sa15 - front porch ministry - front porch... · front porch ministry chaplains building informal...

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Front Porch MinistryNACC Chicago April 23, 2016

John Heath Hilda Lethe-Drake

Th.M, BCC MA, BCC

Providence ElderPlacePortland, Oregon

For Old Age John O’Donohue

May the light of your soul mind you.

May all your worry and anxiousness about your agebe transfigured.

May you be given wisdom for the eyes of your soulto see this as a time of gracious harvesting.May you have the passion to heal what has hurt you,and allow it to come closer and become one with you.

May you have great dignity,sense how free you are;above all, may you be given the wonderful giftof meeting the eternal light that is within you.

May you be blessed;and may you find a wonderful lovein your self for your self.”

Welcome: How many of you work with Elders? In Long Term Care? In other venues? How many of you have been a chaplain 5-10 years? Less than 5? More than 10?Share with one other: “What do you love most about your work?”

Chaplain John Heath• Evangelical Free, Th.M/BCC

• 9 years, Chaplain (3 ElderPlace sites)

• 25 years, Pastor at two parishes

Chaplain Hilda Lethe-Drake• Roman Catholic MA/BCC

• 10 years a Chaplain (2 Hospital 8 ElderPlace)

• 27 years Parish & Archdiocesan Ministry

Chaplains Building

• Informal Relationships

• to

• Improve Spiritual Care

• and

• Caregiver Team Health

in Long-Term Care Facilities and Programs

Front Porch Ministry

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ElderPlace in Oregon

• A Program of All-inclusive Care for the Elderly (PACE)

• We have 10 sites with 1,031 participants.

• Gresham is our largest site.

• Milwaukie is our newest/smallest site.

• 3 are residential

• 7 are day centers only

What does it mean to be medically eligible for long term care?

In order for Medicare to determine medical eligibility,

A. The individual's doctor must complete a standardized form

– In this document, the doctor will provide information about1. the individual's diagnoses2. medications,3. need for assistance with activities of daily living (bathing, dressing, transferring, eating and toileting)4. and need for supervision and ongoing medical care.

B. Medicare uses this information to determine if the individual is in need of

nursing home care and to determine a level of care.

Our population is changing at ElderPlace

• Chaplains are more likely to be the guest of participants than the other way around.

• In California where Pace started many Elders lived in their own homes with family or in home help.

• In Oregon many people live in Adult Care Homes.

• Many of our people have a dual diagnosis.

• They are both more ill and younger than our population was 10 years ago.

goals...

1. PACE prides itself on maintaining independence;& providing supports so that people can live in the least restrictive environment.

2. Providence Mission includes serving the poor & Vulnerable.

3. Hilda’s golden rule for Front Porch Ministry is:

Cultivate Small Talk; Always be curious,

Smile and say Hello.

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“The only way for individuals, families and societies to grow, the only way for the life of peoples to progress, is via the culture of encounter, a culture in which all have something good to give and all can receive something good in return.”

Pope Francis

Every time you smile at someone, it is an action of love, a gift to that person, a beautiful thing.

Let there be kindness in your face, in your eyes, in your smile, in the warmth of your greeting. Always have a cheerful smile. ...

We shall never know all the good that a simple smile can do.

Mother Teresa.

Never underestimate the power of a smile

• Like taking a deep breath and flooding your brain with oxygen; smiling has big benefits.

• A smile communicates good will and cheerfulness, and openness to the good the other has to offer.

Hill and Hodgesin Help is Here advise:

• Keep the Mood Happy

• & Never Argue

• Be in their world

Be Happy… Never Argue

• “ The key is to distract your family member, then change the subject without provoking a confrontation.”

•OTHER USEFUL PHRASES

•

“Wow. I didn’t know that”•

“No Kidding!” “Tell me more”

One that works great with my mom…•

“You’re probably right..” or “I’m sure you’re right.”

The more we practice these the more they become second nature.

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Be Happy… Never Argue

• Don’t worry about small problems.

• Say it again and again. Say one thing at a time.

• Always be in THEIR world. Ordinary Rhythms of Life.

• Visiting. “If your family member who has dementia lives in assisted living or memory care think about what you might talk about before you go and visit… consider bringing a treat… you need to take the lead.

• For Chaplains keep the spiritual assessment in the back of your mind

mining small talk to gather information.

