The Hospital Handbook

A Practical Guide to Hospital Visitation

Lawrence D. Reimer, James T. Wagner

• Publisher: Morehouse Publishing
• Year: 1984
• Print ISBN: 9780819214706
• eBook ISBN: 9780819224729
• Topic: Theology & Religion
• Subtopic: Christian Ministry

Truly a practical guide to hospital visitation and a useful resource for the experienced pastor or concerned lay visitor.––The Clergy Journal

Hospital visitation is a vital part of any church's ministry. Written for the divinity student, the beginning or experienced pastor, and the lay person, this helpful handbook offers comprehensive guidance on many important aspects of pastoral care of the hospitalized.

Valuable advice and practical information on how to understand the hospital structure, gain access to its systems, and establish rapport with the staff.

• General explanation of hospital protocol and etiquette.
• Discussion on the emotional aspects of illness and the opportunity for spiritual inquiry.
• Resources for prayers, scripture readings, and sacraments.
• Detailed information on the needs of specific patient types, including children, adolescents, substance abuse, AIDS, psychiatric, and the terminally ill.
• Glossary of medical terms.

1

Today's Hospital

It's Not Like Where You Were Born

A Revolution You Ought to Know About

Hospitals are experiencing radical changes, some occurring even as you read this book. This revolution is of interest to pastors, lay-persons, and the Church for several reasons. A significant portion of your ministry is carried out in relationship to illness events. Understanding the nature and structure of hospitals can aid you toward working effectively within that system. Second, you and your parishioners utilize health care facilities as patients and being aware will assist you toward becoming an informed consumer. Third, it may be that some of these changes call for the Church to become more active, at least educationally, in the health care endeavor.

At the heart of this revolution are two central questions. Is health care a right to be afforded to all persons or is it available to the privileged only? Privileged usually means that you and/or a third party (insurance) will pay the bills. The second question is: Who is going to pay for the services? In our society the prevailing political answer¹ to the first question is that Americans should have unlimited access to the best available health services. In order to provide the service, however, health care costs currently consume 10.7% of the gross national product.

This wasn't such a problem as long as the family doctor got in his car and drove to your home when you were ill. S/he usually had everything required for treatment in a black bag, predictably a tongue depressant, a stethoscope to listen to heart and lungs, a light to look in the ears or eyes, and, finally, a penicillin shot. As technology developed, however, a clustering of services resulted. Physicians preferred to locate offices near hospitals, which became the centers for the treatment of illness. You now go to the physician's office for care and, if necessary, can be admitted to the nearby hospital, reducing travel time between office and hospital for the doctor.

It has been theorized that when physician house calls became uncommon,² the sanctity of the physician-relationship changed forever. In its place emerged a less personal, more technological approach which can save lives, but also can prolong life unnecessarily, always at a high cost. There is the resulting need continuously to refurbish and replace outdated hospital facilities and to have the latest piece of new technology. Physicians’ salaries have skyrocketed, yet patient-physician relationships have grown even more impersonal, which contributes to a litigious climate. This climate results in higher malpractice insurance premiums, the ordering of more tests for defensive purposes, and higher costs for the patient. The spiral of increasing costs has been staggering. Controlling these costs and preserving the availability of health care has become a national concern.

Private For Profit Not-For-Profit

To address these problems, changes are occurring, both within and without the hospital. Externally, a recent change (October 1983) was made by the Federal Government. Previously, Medicare reimbursed hospitals for actual costs based on services delivered when a patient covered by the program was admitted for treatment. Now a complicated reimbursement program has been implemented over a multi-year span which is based on diagnostic categories of illnesses and is referred to as prospective payment.³ What this means is that hospitals will know in advance what Medicare will pay for the treatment of a particular illness. If the hospital can provide service for less than Medicare will pay, it can keep the balance as profit. Should their costs exceed the amount reimbursed, however, the hospital experiences a loss. As was predicted, most insurers have followed a similar fixed reimbursement formula.

In response, as you can imagine, hospitals and medical staffs are having to re-learn much of their way of providing health care. Some of these changes are positive and others will create further problems in the future. For example, tests which are not critical for the patient's treatment will no longer be performed. This should lower costs for everyone. On the other hand, hospitals have at times provided very humane services which will also necessarily be discontinued. The patient ready for discharge but who has nowhere to go will not be cared for in the hospital until other arrangements can be effected. Again, some illnesses may become viewed as desirable admissions due to their proven profitability for the hospital. Others, however, which become known as marginal, may be avoided. Today, many of the “for profit” hospitals will not provide pediatrics, obstetrics-gynecology, psychiatric or emergency services as they are known to be cost-inefficient.

Other outside agencies exist which seek to guide the development of hospitals. Federal and State cost containment and review groups must approve price increases, allocation of beds, and new construction in an effort to avoid an abundance of resources which would lead to ever increasing costs. By the mid-1970s these outside agencies made hospitals one of the most highly regulated enterprises in the United States.⁴ The response of the health care industry has left the neighborhood hospital where you were born ill-prepared to cope with the new structures which are emerging. The hospital will soon be only a part of the effort to treat and / or prevent illness. The emerging structure is that of the Health Care System, a corporate or holding company model.

