Lutheran denominational chaplain Rev. Ron Bestvater, diocesan ecumenical co-ordinator Celeste Woloschuk, spiritual care practitioner Simon Lasair and Catholic hospital chaplaincy co-ordinator Jacqueline Saretsky (from left) were among those speaking at an information meeting about changes to spiritual care in the provincial health care system with the elimination of government funding. (Photo by Kiply Yaworski)
SASKATOON — Hospital chaplains, pastors, and spiritual care volunteers gathered Oct. 3 for a meeting about the elimination of government-funded spiritual care services in Saskatchewan health care facilities.
Information and concerns about the new reality in the Saskatoon Health Region were provided at the meeting held at the Cathedral of the Holy Family in Saskatoon, along with suggestions about provincial advocacy and moving forward.
As part of the 2017 provincial budget announced March 22, funding for “pastoral care services” was eliminated from provincial health care, for an estimated annual savings of some $1.5 million. The impact of the announcement became reality at Saskatoon City Hospital and Royal University Hospital on Sept. 27 with the elimination of the spiritual care department in the Saskatoon Health Region (SHR). Spiritual care services continue to be offered at St. Paul’s, since it is funded through a legacy from the Grey Nuns.
The situation in other long-term care facilities and hospitals across the province varies, with some facilities like Parkridge Centre Special Care Home without spiritual care services, while others — especially faith-based facilities — continuing to offer it.
Various faith groups are striving to continue offering pastoral and spiritual care to their members, but without the support and co-ordination previously provided by the SHR spiritual care department.
But patients who do not declare a faith affiliation — some 50 per cent of those admitted to SHR facilities — will no longer receive the support that was provided before funding was cut.
At the information meeting, Simon Lasair — a former spiritual care practitioner who presently serves as the Saskatchewan Regional Admitting Chair of the Canadian Association for Spiritual Care — provided an overview of what spiritual care consists of, and what the elimination of government funding means for patients, staff, denominational chaplains and volunteers.
Every human being has a spiritual dimension, and spiritual care is a crucial form of care within public health care, said Lasair. When patients or their families face a crisis, they often need to explore spiritual questions, regardless of whether they have a formal faith affiliation, he stressed.
In addition to patients and families, spiritual care professionals in the province’s hospitals and long term care facilities also provided support to staff who are often dealing with trauma, loss or other crises, he said. “Many times in my own practise, I would have a conversation with a staff member who was experiencing an issue, and I was able to provide support.”
Spiritual care is sometimes called a “ministry of presence,” said Lasair.
“In times of crisis, spiritual care practitioners are skilled at offering emotional and spiritual support. Spiritual care practitioners who work in hospitals or long-term care are able to bear witness to the pain and suffering of the person to whom they are providing care.”
Other health professionals might be sensitive to the spiritual concerns of patients and their families, but no other health care providers are trained to care for these needs explicitly, Lasair stressed.
Certified spiritual care practitioners undergo extensive training, and have achieved at least a master’s level of academic study in theology, divinity, or the equivalent, and have acquired some 1,600 hours of specialized training in clinical pastoral education, plus an additional 1,000 hours of preparation through a certification process, Lasair said. As part of the hospital accreditation process, the national non-profit Accreditation Canada body recommends that professional spiritual care be an integral part of health care teams.
“As a result of this decision, this specialized knowledge, this specialized practise is no longer available to patients and their families in many Saskatchewan hospitals,” Lasair said. In addition, other health care professionals who already have a myriad of tasks must now operate without the support of a spiritual care practitioner.
Professional spiritual care improves health care outcomes, with research showing that it reduces the likelihood of secondary stress-related health concerns, as well as expensive interventions at the end of life, the gathering heard.
The elimination of the spiritual care department in the SHR means that many patients and families will no longer have 24-hour, on-call access to spiritual care. “There were times when I was called out in the middle of the night because there was someone in the intensive care unit who was in crisis, the family was needing support — that service will no longer be available to patients and their families,” said Lasair.
Various denominations, clergy and volunteers will continue to provide some support to some patients, Lasair said, but many more patients will not receive the support they need.
“Under privacy legislation, denominational clergy are not permitted to be contacted by hospital personnel unless there is a specific request, or unless the person requesting support belongs to their denomination. Given that there are, on any given day in the health care facilities, at least 50 per cent of people, patients, families who have no stated religious affiliation: those people are not going to get access to any spiritual support.”
The infrastructure surrounding the professional practice of spiritual care in hospitals and other care facilities has been eliminated — something which affects the pastoral and spiritual care being provided by churches and faith communities.
There is a vacuum when it comes to the connection between SHR facilities and various denominations wishing to be contacted about parishioners who are in hospital and need support — something that is particularly troublesome for smaller faith groups that do not have a regular program of patient visiting.
It was the spiritual care department that provided lists of congregation members in hospital to visiting clergy and volunteers, always operating within the bounds of privacy legislation. Without the spiritual care department to co-ordinate that service, privacy concerns may make it more difficult for hospitals to offer the service. This has already made visits by clergy and volunteers more difficult, and adds to the possibility that patients in crisis are being missed.