The BF Elements of Friendship (Virginia Bell & David Troxel) –

• Friends Know Each Other’s History and Personality (Rev. Brown)• a best friend becomes a person’s Memory• is sensitive to the person’s traditions• learns the person’s personality, moods, + problem solving styles

•Friends Do Things Together (E.K.)• involves the person in activities and chores• initiates activities• ties activities to the person’s past skills and interests• encourages the person to enjoy the simpler things in life• remembers to celebrate special occasions

•Friends Communicate (A.D.)• listens skillfully• speaks skillfully - asks questions skillfully• speaks using body language• gently encourages participation in conversations

•


• Friends Build Self Esteem (Jeanne L)• gives compliments often• carefully asks for advice or opinions• always offers encouragement• offers congratulations

•Friends Laugh Often (Ron & A.M)• tells jokes and funny stories• takes advantage of spontaneous fun• uses self deprecating humor often

•Friends are Equals (Francesca)• does not talk down to the person• always works to protect the dignity of the person, to “save face”• does not assume a supervisory role• recognizes that learning is a two-way street


• Friends Work at the Relationship

– is not overly sensitive (Mr. A)

– does more than 50% of the work

– builds a trusting relationship

– Shows affection often

The Best Friends Approach to Alzheimer’s Care,

by Virginia Bell and David Troxel.Copyright 1977, by Health Professions Press,Inc.,

Baltimore

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Spiritual Assessment


(NOTE: Delete italicized text when using this smartphrase)

Spiritual/Religious Tradition:

History of spiritual/religious practice, beliefs, community:

Current Belief/Practice/Religion: Verify their current Religious Preference and then go to Demographics section of EPIC and make sure that it is correct, if not enter corrected information

Clergy/Spiritual Support Person: (include contact information, AND put in "Contacts" section of "Demographics" to the extent you have participant/POA permission to do so)

Current Faith Community: (include contact information AND put in "Contacts" section of "Demographics to the extent you have participant/POA permission to do so)


• Social History (from Social Work Assessment):

(copy/paste pertinent part from SW Assessment note)

• Cultural Identity: What is most important in how do you identify

yourself as a member of the larger community? Things like Nationality,

Ethnicity, Race, Language, Gender, Sexual Orientation, Age group,

Birth order in family, Relationship to place (country/city person,

state/local/regional affiliation, geography), School affiliation

(Beaver/Duck), Physical

Abilities/Disabilities/Attributes/Strengths/Weaknesses (Blind, Deaf, Tall,

large, Strong, Intelligent)

• Personal Support / Family Information: Important family/personal

support relationships, main contacts, estranged relationship that my

impact participant health and care


• Meaning and Joy: Who/what brings meaning and joy? would some

prompts from #1 above work here? Maybe school affiliation, physical

abilities/disabilities/attributes, skills/gifts

• Service/Vocation/Work: How have you engaged in service to community,

country, world? (Military, volunteer work, ministry? Vocation/work you felt

called to?) Include Skills/ Gifts: (Musician, Artist, Writer, Athlete, Friend,

Listener, etc.)

• Renewal: What do you do to refresh and renew yourself? (Hobbies,

recreation, fun? Life Enrichment Assessment may help.)

• Sorrow / Grief / Regret / Guilt / Shame (past): Anything the person is

still integrating? Include major losses and traumas?


• Concerns, Worries, Fears (present/future): Worries from present

regarding own life, beloveds, the world? Fear for the future?

Existential angst?

• Coping: What helps you get through hard times in life? For

participants with limited communication, what is observed/reported to

bring calmness, peace, relief of tension/distress/anxiety?

• Death: What would a good death look like? Or how would you not like

to die? What would be a “bad” death? What do you believe happens

after we die? Do you have any fears or worries about

dying? Memorial service plans / wishes?

• Anything else I should know?

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• Visit/Intervention Narrative: Describe the setting for the visit;

observations of participant and their overall condition and interactions;

other people present; flow of the encounter; therapeutic/relational/spiritual

interventions used; and other people/sources contacted/used to obtain

information for the assessment.

• Assessment Summary & Chaplain Follow-up:

diagnostic assessment, planned interventions

• Participant involvement:

Participant and/or responsible other party have participated in the

development of this plan of care and agree with it.

What is your experience with Elders and small talk and smiles?

• In small groups of two or three please share how informal conversation

has given you insights to the spiritual needs of those you serve.