The function of the “system” is to capture a significant portion of the health care market in its geographic region. It is a business approach with key notions being “cost containment” and “revenue production” without compromise in quality of care. To achieve these goals, the system must structure itself to accomplish two things. First, it must market health care, including preventive and rehabilitative functions. This means offering a diversification of services, some of which were originally provided by the hospital. This is a reversal in the earlier trend to center activities in the hospital. Second, each division in the system becomes a referral source to the hospital, in order to maximize occupancy rates, and, in turn, the hospital refers back to other parts of the system for its specializations.

The changes in the hospital structure relate both to its role in the system and the severe regulations described earlier which govern its functioning. Rate reviews, price structuring, and prospective payment, for example, do not currently apply to outpatient services but only to inpatient hospitalization. Consequently, the system will seek to “unbundle” hospital services and separate out any function which can be independently organized. Some of the more common services which have been unbundled are surgery procedures which can be done on an outpatient basis. “Surgi-Centers” are the result. Emergency clinics are another illustration. Not only can the system charge more for services provided by these facilities, but, should the patient require more serious attention, s/he can be referred to the system's hospital. If the patient has experienced a stroke and is treated at the hospital, upon discharge the patient can be referred to the system's “Wellness Center” or “rehabilitation program” for recuperative care.

Economic restraints on the hospital have resulted in the necessity to restructure health care delivery. Marketing this health care has fashioned a much broader, more wholistic approach. It is quite different from the single-minded acute care facility which has been the identity of most hospitals. In the system the hospital is only one dimension, although it remains the central one.

Obviously, other disadvantages await the neighborhood hospital which continues to try and stand alone. Larger systems will either link themselves in cooperative voluntary ventures or be owned/leased outright by corporate structures, as in the case of Hospital Corporation of America. By virtue of size, purchasing and personnel advantages abound. Supplies can be bought at such volume to assure discounts when compared to single unit purchases. It is hoped that these savings can be passed on to the patient. If this is true, then the patient will prefer to select admission to a hospital which is part of a larger system, and not the local, independent, neighborhood hospital. An idea which improves health care can be duplicated throughout similar facilities in a larger system. As well, the system may only have to employ one person with high-tech skills, sharing the costs, and make him available to all parts of the system. These are but a few examples of other advantages when systems are compared to your free-standing, neighborhood hospital.

The changes which this revolution represent are an industry's efforts to meet the need of providing health care services at a reasonable cost. These changes are in their early stages and their impact is not yet clearly known. They attempt to be more cost efficient for consumers while being businesslike in approach. Clearly, if the system fails in this country, the persons hurt most will be those who have the least ability to gain adequate care: the poor, the disabled, and those on fixed incomes.

Meaning For Ministry, Lay Persons, and the Church

Unlike the free-standing hospital of the past, which provided crisis intervention when illness or accident occurred, the system will market health care. Persons who wish to participate in maintaining or enhancing their state of health will find organizations such as Wellness Centers available. In this sense, the shape of health care will become more wholistic, which is a positive development. The dimensions of health which systems will find themselves least able to provide, however, have to do with life questions of meaning and purpose.

These are spiritual concerns which have as much to do with our health as good nutrition, proper exercise, and stress management. Although chaplains and social workers will continue to be employed by hospitals, the need for the Church's ministry during the crisis of illness will probably increase. This will be true because of several factors, all related to illness being a “teachable moment” that invites a re-examination of life values. First, the patient's experience of hospitalization will likely become more brief and intense. Inpatient days will be reduced. There will be less time in the hospital, both before and after the onset of illness or having surgery. Second, opportunities to review life experiences and reframe values and priorities will be minimized. Yet questions like “Why is this happening to me?” “What meaning does it have for my life?” “What have I learned?” remain important in the adjustment and recovery process.

What is being communicated here is not that pastoral ministry to ill persons is new or that pastors have neglected their parishioners. The message is that the need for the Church's ministry is heightened by the changes going on in hospitals. In his popular book Megatrends,⁵ John Naisbitt talks about the growth of high technology creating a corresponding need for “high-touch.” It is not the intent of hospitals to be less personal as they become more businesslike and as medicine relies increasingly on new technology. It will happen, nevertheless. The patient's need will grow for someone to enter his life who has no form for them to complete, no technology to be explained, no procedure to be done. The pastor is someone who can sit quietly, hear what the patient is feeling, respond with empathy, and relate it to a faith that enhances healing and wholeness.

