychosocial care to augment medical caregivers’ impact.
Yet while we had not previously provided chaplaincy to Home Health or Home Care clients, we found that the leadership of these programs were eager to involve chaplaincy as another service for their patients and welcomed the assigned chaplains. We learned more about the rhythms of care in this area — for example, that Home Care admits an influx of new patients before major holidays, as families bring their loved ones home from inpatient care. So, the time after holidays could be an especially fruitful time for cold-calling new patients. This grant and research experience provided us the opportunity to connect and collaborate with these teams, and to extend the reach of our spiritual care into new parts of our health system.
We would like to express our thanks to the patients who participated, and to our collaborators for their help: Rebecca Arbouet MSN, RN-BC; , Maureen T. Bannan, RN, MA; Wendy Cadge, PhD; Shirah Hecht, PhD; Rabbi Beth Naditch, BCC; Zoe Pringle; Petra Sprik, M.Div.; and Rabbi Mona Strick.