Rural providers stretch resources to preserve pastoral care

December 15, 2012

Iowa hospital is building an endowment to fund spiritual services


Comforting family members when a loved one is in crisis in the emergency room, praying at the bedside of a hospice patient, baptizing a newborn — these pastoral services are central to Catholic health care. And, while some of the smallest Catholic hospitals, those serving rural communities, are finding it a challenge to staff and pay for these services, they are determined not to forgo pastoral care.

"People tell me, 'When I enter the hospital, I feel a terrific spiritual sense,'" said Sr. Dolores Demulling, RHSJ, director of pastoral care for Langlade Hospital, a 25-bed critical access hospital in Antigo, Wis. Pastoral services help set this tone, she said.

St. Anthony Regional Hospital & Nursing Home, a 99-bed stand-alone hospital and 79-bed nursing home in Carroll, Iowa, is likewise committed to providing pastoral care. "It comes down to finding practical solutions to ensure we have the resources" to maintain the service, said Trish Roberts, St. Anthony's development director.

According to analysis by Dr. Christina Puchalski, pastoral services can help patients cope with their illnesses, recover from surgery or handle a difficult prognosis. Puchalski is director of Washington, D.C.'s George Washington Institute for Spirituality and Health, and a professor at George Washington University School of Medicine.

Threat of cuts
Neither government nor private insurance payers reimburse for pastoral services in the vast majority of cases (some reimbursement is available for some palliative care services, particularly in the case of hospice patients). Most hospitals must find funds for pastoral care services from their annual operating budgets. That can be difficult for low-volume hospitals with small budgets, including critical access hospitals, which can have a maximum of 25 acute care beds, and for facilities informally called "tweeners" because they are larger than critical access hospitals, but too small to have the economies of scale of urban facilities.

According to the American Hospital Association, rural hospitals disproportionately rely on government payments — owing to their small size, modest assets and financial reserves, and higher proportion of Medicare patients.

Critical access hospitals receive some special consideration in Medicare reimbursement formulas to make up for their low volumes (some states provide allowances in Medicaid reimbursement formulas too). There are federal grants and programs to offset heavy losses and costs, according to information from AHA. But these hospitals are vulnerable to reimbursement cuts as politicians negotiate ways to reduce the federal budget deficit.

Even more exposed are tweeners that are "too large to qualify for critical access hospital status, but too small to absorb the financial risk associated with prospective payment system programs," according to AHA.

Funds for the future
Ed Smith, St. Anthony president and chief executive, said that with few solutions in the offing for tweener hospitals like his and with reimbursement cuts looming,

St. Anthony is focused on protecting vital services that are not money makers.

Topping the list: pastoral services. St. Anthony is the only hospital within 90 miles offering pastoral care, said Smith. Paradoxically, they chose to protect pastoral services from budget cutting by, in time, removing it as a line item on the hospital's operating budget. To secure dedicated replacement funding, St. Anthony is building a donor-funded endowment, and it is two-thirds of the way to its $3 million goal. Roberts said pastoral care delivery currently costs more than $100,000 annually — the plan is for the endowment proceeds eventually to cover the entire pastoral care budget.

St. Anthony began its fund-raising in July, soliciting seed gifts from board members and senior leaders at the hospital. It reached out to the public in October. Smith said many community members are donating to the endowment in gratitude for pastoral services they themselves or a family member received.

Human resources
Because resources can be tight at small hospitals, bare-bones pastoral care staffs with lots of responsibility are the norm. Mayo Clinic Health System Ð Franciscan Healthcare's critical care hospital in Sparta, Wis., has one, quarter-time chaplain — United Church of Christ Rev. Curtis Miller. Chaplains Vince Maly and Sr. Marcia Baumert, FSPA, share one full-time pastoral care position at the St. Francis Memorial critical access hospital in West Point, Neb. At the St. Joseph Health System in Bryan, Texas, three of five system chaplains travel to St. Joseph's three critical access hospitals — each hospital gets one chaplain visit once per week.

The pastoral care staffs typically minister to patients, families and staff members in inpatient and outpatient sites and visit homebound patients. Some have additional responsibilities at long-term care facilities connected to the hospitals. Many pastoral staffs are on call for traumas in the emergency room.

To reach as many people as possible, pastoral care professionals look beyond their ranks. At Texas' St. Joseph system, pastoral care providers regularly talk to staff about being responsive to opportunities to provide spiritual care, including praying with families and patients. St. Joseph annually hosts a spiritual care day to teach leaders about spiritual topics, so they can share that knowledge with staff.

Pastoral care providers also rely heavily on volunteer support from their local ministerial associations, particularly for patient visits, and from their communities' priests, who provide sacraments to Catholic patients.

Volunteer laity are also being recruited, trained and added into the pastoral care mix at critical access hospitals.

While Catholic hospitals of all sizes involve staff and community in pastoral care services, it is particularly important and beneficial to do so in small towns, say the pastoral care experts who spoke to Catholic Health World.

Rev. Miller said many people in rural areas value deep, long-term relationships, and so they appreciate having or building those connections with hospital staff and the volunteers providing spiritual services at the hospital.

Chaplain Maly agreed, but he noted such closeness with patients can be emotionally challenging for staff and pastoral care volunteers because it can make it even more difficult to be truly present to the people enduring health crises without absorbing their suffering.

Valued by leaders
Langlade Hospital helps ensure the continuation of pastoral services by immersing administrative and clinical leaders in the spirit of pastoral care, so that those services remain a priority for them. Sr. Demulling said meetings of the board, middle managers and committees of all types normally begin with a spiritual reflection. She said this keeps leaders grounded in the pastoral mission of the facility.

Sr. Rachel Castillo is spiritual care manager at the 25-bed St. Joseph Memorial Hospital in Murphysboro, Ill., the only Catholic facility in the three-hospital Southern Illinois Healthcare system. Sr. Castillo said she helps ensure spiritual services will remain a priority by finding opportunities to remind system and hospital leaders how much pastoral services benefit patients.

Sr. Castillo said people who come to the hospital recognize the difference that pastoral services make. "When they can choose their hospital, they want to go to St. Joseph because of the spiritual element," she said.


Copyright © 2012 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.

Copyright © 2012 by the Catholic Health Association of the United States

For reprint permission, contact Betty Crosby or call (314) 253-3490.