Home care is where the heart is: the role of interpersonal relationships in paraprofessional home care

While the provision of an adequate floor of wages and benefits for paraprofessional workers in the home care component of our long-term care system is desirable, efforts to provide it are curtailed by cost constraints. As a result, other factors which encourage the retention of an adequate home care workforce are all-important. Findings from a study of a representative sample of 487 paraprofessional home care workers in New York City indicate that the ability to develop close interpersonal relationships with home care clients and their families is one of the most attractive and rewarding aspects of the work. It is suggested that agencies focus on their roles in providing an optimum environment for the development of such relationships.     

Ministering to persons who face death. Practical guidance for care givers of persons making end-of-life treatment decisions

It is time care givers learn how to minister effectively and sensitively to those making end-of-life treatment decisions. To do so, care givers need to be aware of the various meanings death and dying hold. Culture, religion, past experiences with death and dying, and current situations can all influence the way persons perceive death and dying. Sensitivity to who the patient and family are, to how they perceive the disease or illness, and to how this perception influences their ability to achieve their life goals is a critical care-giving skill. Sensitivity, however, need not result in value neutrality or tolerance. Care givers should not be mindless executors of patient or family demands. Care givers must learn to talk honestly with patients and families about how a particular disease is most likely to progress and about the types of decisions they are likely to need to make. And then care givers need to present options, remaining sensitive to the patients' beliefs, values, and interests. Persons who care for the dying will face three types of patients, who will require different types of responses. The three types are patients who welcome death, patients who accept death, and patients who fight death. For all types of patients, care givers must keep the care patient centered and responsive to patients' priorities; facilitate informed decision making; promote communication among the patient, family, and healthcare team; support autonomous decision making; mediate conflicts; and offer spiritual counseling.     

Home is not where the heart is: looming problems of the home care industry

This analysis shows a definite trend of fiscal and social retrenchment policy by the government concerning in-home care service delivery (Tables 1 and 2). Ruggie (1990:164) notes that such shifts and changes in Medicare reimbursement patterns may be efforts of the government to realign itself to become the pivotal force in the provision or delivery of in-home care. Cost-containment pressures, although most needed in the health care industry, are the primary driving force behind retrenchment and the subsequent realignment of government. Such forces tend to impede the development of a comprehensive system for the provision of long-term care services. As noted, the movements and shifts in reimbursement patterns documented by this analysis can lead one to conclude that the same old features will continue to prevail instead of new and innovative delivery structures or public-private partnerships. In other words, the in-home care industry will become more like the nursing home industry--highly regulated and perpetually plagued by questions concerning quality of care. Although government is attempting to diminish its task as the prime provider of health services (i.e., through fiscal retrenchment) and the public's role as the dominant delivery system (i.e., social retrenchment), nevertheless the government has been unable to retrench politically in spite of its present direction of cost containment and fiscal restraint. Consequently, Ruggie (1990:147) notes that "the social welfare functions may continue to be performed" in spite of cost restraint policies. As a result, another "no care zone" is created and policy-makers will continue to develop "crisis policy" such as intense demands to hold unit costs low. The home care system has expanded many of the long-term care options and has emerged as a salient segment of our health and social service system (Applebaum and Phillips, 1990). Yet, policy-makers have not developed a comprehensive long-term care system, particularly one that defines a common policy for home care benefits and engenders the right kind of public-private partnership for the delivery of quality home care.     

Hospital community partnership. A daycare venture provides benefits, opens doors for new opportunities

Building successful joint ventures with local community organizations is a priority for many hospitals. Not only does this type of venture strengthen important relationships, it can also open the door for other mutually beneficial joint activities as well. When a partnership provides a needed service and can be started with minimal expenditures, it becomes even more valuable for all parties concerned.     

Introduction to the Discipline for pastoral care giving

During the last eight years, the professional chaplains of Spiritual Care Services at Barnes-Jewish Hospital-Washington University Medical Center (BJH) have developed a discipline based, outcome-oriented model for chaplaincy. This article introduces the elements of The Discipline, our development process, the effects on our chaplaincy attributable to its consistent use, and implications for the future. While many of our assumptions about chaplaincy have been challenged, our experience is that a disciplined, outcome-oriented model for chaplaincy has deepened our relationships with patients and significantly increased our integration into the care teams of the hospital. It has also challenged and enhanced our abilities to be emotionally present with patients while also giving attention to the process of the visits and chaplain interventions that contribute to patient healing and well-being.     

Home health care for the elderly.

Home health services must be expanded and must include ongoing social work services. In addition to the provision of direct service, social workers are encouraged to advocate for quality home health services, to develop effective techniques for providing social services to home-care patients, to incorporate these techniques into social work education, and to become involved in the education of their medical colleagues. In this way, the home health field can begin to fulfill its goals by providing patients with quality care in the home setting, thus allowing them to remain independent and at the same time meeting their health and social needs.     

Attention to the scientific benefits of pastoral care is a blessing and a curse

The art of pastoral care may be difficult to describe but we know that the ability to measure and describe the process of becoming a clinically trained, professional pastoral care provider is possible. Within the Association for Clinical Pastoral Education we have developed standards that spell out the competencies needed to complete the desired skill outcomes. Instead of diluting the meaning of pastoral care, this movement has strengthened the training, at least for many supervisors, students and seminaries. I argue that being able to understand with more precision what we do and how we do it could only enhance the practice of our art and the understanding by others of what that art might look like.