By Jim Coggins

VOLUNTEERS and social workers have said they will not be able to fill the gap left by the Fraser Health Authority's decision to eliminate a dozen paid spiritual care coordinators from its acute care facilities.

Fraser Health president Nigel Murray announced the cuts in a November 5 report, in which he said this "non-core service" would be provided by "social workers and volunteers from faith communities."

But some observers questioned whether volunteers or outside agencies would be able to fill this role as Murray suggested.

Social workers are "already stretched beyond what they can handle," said Graeme Isbister, spiritual care director at Chilliwack General Hospital, and many social workers "are not comfortable" with dealing with spiritual issues. They are already dealing with increasingly complex social issues, he said, and about nine of 200 social worker positions were eliminated in other recent cuts.

Gloria Woodland, the former director of spiritual care for Fraser Health, said the decision was odd for an organization that prided itself on caring for "the total person." She added it is unrealistic to think that others can easily replace the spiritual care practitioners, who all had at least a master's degree and often additional training in areas such as end-of-life issues.

Arden Krystal, vice-president of clinical operations for Fraser Health, said the authority has "vibrant spiritual care volunteers."

However, Woodland noted that those volunteers all took a six-week training course administered by the spiritual care practitioners and their work was coordinated by the practitioners. Now they will be coordinated by the volunteer managers who oversee other hospital volunteers.

Churches

It will also be difficult for "faith communities" to fill the gap.

Hans Kouwenberg chaired the inter-faith spiritual care advisory council in Abbotsford, which advised Abbotsford hospital on the hiring of its spiritual care practitioner John Haycock and helped design the "sacred space" at the new Abbotsford hospital. However, he said, the council later disbanded since "Fraser Health ignored us in recent years."

Kouwenberg said his church, Calvin Presbyterian, has a "pastoral care team" of volunteers who visit hospitals and care homes, but the church sent all of them for training administered by Haycock.

These "denominational volunteers" are different from hospital volunteers, organized by and accountable to churches rather than Fraser Health.

Another problem, said Kouwenberg, is that hospitals are limiting access to patients. About a year ago, citing the recently passed BC Freedom of Information and Protection of Privacy Act, Fraser Health began denying religious representatives access to patient lists. Previously, a Presbyterian minister would be given a list of patients who had had listed their religion as Presbyterian.

Philip Crowell, a member of the executive of the BC chapter of the Canadian Association for Pastoral Practice and Education, said the change was instituted to protect patients from "proselytizing [attempts to convert patients] in a multi-faith climate." Crowell noted that "most hospitals don't even ask for religious affiliation" any more.

Mitch Burrows, chair of the Abbotsford Christian Leaders Network (ACLN), dismissed the privacy concern since hospital forms used to include a box where patients could say whether they wanted a visit or not.

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Under the new system, churches don't know one of their members is in hospital unless the patient or a family member contacts the church. And this doesn't happen if the patient is incapacitated, there are no family nearby or "the family don't realize how important religion is in Mom's life," said Woodland.

Nurses and other hospital staff will call a church if the patient requests it, but often it was the spiritual care practitioner who asked patients if they wanted a visit.

While churches may pick up some of the slack in regard to their own members, churches have no access to the increasing number of people who have no church home, said Burrows. He said the ACLN would look at trying to fill the gap, but noted the ACLN is already committed to supporting the local food bank and addressing homelessness.

Even if the ACLN offered to fund a chaplain, Burrows wondered, "Would Fraser Health recognize someone we assigned?"

The local hospital used to give passes to pastors, allowing them free parking, said Burrows. Now pastors have to buy a pass, and there is only one pass allowed per church. Other pastors at a multi-staff church have to pay for parking.

It was also the spiritual care directors who led grief support groups and arranged for faith groups to offer regular religious services in hospital chapels. Groups such as the ACLN will still be willing to offer those services, said Burrows, but there will be no one to coordinate it.

Fraser Health "hasn't looked at everything we do," said Woodland. She noted studies that show patients who were visited daily by a spiritual care practitioner went home more quickly, required less pain medication and made fewer demands on nurses.

She also noted that the spiritual care practitioners had 1,500 one-on-one sessions with staff last year, often helping them deal with "bad days" when a patient has died. This is far cheaper than the staff member calling in sick the next day or having to go to a psychologist at hospital expense, she said.

Model

Ironically, before the cuts, Fraser Health was known for its "strong focus on spiritual care," said Woodland.

In 2005, Fraser Health commissioned Woodland, then a spiritual care practitioner at Langley Hospital, to study its spiritual care program in comparison with other jurisdictions across Canada. As a result of her study, Fraser Health accepted the principle that "every patient needs spiritual care"; increased the number of practitioners from seven to 17; and created the regional spiritual care position. Spiritual care was given equal status with other health care disciplines, and spiritual care practitioners were considered "part of the team."

Woodland used to receive requests from across the country from health authorities wanting to learn from the Fraser Health model. "This is the loss of a national resource," she said.

An indication of how important they consider their work, said Woodland, is that even though the practitioners were told they could go home November 5, they "continued to answer their pagers" and do their work until they were formally finished November 10.

Kouwenberg suggested the Fraser Health decision is short-sighted because it does not recognize the many contributions that faith groups have made to health care. "Spiritual care has been devalued," he said, and "faith has been marginalized."

Fraser Health serves 1.5 million people in British Columbia's Lower Mainland. The cut was one of many designed to reduce the authority's $2.48 billion budget by $160 million.

Even though the BC government has given Fraser Health a 20 percent funding increase over three years, it is struggling to keep up to demand for its services. The region is growing rapidly, and the authority has $2 billion in building expansion projects under way. The cuts to spiritual care will save about $650,000.

Spiritual care practitioners will still be involved in residential and hospice care, but because some of them worked in acute care as well, their positions may be re-posted as part-time positions.

November 19/2009