Far less is known about the human spirit than is known about the body and the mind. But issues of the spirit are important when caring for the elderly in long term care environments, as well as preparing residents, families, and staff for the death of a resident.
Therefore, it is judicious for the care giving team to gather information about spiritual as well as physiological, mental, and psychosocial needs. Dodge Park Rest Home (DPRH) has created a spiritual assessment tool congruent with the minimum data set (MDS 2.0) to help determine each resident’s spiritual needs, which then can be addressed in the care plan.
Dodge Park Rest Home DPRH spiritual care program is rooted in a theory of logotherapy developed by Viktor Frankl, a Viennese psychiatrist who survived several World War II concentration camps. He proposed that people can find meaning in life events, including suffering, and can transcend what fate bestows. Frankl believed that people search for meaning in life up to and often through the death event.
Asking questions pertinent to spiritual needs makes residents feel welcome to share their spiritual side. How a person chooses to live life is reflective of the spirit that lies within.
By using an assessment tool to gather data, caregivers can build a care plan upon the experiences the resident values most and wishes to retain.
The first part of DPRH spiritual care assessment tool gleans information from the resident pertaining to concepts of a god or deity, religious practices, and helping others. Questions include: Do you usually attend church, temple, or synagogue? Do you find strength in your religious faith? Have you participated in or would you be interested in a Bible study group? Do you enjoy helping others? In what ways have you helped others?
Part II of the spiritual assessment tool engages the resident in conversation about sources of help and strength, relation between spiritual self and health, and impending death. Questions in this section include: What are your personal goals? Do you want to participate in or assist with religious services at the facility? Are there roles you had in your life before that now are closed off to you? What has given your life meaning in the past? What gives your life meaning now?
Once the caregiver has completed the resident interview, information from the spiritual assessment tool is incorporated into the individual’s care plan. For example, when a resident reports prayer as a daily part of his or her past life, staff can include “provide private times for prayer” in the care plan. A resident with Alzheimer’s disease for whom evening prayer had been a ritual can be guided by staff each evening in this routine. Staff can assist family members to record familiar prayers for playing to their loved ones.Furthermore, resident prayer and hymn requests can be incorporated into a weekly nondenominational service. If the assessment shows the resident is experiencing spiritual distress, care plan approaches may include pastoral counseling, psychotherapy intervention, and medication regimen evaluation._But caregivers should not assume that residents’ feelings will remain static. Entering a long term care facility does not mean a person stops growing and changing. Residents often reevaluate and change what they value.
Therefore, spiritual needs must be regularly monitored and changes to the care plan made accordingly to guide staff in providing the support the resident needs.
Ben Herlinger and Micha Shalev, MHA