• What are some of your tips for

starting small talk …

or informal conversations?

Front Porch Ministry

Chaplains Building Informal Relationships to Improve Spiritual Care and Caregiver Team Health in Long-Term Care Facilities and Programs

It’s all about relationships!

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The Importance of Relationships

The most important single ingredient in the formula of

success is knowing how to get along with people.

--Theodore Roosevelt

In real life, the most practical advice for leaders is not to

treat pawns like pawns, nor princes like princes, but all persons like persons.

--James MacGregor Burns


Trust men and they will be true to you: treat them gently and they will show themselves great.

--Ralph Waldo Emerson

When dealing with people, remember you are not dealing with creatures of logic, but creatures of emotion.

--Dale Carnagie


I am convinced that nothing we do is more important than hiring

and developing people. At the end of the day you bet on people,

not on strategies.

--Larry Bossidy

CEO, Allied Signal

You can take my factories, burn up my buildings, but give me my people and I’ll build the business right back again.

--Henry Ford


The soft stuff is always harder than the hard stuff.

--Roger Enrico

Vice Chairman, Pepsico

How far you go in life depends on your being tender with the young, patient with the old, sympathetic with the striving, tolerant with the weak and the strong, because someday in life you will have been all of these.

--George Washington Carver

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Relationships are important but

do you believe they are?

We need to blast before we build!

Relationships thrive when

physical, emotional, mental and

spiritual needs are met.

Spiritual Needs Are Important in Work SatisfactionPeople feel better and perform better and more sustainably when four basic needs are met:

Renewal (physical)

Value (emotional)

Focus (mental)

Purpose (spiritual)

--Tony Schwartz and Christine Porath, The Power of Meeting Your

Employees’ Needs, Harvard Business Review, June 30, 2014

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Spiritual Care is desperately needed

1. Physicians are burning out.

--Judith Vandewater, “Spiritual Practices, Community Building Buffer against

Physician Burnout,” Catholic Health World, January 15, 2016

2. Nurses are grieving.--Christina G. Shinbara and Lynn Olson, “When Nurses Grieve: Spirituality’s Role in Coping,” Journal of Christian Nursing, Vol. 27, No. 1

3. Productivity suffers when employees core needs are not met.

--Tony Schwartz and Christine Porath, The Power of Meeting Your Employees’

Needs, Harvard Business Review, June 30, 2014

Spiritual Care is desperately needed.

4. Employees leave when their needs are not met.

--Christina Merhar, “The Cost of Replacing an Employee,” Zane Benefits: Small

Business Employee Benefits and HR Blog, February 4, 2016

Studies on the cost of employee turnover are all over the board but a recent

study suggested . . .

• 16% of annual salary for high-turnover, low-paying jobs (earning under $30,000 a year). For example, the cost to replace a $10/hour retail employee would be $3,328.

• 20% of annual salary for mid-range positions (earning $30,000 to $50,000 a year). For example, the cost to replace a $40k manager would be $8,000.

• Up to 213% of annual salary for highly educated executive positions. For example, the cost to replace a $100k CEO is $213,000.

• So what can be done to improve

Spiritual Care and Caregiver Team Health

among staff in Long-Term Care Facilities and

Programs?

Steps to Improving Spiritual Care

• Regular spiritual practice

• Mental processing (thinking, reflecting)

• Open expression (talking, sharing, group support, laughing, crying, debriefing)

• Self-care (exercise, relaxation, proper eating/sleeping habits, stress reduction, vacation)

• Spirituality/religion (meditation, attending church, praying)

• Accessing institutional supports (chaplain/pastoral care, psychologist, support group)

• Experiencing growth (personal growth, professional growth)

• Engaging in physical and /or emotional tasks that creates meaning

• Counseling

--Christina G. Shinbara and Lynn Olson, “When Nurses Grieve: Spirituality’s Role in Coping,” Journal of Christian Nursing, Vol. 27, No. 1

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What can you do?

Build a foundation of trust and respect

• Remember that the right to offer spiritual care is gained through

trust and respect.

• In an employee satisfaction survey, one employee said, “Great bosses earn respect by giving respect.”

• You give respect when you say thank you.

• You give respect when you realize that your fellow employees are human beings, not just “resources.”

What can you do?• You give respect when you publicly give credit where it’s due.

• “Praise in public, correct in private.”

