When confronted with the emotional and medical complexities of death and dying, a caring chaplain can make all the difference.
Consequently, hospice is one of the few areas of the American health care system that requires spiritual care be provided, said Dr. Gary Applebaum, national medical director of Seasons Hospice and Palliative Care. Medicare pays 100 percent of the cost of grief support, whether that happens in a patient’s home or in a hospital or in an in-patient hospice setting.
“In hospice care, we’re not curing. We’re meeting the patient where they are,” said Rabbi E.B. “Bunny” Freedman, director of the Jewish Hospice and Chaplaincy Network.
That means meeting them where they are emotionally, spiritually, physically and mentally. Freedman underscored that chaplains are trained not to impose their religious ideas onto families, but rather to listen to the patient and family’s wishes.
“I tell the people I train that if you’re doing more [than] 30 percent talking in the early stages of the relationship, then you’re doing it wrong,” said Freedman.
“Seventy percent of communication is coming from your ears, your eyes, your smile — not your talking. Rabbis tend to be loquacious, we’re talkative,” he said, “but when I’m with a family, I am an open book for them to write on.”
Patients can remain in hospice care for a long time. Through frequent visits, a strong rapport is built up between patients, their family and the chaplain.
Rabbi David Rose, a hospice chaplain with the Rockville-based Jewish Social Service Agency, estimates he visits patients every two to three weeks for an hour or more at a time.
“I learn a lot about people’s lives, their goals, accomplishments, regrets, their fears. It’s very deep work and very meaningful,” said Rose.
Rabbi Randi Nagel has been working as a staff chaplain for Seasons Hospice and LifeBridge Health for almost five years. Her great love of Judaism drew her to chaplaincy, which allows her to “meet and serve the most wonderful people and families during some of the most difficult and challenging times in their lives,” she said.
All patients and families need to do to meet with a spiritual adviser is to make a request for chaplain services upon admission.
The main concern of families, said Nagel, is ensuring that their loved ones receive the best possible care.
“As a chaplain, I advocate and support both the family’s and the patient’s desires and decisions while framing the conversation in a Jewish context,” if that’s the route the family decides to take, said Nagel.
Faith, Jewish or otherwise, is not a prerequisite for receiving chaplaincy services. The JSSA hospice is open to patients of all faiths or none at all.
“This is a time of intense meaning, of intense spirituality and that’s very different from religion,” said Rose, who spent 28-plus years as a congregational rabbi, most recently at Congregation Har Shalom in Potomac. “Sometimes my most spiritual interactions are with people who are agnostic or atheist.”
When a dying patient is considering their legacy, they often engage with a part of themselves that “we just can’t put our finger on that spirituality points toward,” said Rose.
He added, “This time that someone is in hospice is pregnant with meaning. The hospice team helps deliver that meaning and that meaning is such a source of comfort for the families.”
Though clergy are trained in caring for the dying in seminary, chaplains, Freedman said, receive additional training known as Clinical Pastoral Education. The required level, he said, is typically four credits, though chaplains can be active while receiving training.
Freedman, who has been involved with end-of-life chaplaincy for 23 years, said that chaplains are increasingly being called to work with Holocaust survivors and their families, which adds another dimension of care.
“There are a lot of complex issues,” said Freedman. “One of them is making the decision of unhooking hydration, [which is] much more complex for a Holocaust family. The idea of not providing nutrition is crossing a sacred or not understood emotional line.”
Feelings of survivors’ guilt, of readiness or trepidation of “meet[ing] their relatives on the other side” commonly surface. Sometimes, Freedman said, a formerly talkative person may fall silent while others feel the opposite urge.
“I’ve been called in by Holocaust survivors who only want to speak with me so some human ears will have heard their plight,” added Freedman.
Though the conversation can be difficult, the rabbi emphasized the importance of discussing a loved ones’ end-of-life preferences.
“Having a durable power of attorney, even if it’s not on a document, but as long as it’s understood, is important to have because sometimes a patient is not able to talk toward the end of life,” said Freedman.
Care for families extends past a loved ones’ death. Chaplains can help a family learn to say Kaddish, find a synagogue in their neighborhood and locate support groups. Seasons co-sponsors with Jewish Community Services a special bereavement group, said Applebaum, and conducts follow-up with families for 13 months after a loved one’s passing. Staff have been trained, he continued, not to disturb families while they are sitting shiva.
Nagel added that for the second year, Seasons is “providing a weekend-long bereavement camp for children called Camp Kangaroo in which children of all ages with the shared experience of loss can come together to find support, guidance, healing and fun in a nurturing and understanding environment.”
Though the work is emotionally demanding, Freedman rests easy at night knowing that “helping people through natural death and dying is one of the most rewarding things people can do.”