September 20, 2017
National Consensus Project Clinical Practice Guidelines for Quality Palliative Care, Fourth Edition, Being Developed PlainViews Staff OPEN ACCESS
Spiritual Care Consult Screening as a Part of Staff Rounding Brian C. Sayre
What Do Chaplains Do About Bigotry and Hate? George Handzo
New Book Reflects on the Limitless Potential of the Human Spirit Marian Betancourt
A Window into Pastoral Care in Israel Miriam Berkowitz and Aliza Pilichowski
Chaplains Weather the Storms in Houston and Florida Marian Betancourt
It Is About the Money
Editor’s Note: George Handzo blogs regularly on his website.
I have devoted a lot of time and energy over the past several years to the development of the "evidence" for spiritual care and chaplaincy. That means mainly guidelines and studies with numbers. We have made some major gains over that time. The 3rd edition of the NCP guidelines and the research of Tracy Balboni and colleagues and Deborah Marin and colleagues are major examples. The case for the inclusion of spiritual care and chaplaincy is much more compelling today than it was 10 or even five years ago. And yet, despite the fact that spiritual care is named as a required service in virtually every model for palliative care, study after study continues to show that chaplaincy (and to a lesser degree, social work) lag behind and are the most often omitted members of palliative care teams.
In an interview discussing this study, Dr. Sean Morrison said:
“We've seen really a tremendous growth in the number of advance practice nurses that are in the field. We've also seen a growth, you know, an accompanying growth in terms of the number of physicians. But where we, as you said, we still have a lot of room for improvement is both in social work and in chaplaincy. And it's perhaps not surprising that those are the two disciplines where they can't bill for their services. And I think a large part of the lack of growth in those two areas is because of finances.”
Recently I reviewed and submitted comments on two documents outlining guidelines for community palliative care. In both, spiritual care was included. In one case, the document stated that spiritual care should be provided "when reasonable". In the other case, "availability" was all that was required. Further investigation convinced me that at least a part of the issue in each case was the presumed costs of chaplaincy. This will certainly amuse or anger many chaplains who know how little money most institutions invest in spiritual care and how cheap it is. While we should continue to develop "evidence" in all forms, we need to go after the money issue directly and aggressively.
Why is this happening? What is missing?
There is no silver bullet here of course but at least in part, I think we have not focused on making the business and financial case justifying the value of what we do. Years ago, the values of health care, the reimbursement structures and the lack of spiritual care research would have made that task impossible in a convincing way. I and others now believe that the situation has changed dramatically. It is now entirely possible and essential to the survival and growth of spiritual care that the case be made both in general terms and in terms that are customized to each institution.
What needs to happen for that case to be made in a convincing and widespread way?
Again, this is not the time for turf wars or "we are the best" talk. We want to see all our associations grow and thrive. What we should be caring about is how we are supporting each other in making a difference, not for our association, but for the patients we serve.