Religious issues and spirituality are as much a part of the nations best hospice programs as are adequate pain control and home care visits.
Many think of end-of-life healthcare as a somewhat disconcerting departure from medicines traditional “fix-it” mentality. When a curative approach is no longer the best option, palliative care takes VITAS patients to a different placeboth physically and spiritually. At VITAS Innovative Hospice Care®, “a good death” is hardly an oxymoron. It is the ultimate goal we strive to meet for the almost 9,000 patients we serve every day. Our interdisciplinary teams of physicians, social workers, chaplains, nurses, home health aides, volunteers and bereavement specialists are as alert to a patients spiritual needs as they are to decubitus and diarrhea. The common misconception is that hospice is about death. In fact, hospice is about lifesome of the most important moments in life. In 20 Common Problems in End-of-Life Care (Barry M. Kinzbrunner, Neal J. Weinreb, Joel S. Policzer; 2002; McGraw-Hill), the end of life is embraced as an opportunity for growth by:- Moving through fear to peace
- Moving through despair to hope
- Moving from isolation to community
- Moving from loss to closure
Any one of these can improve a hospice patients quality of life immeasurably. For that reason, every VITAS hospice team includes a social worker and chaplain with extensive training and experience in spiritual awareness, end-of-life issues and bereavement. Often they are the only spiritual advisors a patient sees, but they also can work with the patients physician and religious advisor to ensure a holistic prescription for quality of life.
Not every patient is open to spiritual care at the end of life, and those wishes must be respected. “Spirituality is an individual concept,” notes Thom McLeod, Bereavement Services Manager of VITAS Palm Beach County Program. “But patients who say they dont need spiritual support to help them through the dying process are sometimes the very persons who need it the most.”
Paul Veliyathil, Home Care Chaplain for the Miami-Dade VITAS program, agrees. “There certainly is no formal religious aspect to our team members visits unless the patient and family specifically ask for it. But our training helps us gain acceptance from the patient and family, hear their concerns and offer non-judgmental support.”
When spiritual care is declined, VITAS hospice team members work together to find non-threatening, non-intrusive ways to include support and companionship in the patients care plan. Perhaps the chaplain accompanies the admitting nurse at the initial patient assessment. Or the social worker is introduced by the nurse as a member of the team who occasionally accompanies her on her rounds.
Whatever the method, the results are always worth the effort. “The level of intimacy achieved when we address the spiritual concerns of any patient,” Veliyathil has found, “opens the door to a vulnerability that can be rich with meaning.”
Spiritual support is so important in end-of-life care that it is legally mandated. “Psychosocial/spiritual support is a basic component of the Medicare Hospice Benefit,” notes Dian Backoff, General Manager of VITAS Broward program. “Heres a case of the government doing the right thing, because the last days of life dont need to be painful or lonely or confusing. With spiritual support, the last days of life can be an opportunity for growth, remembrance and closure.”
Professionals and lay people who would like to know more about providing spiritual care and companionship to the terminally ill should read Parting: A Handbook for Spiritual Care Near the End of Life by Jennifer Sutton Holder and Jann Aldredge-Clanton, published in 2004 by UNC Press in association with the Foundation for End-of-Life Care and the P.L. Dodge Foundation. It is available at bookstores or at www.uncpress.unc.edu.
