Professional Practice

Traditional Rhythm of Care in Hospice: Measurability and Progress Towards Plan of Care Goals

Dr. Saul Ebema

With the new CMS requirements for hospice plan of care to be individualized, time specific and measurable, here is how this can be done through my understanding of the traditional rhythms of spiritual care in Hospice. In the traditional rhythm of spiritual care, the hospice chaplain directs spiritual care through traditional methods of sacred texts, sacred symbols and rituals, devotionals, and communal worship.

Measurability and progress in the traditional rhythm

In the traditional rhythm of spiritual care, hospice patients and their caregivers seek spiritual comfort and encounter with the Holy in ways that appear immediate, intuitive, and unquestionable.

Below is a sketch of examples of plan of care orders, progress towards the plan of care and measurability of the plan of care.

PLAN OF CARE ORDERPROGRESS IN 2 WEEKS PROGRESS IN 4 WEEKS
Sacred text reading and prayerPlan of care is still effectivePlan of care completed
Patient needs anointingPlan of care completed
Patient needs communion/EucharistPlan of care completed
Patient wants chaplain to provide spiritual support through worship songs and musicPlan of care is still effective
Patient asked for baptismPlan of care completed
Patient asked for rosary, bible or religious itemPlan of care completed
Patient and spouse want chaplain to facilitate vow renewalPlan of care completed
Patient and partner want to get married and asked chaplain to officiatePlan of care is effectivePlan of care completed
Patient requested for chaplain to provide devotionals during chaplain visitsPlan of care still effective

IDT NOTES: WORDING MEASURABILITY AND PROGRESS IN THE TRADITIONAL RHYTHM OF SPIRITUAL CARE IN HOSPICE

EXAMPLE ONE

Chaplain plan for the last two weeks: In the last two weeks, chaplain completed the initial visit assessment.

Funeral/Memorial needs: Family have asked chaplain to facilitate the service when the moment comes.

Available community spiritual/religious support: The patient’s faith community is not involved. Therefore, chaplain and family remain the source for spiritual support.

Current spiritual needs/Issues to be addressed: According to the family, patient enjoys the reading of sacred texts and prayers.

Chaplain plan for the next two weeks (Include visit frequency and evidence of declining status): The current chaplain visit frequency is once a month. In the next two weeks, chaplain will visit the patient to help sustain his sense of relationship with the Holy through sacred texts and prayers. According to the family patient’s health has declined a lot in the last three months. Patient seems weak and his verbal responses are minimal.

SAME PATIENT

FOLLOW UP EXAMPLE TWO

Chaplain plan for the last two weeks: Since chaplain’s visit frequency is only monthly, in the last two weeks, chaplain didn’t visit the patient and there were no requests for a PRN visit from the patient or family.

Funeral/Memorial needs: Family have asked chaplain to facilitate the service when the moment comes.

Available community spiritual/religious support: Chaplain and family remain the only source for spiritual support for the patient.

Current spiritual needs/Issues to be addressed: Chaplain will continue with the current plan of care of reading scared texts and prayers.

Chaplain plan for the next two weeks (Include visit frequency and evidence of declining status): In the next two weeks, chaplain will continue with the current plan of care. Since chaplain only visits patient monthly, chaplain was able to read the case manager’s notes and the patient continues to decline and remains hospice appropriate.

SAME PATIENT

FOLLOW EXAMPLE THREE

Chaplain plan for the last two weeks: In the last two weeks, chaplain visited patient to help sustain his sense of relationship with the Holy through the reading of sacred texts and prayers. Patient enjoyed the readings and participated in the reciting of some of the prayers. Patient felt comforted and peaceful. Patient asked chaplain to incorporate worship songs in the next chaplain visit.

Funeral/Memorial needs: Chaplain will officiate the service when the moment comes.

Available community spiritual/religious support:  Chaplain and family remain the only source for spiritual support for the patient.

Current spiritual needs/Issues to be addressed: Faith affirmation through worship songs.

Chaplain plan for the next two weeks (Include visit frequency and evidence of declining status): The current chaplain visit frequency is once a month. In the next two weeks, chaplain will visit to help affirm his faith through music and worship songs. Compared to chaplain’s last visit, patient’s health has declined and he seems much weaker.

SAME PATIENT

IDT DEATH NOTE EXAMPLE

Issues surrounding the patient’s death: Patient died peacefully. There was nothing unusual noted or stated by family.

Funeral/Memorial needs: Chaplain will officiate the funeral/memorial service

Available community spiritual/religious support: Chaplain remains the sole of spiritual support for the family.

Bereavement Risk- low, moderate, or high: Family is grieving appropriately, and the bereavement risk is low.

Hospice Chaplaincy is a nonprofit organization committed to promoting excellence in spiritual care at the end of life. We are committed to the belief that people from all backgrounds, cultures and faith traditions should experience the end of life in a way that matches their own spiritual/religious values and goals. The task of dying is complicated and often confronts us with lots of spiritual, emotional and physical suffering. Hospice Chaplaincy is dedicated to providing support and professional development resources for hospice chaplains, patient advocacy, and education services to the public, to create a cultural shift to inform and transform our thinking around the psychosocial and psychospiritual issues at the end of life .

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