once again I haven’t written in a while. once again due to feeling incredibly busy.
We had a speaker at our hospice a few days ago who talked about how social workers and chaplains tend to be seen as mildly irrelevant in hospice care. Many chaplains, for example, routinely carry caseloads of over 100 as well as on call duties. I know one chaplain who has over 100 patients and a church. That to me is insane.
Given the fact that I have about 80 patients, and only about 60 of those I see regularly, I should feel like I’m on a luxury cruise. However that’s hardly the case. Admissions happen on an almost daily basis, and these require quick attention even though the impulse is to put them off until absolutely necessary. A quick phone call to the family or patient can usually tell you how much of a problem there may be, so that can help to prioritize things.
But then there are emergencies like declining patients. Our company likes to have social workers and chaplains do afternoon visits on patients who may be actively dying. When your caseload is over half of the entire census though, it can easily become a practical nightmare if you have two people declining at the same time at opposite ends of your territory. Our company also likes to give our patients a birthday party which our staff are obligated to attend. Again, this is a good and fun thing. And you get cake. But the parties can often be scheduled at the last minute and require a long drive out of your way in the middle of your day.
My patients are all seen at least monthly unless they explicitly decline services, and some are seen more often. Sometimes that increased visitation is due to need and other times due to them just being lonely and wanting extra support. As we currently don’t have a pool of volunteer visitors, it’s easy to feel torn. The social workers typically see our patients 2-4 times per month, but have smaller caseloads. Rightfully so, as they tend to manage more crises such as emergency placements for respite and the occasional family meltdown.
All that is to say that it’s quite easy, and common I think, for chaplains to feel that they aren’t doing enough or doing a good job, as there always seems to be more that could be done. That’s not necessarily should, mind you. I often feel as if I could have spent more time, called the family more often, or just done a little more than I did. This is especially the case when you see others (nurses, social workers, etc.) actually doing more. But I often feel like I can’t do more. I have to be somewhere else with someone else. This violates one of the central features of chaplaincy of course, which is being present with the person. It’s hard to be present when you’re preoccupied with how traffic will be on the way to your next visit and how many others you have to make before you see the person at the end of the day that you had to add on at the last minute.
The solution is, quite simply, to not care so much. It sounds horrible but it’s true. I can care too much – so much so that it distracts me from doing what I should be doing. But I must be careful to care less about the things that I should care less about; keeping to my arbitrary schedule, being late or even skipping patients that can be skipped.
At times I feel as if I have to step out of the room (the metaphorical room of hospice work, that is) and out into the hall to re-evaluate what I’m doing and why I’m doing it before I can go back in. At times I do this with sadness and anxiety, other times with peace and joy. But every day I have to give myself a reason as to why I’m going back in to that room. Sometimes it’s because of a particular patient or family, other times it’s for a paycheck, other times because there’s work left to be done.
We don’t choose callings, they tend to choose us. From time to time we have to all reflect on that calling and see if we can still carry the mantle handed to us.
4 thoughts on “Standing in the hallway”
I love hearing the other side of things. I am a volunteer for Providence Hospice in Portland. I never see any of the other care team. It wasn’t until recently I even got to see their names on the report that was sent to me prior to my visits. I have learned the value in quality of time spent. Depending on the PT I spend 1-3 hours with them. If it is in a care facility usually it is just an hour once a week. But even though it is only an hour I feel I obtain such a strong connection with them. If you are ever in Portland I recommend going to some workshops at the Process Work Institute. Our chaplain frequents the institute and it is open to the public. Thanks for sharing your story!
thank you for this message. It is a struggle, being a minister, full of care, and knowing how much of our care-full hearts to leave with each broken heart we touch. I feel your words to ‘care less’ are wise and not to be seen as support for being ‘careless’, but instead they are an affirmation to empower each patient with a connection to a source of care that does not deplete our own. I am grateful for this conversation.
Thanks for articulating so well the predicament that so many chaplains (and so many parish clergy) feel. Seems like you have taken a route which at least helps you avoid the burnout that so many fall victim to and thus continue to provide good care for those you are able to see. I think the reality is that chaplains and probably social workers as well will never have “enough” staffing as far as we are concerned. So what to do? A major help for many is to have screening for spiritual distress be part of the regular intake screening for the hospice or hospital. This at least points you to those who really have spiritual needs. What then tends to happen is that more spiritual need surfaces than you can meet. The agency then has to get more chaplaincy staff or accept that they are not meeting all the spiritual needs of their patients and families.
Thanks so much for your comment George. Avoiding burnout is extremely important and at the same time very difficult. I think often I expect my manager(s) to know what’s going on in my schedule and work life, but I realize over and over again that this is not the case.
Our hospice is still very much in start-up mode at just over two years old, but our growth has been staggering. That growth largely comes due to the commitment of our staff to go over and above, as with the birthday parties I mentioned. But that growth happens when we aren’t prepared for it. The ways of doing things when you’re at 40 don’t work when you’re at 80 or 100. The processes haven’t caught up yet. But changing the process takes time and flexibility, and when you’re running full steam ahead you have less of both.