July 19, 2017
Everyone Can Contribute to the Profession: Here's How Sue Wintz OPEN ACCES
Integrating Pet Therapy into Spiritual Therapy (August 17, 2016) Nancy Lynch OPEN ACCESS
New Year's Resolution: Being Able to Support What We Claim (January 20, 2016) George Handzo OPEN ACCESS
Treating Moral and Spiritual Injuries Among Military Combatants (September 16, 2015) William D. Smith OPEN ACCESS
A Pilot Project for Outpatient Screening for Chaplaincy Services (April 14, 2015) Andrew Simkins OPEN ACCESS
Spiritual Assessment for Early-Stage Dementia Patients (July 2, 2014) Jennifer Mahru OPEN ACCESS
Hope: A Clinical Catalyst (November 20, 2013) Doug Longstaffe OPEN ACCESS
Diagnosis: Meaning Fatigue (July 17, 2013) Holly Gaudette OPEN ACCESS
Touching Lives: The Voices of Two Chaplains (June 6, 2012) Vera O'Brien and Katy Z. Allen OPEN ACCESS
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.