The spiritual care department also provided orientation and information to local clergy and volunteers around such matters as infection control and privacy legislation. Church representatives and volunteers will now have to travel to St. Paul’s Hospital for registration and paperwork.
Other services have also been lost as a result of the elimination of government funding for spiritual care departments.
“The departments, through their administrative support, were able to facilitate the provision of religious services within health care facilities on a regular or on-demand basis,” said Lasair. This included recruiting and organizing clergy to assist with services or ceremonies. Although Roman Catholic mass continues to be provided at Saskatoon City Hospital and Royal University Hospital (organized through the diocesan office of hospital chaplaincy, funded by the Bishop’s Annual Appeal), other Sunday services are no longer being offered, because of the elimination of the infrastructure needed to organize them.
At times, when patients were unable to attend significant family or life events, the spiritual care department would assist in organizing such things as weddings or funerals at the hospital chapel. “This is no longer going to happen, because there is no one to oversee what is happening in the chapels, there is no one to facilitate the services for these people who are needing to have these significant life events while in hospital.”
Jackie Saretsky, co-ordinator of Hospital Chaplaincy for the Roman Catholic Diocese of Saskatoon, described how the whole of spiritual care has fallen on the shoulders of denominational chaplains and volunteers, and described some of the changes in procedure that are happening.
Saretsky encouraged the pastors, ministers and volunteers in the room to make sure they get their health region clearance tags, necessary paperwork and checks done to reassure staff and patients. Another step would be to get Clinical Pastoral Education training, she added. “We have been called to a specific and important and worthy ministry, and we are professionals at what we do.”
Now that the spiritual care department has been eliminated, churches need to take the initiative to make sure that the names of designated chaplains are on the health region lists for both City Hospital and RUH, so that the correct, up-to-date information will be available at the switchboard, to nurses’ desks, at emergency and in the intensive care unit, to ensure that staff know who to call “to get the right chaplain to the right patient,” she said.
As the health care system in Saskatchewan undergoes other fundamental changes, with the planned elimination of health regions and the creation of a single provincial authority, church leaders and denominational chaplains are also looking ahead, hoping to develop a new spiritual care affiliation agreement with the new authority, Saretsky noted.
Rev. Ron Bestvater of the Evangelical Lutheran Church in Canada reported that only a few faith groups have negotiated an agreement with the Saskatoon Health Region for the provision of denominational spiritual/pastoral care, including the United Church, Anglicans, Lutherans, and Roman Catholics.
The creation of a province-wide health region will call for serious ecumenical engagement and co-operation to ensure that people are cared for. “If your denomination isn’t included in the affiliation agreement, start making noise and get that process going, so that the affiliation agreement gets expanded to include all of us who need it,” Bestvater said. “Volunteers — you cannot be fired, and if you show up, somebody will have to make a decision about what to do with you. Nobody knows who that somebody is going to be right now, but what I am saying is: be the squeaky wheel.”
There is still a willingness in the region for spiritual care, but the support of an actual department is gone, he stressed.
In the discussion that followed, it was again noted that the presence of denominational chaplains still does not answer the needs of the 50-some-per cent of patients who do not belong to a faith community. They may not have an affiliation, but that doesn’t mean they do not experience fear, or a need to talk to someone about existential questions, or the experience of dealing with illness, suffering or dying.
Ways to advocate for publicly funded spiritual care in the provincial health system were discussed, with participants noting the need to stress the health benefits of spiritual care, which in turn bring financial savings. There was also a question raised as to whether the elimination of publicly funded non-denominational spiritual care is a violation of the rights of patients with no faith connection.
The days when volunteers and non-professionals can handle this outreach on their own has passed, one speaker suggested, comparing it to how a growing community moves beyond a volunteer fire department to a professional, paid department when the complexity, size and challenge of providing the service becomes too much for volunteers.
Parish nurse Ethna Martin of St. Philip Neri Parish suggested the issue must be talked about in local churches, and spoken about from the pulpit in order to raise public awareness about a cut to spiritual care services that many are not aware has happened. Those who require spiritual care for themselves or family members may now have to be more active in requesting that support, others noted.
It was also suggested that with both the Saskatchewan Party and the New Democratic Party engaged in leadership races in Saskatchewan, this is a good time to raise the question with leadership hopefuls about their position on restoring funding to spiritual care in the health care system, as well as raising the issue with local MLAs.
“As people of faith we are called to a loving response, a compassionate response to decisions that we deeply disagree with,” Lasair said, urging those concerned about the issue “to call the government to greater love, to greater compassion, to greater peace.”
Lasair encouraged those in attendance to move beyond anger and frustration to work with each other and with government to address the issue, and to call government to account — but also calling them to a place of deeper love and compassion, as part of becoming “a more loving and inclusive society, a place where people of all faiths, of all religions, and all ethnicities can co-exist and call one another brothers and sisters.”