This same need for “high-touch” exists for persons who work in hospitals. The new technology saves lives, but it can also prolong and unnecessarily complicate dying. It isn't simply that a respirator frustrates the natural occurrence of death. More critically, a machine that can breathe for you has almost become a part of the natural order. In the case of reversible causes, such as a drug overdose, the respirator breathes for you until life is safe and recovery under way. The emotional problems which lead to the overdose can then be sorted through. In other cases, the respirator provides needed time to evaluate and diagnose, or to give further treatment. But when it is believed, but not yet a certainty, that meaningful life is not possible, no uncomplicated decision-making process exists to discontinue life-sustaining treatment.⁶ Hospital staff need the sustenance of their faith to adequately cope with the stress of being responsible for difficult decision-making.

Ministers and churches need also to be aware that, as health care systems and participating hospitals become more competitive, they also become more sensitive to public relations and community opinion. The Church can encourage support for chaplaincy as well as the pastoral care of individual ministers by communicating with the administrations or boards of the hospital. There are many services churches can provide to hospitals. For example, almost every hospital has an auxiliary for volunteers. A church which invites the director of that service to speak and encourages participation breeds good will. Parishioners hospitalized can communicate their appreciation for a chaplain's visit or the accessibility to their pastor, even in an intensive care unit. Obviously, any church expressing these interests must represent needs and concerns common to every denomination and not attempt to manipulate personal advantages. At times, a responsible Ministerial Association can assume this role.

Just as pastors are gaining new understanding regarding the emergence of health care delivery systems, parishioners will benefit from a similar exploration. Perhaps the idea of establishing a Health Care Committee in your church would assist in educating members to these new structures. Other, equally important concerns need exploring also. For example, most major faith groups are increasingly relying upon lay persons to provide ministry during life crises. Although a chapter of this book discusses the topic of lay ministry in depth, a Health Cabinet can provide a portion of that education.

Moreover, there are several direct ways in which the Church's educational program can speak directly to the national issues of preserving availability of health care and cost containment. First, the Church can remind its membership of stewardship which relates to care of the body. The larger issue is that of preventive health care. It is hoped that research will soon emerge to provide cures for many types of cancer. Even if this happens, most of the dramatic breakthroughs which impacted so positively on health, like the discovery of germ theory, antibiotics, and polio vaccine are past history. Most authorities agree that the major breakthroughs lie in the realm of individuals adjusting their life style, specifically reducing caloric intake, eating better foods, exercising more, and learning to manage stress. The major killers, such as coronary artery disease, strokes, and hypertension, cannot be cured with a vaccine. The Church should take a more active role in spreading the “good news” which relates to an abundant, physically healthy life.

Second, containing costs of health care is not simply the responsibility of physicians and hospitals. The need is for all persons to become informed consumers. Out of a false sense of fidelity, for example, an individual might decide against seeking a second medical opinion. Checking into a hospital on a weekend, apart from an emergency, will usually not result in any meaningful treatment until a weekday, but it increases costs to the consumer. Being hospitalized for minor surgery because you are reluctant to investigate an out-patient alternative does not mean you will receive better care. It does guarantee higher bills. The patient-physician relationship previously characterized as paternalistic but now becoming more collaborative is probably a healthy one.

Yet none of these changes is easy, not for individuals nor for institutions such as the health care system. What motivates the changes is the necessity to preserve availability of health care at a cost that is affordable to all. That is the hope. The voice of the Church and ministry is a powerful one. Informed and aware, it can assist in shaping the structures and practices which develop. Historically, it can continue to be a meaningful part of a life experience that is common to all. Its ministry, in both professional and lay forms, must be prepared to increase input. The alternative is further fragmentation of life experience, particularly the search for meaning and purpose in the midst of life crises.

Bibliography

Cousins, N. Anatomy of an Illness. New York: W.W. Norton Co., Inc. 1979.

The author recovers from a serious illness through following standard medical regimens in addition to his own prescriptions. This book is now a classic and highlights partnership between physician and patient.

Cousins, N. The Healing Heart. New York: W.W. Norton Co., Inc., 1984.

Cousins offers personal reflections on ways he managed his recovery from a significant heart attack through monitoring his own anxiety and developing a partnership with medical staff.

Florell, J.L. “Wholistic Health and Pastoral Counseling.” Journal of Pastoral Care. Vol. XXXIII, No. 2, June 1979, pp. 96–103.

Presents an overview of approaches to wholistic health care in a variety of settings.

Goldsmith, J.C. Can Hospitals Survive? Homewood, Il.: Dow Jones-Irwin, 1981.

The author puts forth a thoughtful and insightful discussion of the major changes occurring in the health care field. He describes the already intense competition among hospitals, which is resulting in restructuring of the entire system. Consumer choice as well as cost consciousness are guiding principles which will result in the closing of some facilities and the survival of other...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Dedication Page
• Contents
• Introduction
• 1. Today's Hospital: It's Not Like where you were Born
• 2. You're an Outsider: How do you Get Inside?
• 3. The Minister is a Team Member: Getting into the Game
• 4. Resources for Prayer, Scripture and Sacrament
• 5. Special Situations
• 6. Medical Ethics and the Pastor
• 7. Training Lay Caregivers in Hospital Visitation
• Glossary of Medical Terms