• You gain respect when you have faith in those around you.

• You gain respect when you speak well of those with whom you work.

• You gain respect when you are approachable.

• You gain respect when you respect other’s faith traditions even when they are different from your own.

What can you do?

Work on fostering excellent

relationship with your staff!

• Be real.

• Speak well.

• Show them appreciation.

• Be an encourager.

• Have a sense of humor

Work on fostering excellent

relationship with your staff!

• Know about their personal lives.

• Be aware of milestones.

• Celebrate the everyday!

• Advocate for your staff.

• Stick up for your team, not because it’s about your performance, but because you are loyal and on their side.

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It’s All About Relationship!

“The majority of us lead quiet, unheralded lives as we pass through the world. There will most likely be no ticker-tape parades for us, no monument created in our honor. But that does not lessen our possible impact, for there are scores of people waiting for someone just like us to come along; people who will appreciate our compassion, our unique talents; someone who will live a happier life merely because we took the time to share what we have to give.”

--Unknown

It’s All About Relationship!

“Too often, we underestimate the power of a touch, a smile, a kind word, a listening ear, an honest complement, or the smallest act of caring, all of which have the opportunity to turn a world around.”

--Leo Buscaglio

Closing: A Place Like No OtherBefore I came to you my life was different;

people wanted to treat my diseases as my insurance would allow,

but they never really saw me.

As the years went by…

I lost more and more control, freedom, and dignity

I became more fragile and then I came to you.

When I first came here, I told you I didn’t belong here,

and you touched me.

When I realized I did, you understood.

When I shared my life story, you listened.

When I had pain, you relieved it.

When I soiled myself, you washed me.

When I was hungry, you fed me.

When I told a joke, you laughed with me.

When I was rude, you forgave me.

When I shared my secrets, you held them in your heart.

When I was ashamed, you returned my dignity.

When I told you my troubles, you sorrowed with me.

When I was angry, you raged with me.

When I wondered about my soul, you comforted me.

When I was concerned about my family,

you brought them into the circle.

When I was dying, your thoughts, your prayers

and your presence helped me along my way.

And now that all is said and done, you remember me.

I thank every one of you who cared for me,

in a place like no other.

Bibliography• Christina Merhar, “The Cost of Replacing an Employee: Employee Retention –

The Real Cost of Losing an Employee,” Small Business Employee Benefits and

HR Blog, February 4, 2016. www.zanebenefits.com.

• Christina G. Shinbara and Lynn Olson. “When Nurses Grieve: Spirituality’s Role in Coping,” Journal of Christian Nursing, Vol. 27, No. 1, January-March 2010, 32-37.

• Joe LaGuardia, “Spiritual Needs Are Important in Work Satisfaction,” June 27, 2014. www.ethicsdaily.com/spiritual-needs-are-important-in-work-satisfaction.

• Judith Vandewater, “Spiritual Practices, Community Building Buffer Against Physician Burnout,” Catholic Health World, Vol. 32, No. 1, January 15, 2016

• Susan Hedlund, “When the Well Runs Dry: Facing Compassion Fatigue in Professional Practice.” www.oregonhospice.org/media/PPE201316Hedlund.pdf.

• Tony Schwartz and Christine Porath, “The Power of Meeting Your Employees’ Needs.” Harvard Business Review, June 30, 2014.

• Dale G. Larson (1993). The Helper’s Journey. Working with People Facing

Grief, Loss, and Life-Threatening Illness Champaign, IL: Research Press.

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Websites: www.healthyaging.net

National Pace Association: https://www.npaonline.org/websitewww.amazon.com/Healthy-Aging-Lifelong-Spiritual-Well-Being

Books:The Best Friends Approach to Alzheimer’s Care,by Virginia Bell and David Troxel.Copyright 1977, by Health Professions Press,Inc., Baltimore

HELP is Here When someone you live has dementia

by Marian O Hodges, MD, MPH & Anne P. Hill JD ISBN 978-0-615-99300-3 www.dementiahelpishere.org

Novels:Still Alice by Lisa GenovaThe Madonnas of Leningrad by Debra DeanThe Notebook by Nicholas SparksWater for Elephants by Sara GruenTangles: A Story About Alzheimer’s, My Mother, and Me by Sarah Leavitt

• Give titles to these photos… or ask…

• Which one is you? And who’s your friend?

Small Talk & SMILE Aids

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