Pandemic alters delivery of sacraments in health care settings

September 1, 2020
Fr. Warren Harvey celebrates Mass at CHI St. Vincent Infirmary in Little Rock, Arkansas, in May. In the midst of the pandemic, he and other ministry chaplains have been adjusting how they administer the sacraments, following the guidance of the Catholic Church.
© Arkansas Democrat-Gazette

Several of the sacraments that ministry pastoral care departments administer are highly intimate, involving close personal interaction and touch. For instance, during the sacrament of the Anointing of the Sick, a priest normally uses his bare thumb to apply blessed oil to a patient's forehead and hands. In Holy Communion, a priest or eucharistic minister may place a consecrated wafer on a patient's tongue or put it into the cupped palm of the communicant.

Because of the high risk of contagion during the COVID-19 pandemic though, those high-contact protocols are not permitted in many health care settings. The pandemic creates what canon law defines as a "grave reason" to don personal protective gear and use a surgical glove and/or a cotton ball to anoint a patient, or make other adaptations as needed for public health.

As part of their pandemic protocols, some hospitals and nursing homes have defined clergy members as nonessential personnel who are prohibited from entering the rooms of COVID-19 positive patients, or even the entire facility. In those cases, some spiritual care providers minister over the phone or iPads. Priests may offer "spiritual communion" in lieu of a consecrated wafer or special indulgences at the point of death for the faithful who have been unable to receive the Last Rites.

Meyer McGrath

Carrie Meyer McGrath, CHA's director of mission services, said pastoral care departments throughout the ministry began adjusting their protocols early in the pandemic, and several CHA members reached out to CHA for input and resources. "It was work that had to happen," she said, adding that members of the CHA pastoral care advisory committee she staffs "wanted to do the work together."

Working with peers at the National Association of Catholic Chaplains, the CHA committee drafted general guidance for the administration of the sacraments in health care settings which were adopted by both associations. With so many variations of circumstances in facilities and localities across the U.S., the guidelines are necessarily broad and allow for prudent situational judgment, said Meyer McGrath.

"Guidelines for Sacramental Celebrations in a Health Care Setting During COVID-19" has a grid format that sets out safe practices during COVID-19 surges when contagion risk is extreme, during periods when there are both COVID-positive and COVID-negative patients in a facility, and during periods when a facility may have no known COVID positive patients and remains on guard against contagion.

"Reminder of the Fundamentals for the Sacrament of Anointing the Sick," another joint resource from the associations, encapsulates Catholic teaching on end-of-life rituals during exceptional circumstances including the current pandemic. There also is a Q & A on sacramental practices during the pandemic. All the resource materials can be found at

The documents incorporate input from infection control specialists and from the United States Conference of Catholic Bishops.

Urgent response
CHA pastoral care committee member Tim Serban is Providence St. Joseph Health's regional spiritual health officer for Oregon and the system's disaster spiritual response leader. He said the committee members had a shared sense of urgency about the work that overcame their apprehension over offering guidance on the distribution of Holy Sacraments in health care settings. "This resource needed to be available to health systems who have had to confront these challenges in real-time," he said. The guidance resources were distributed by email to CHA members in late June.


As part of its research, the committee reviewed a variety of guidelines related to the pandemic from multiple dioceses. Serban said, "Guidelines which were being developed in dioceses were primarily focused on reopening parishes, with the direction that anyone who was ill should remain home." There was little to no specificity about sacramental protocol in health care settings where visitors and pastoral staff could be a source of contagion, or at risk of contracting coronavirus.

Meyer McGrath said, "Those we serve are more vulnerable than the general population and so the guidelines had to be a bit more restrictive. This was especially true regarding our long-term care facilities."

Serban said in drafting the guidelines, careful attention was paid to preserving sacramental integrity while following strict infection control procedures.

The guidelines also address the safe delivery of compassionate pastoral care in acute and long-term care settings and safety protocols for reopening chapels to provide a space for prayer and solace for caregivers, patients and families.

Made to order
Deacon Tom Avery, palliative and hospice spiritual care coordinator for Trinity Health at Home, said each interaction with a patient or family leads to new learnings about what best suits their particular needs. "One size fits all is not in my vocabulary any longer."


Before the pandemic, Avery said he felt that being physically present with a patient was foundational to his spiritual work. But now, having prayed with and for patients over a telephone, he understands that God's presence does not depend on the physical proximity of believers to each other.

Fr. Lawrence Chellaian, a CHA pastoral care advisory committee member, is vice president of mission integration at CHRISTUS St. Michael Health System in Texarkana, Texas. Fr. Chellaian said when one of his directors was having conversations with a local clergy member who requested unrestricted access to all units in the hospital in order for him to provide sacramental services, the guidelines helped the director highlight the importance of safety considerations and the opportunities to provide pastoral services in nontraditional ways.

Dynamic learning
David Lichter, executive director of the National Association of Catholic Chaplains, said respective professional competencies commissions — including his organization, the Association of Professional Chaplains and Neshama: Association of Jewish Chaplains will assess whether chaplains continue to routinely provide virtual spiritual care post-pandemic, and, if so, whether that shift will require more professional preparation.

"As you can imagine, we are still in the midst of providing such service, and our members are sharing and learning from each other best practices while being creative and responsive. It will take some time to determine what will be the enduring practices that will be core practices," he said.

Serban said Catholic health care will emerge from the pandemic with new concepts of care delivery and new ways to imagine pastoral and sacramental ministry.

"As we come through this living storm," Serban said, "I pray we will emerge with a deeper understanding of the value chaplains are as essential meaning makers in the journey of life and death."

Julie Minda contributed to this report.



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