The Pillars of Hospice

A Deeper Look at Spiritual Care

In our society, there are a lot of pre-conceived notions about hospice care. Often those presumptions stigmatize the core intention of hospice and prevent patients and families from taking full advantage of the services available, sooner rather than later.

To provide our community with an in-depth look of the core values of hospice, we have decided to create a series featuring the pillars of Hospice. This month, we’ve spoken with members of our Spiritual Care team to capture what is at the heart of Spiritual Care and its significance in a person’s end of life journey, including:

– Berkeley Johnson, J.D., MDiv, Spiritual Counselor at Wilshire Hospice
– Franziska Castello BSN, RN, CHPN, Director of Patient Care Services at Wilshire Hospice
– John McAndrew, MA, MDiv, Spiritual Counselor at Wilshire Hospice
– Michael Sparrow, Spiritual Counselor at Wilshire Hospice
– Laurie Smith, ACHCE, Vice President of Home Health & Hospice at Wilshire Health & Community Services

What is the significance of spiritual care as a discipline of hospice?

“Spiritual care is one of the three core disciplines of hospice, along with nursing and social work, so its significance cannot be overstated. Our spiritual counselors provide a non-anxious, non-judgmental presence to our patients, their families, and loved ones. We come alongside them and offer support and affirmation. Often, our greatest gift is simply to “normalize” for patients and families what they are going through. Normalizing, without minimizing, is what I like to say.”
Berkeley Johnson

From your experience, what is the impact of the spiritual care team on our hospice families and patients’ experiences?

“As one of the main disciplines in hospice care, Spiritual Counselors offer support to the patient in a way that is unique, complementary and necessary for a holistic approach. There have been several instances as a nurse when I have worked through managing the manifestations of discomfort (pain, agitation, anxiety for example) with the assistance of our Spiritual Counselors – they have insightful, thought-provoking questions/observations that often shed light on how we can best support that person with dignity and respect through their end of life journey.”
Franziska Castello

“The spiritual-care team often plays a significant role in patient and family outcomes. We help untangle a lot of family dynamics simply by reminding them to keep the patient at the center of their care and concern. Often, the primary caregiver may be struggling with decision-making or guilt around difficult choices that must be made. By offering reassurance and support, we help reduce their anxiety around these decisions. I often tell people, when there isn’t a clear “right or wrong” answer, just keep the patient at the center of your care and concern, utilize the resources around you (nursing, medical, social work, etc.) and operate from a place of love and compassion for the patient. That’s really the best any of us can do in those situations.”
Berkeley Johnson

“Spiritual care is not about preaching or proselytizing; that’s not our goal. We’re here as another means of support. I think prayer and meditation are good medicine. We try to meet people where they are.

Truly, 90% of what we do is presence. It may sound a little simplistic, but it’s about just being present, not talking, not saying anything, not filling the awkward silences. It is a learned skill. A large part of my own education in hospice, and what I try to help others embrace, has been learning how to be with dying, in a non-anxious way. So, when the moment of death comes it’s not a medical emergency, and the patient’s loved ones know we are there if they need us.”
John McAndrew

“The spiritual side of a person is the internal consciousness that connects at the deepest levels with others, with nature, with love and acceptance and/or with God as people understand God from their own journey. Depending on the person’s belief system, as people face end of life, often their focus shifts from the hopes of future things, toward the past and present. One role of Spiritual Counselors is to guide people through “life review” – helping them see the positive impacts they have made on others, the significant things they may have accomplished and part of the legacy they are leaving behind. With that, we point them to experiences and situations they can still be grateful for, and help them maintain a balance in their focus between things they may be grieving the loss of, but also the things they still can enjoy “in the moment.”

Sometimes there are unresolved “spiritual issues” with God… situations of regret and disappointment. Often people have questions about “why did this happen to me or my love one?” These questions are often impossible to give definitive answers to, but still offer the opportunity for comfort and the ability to turn these things over to the Divine.”
Michael Sparrow

“I believe the Spiritual Counselor’s significance in hospice is they listen carefully for what is important to patients/families, their values, beliefs, goals, opinions, and preferences in order to support them in living the rest of your life in the way that makes sense to them.”
Laurie Smith

Will you describe one of your memories from your time working as a spiritual counselor?

“One of my most memorable times I have had experienced with a patient was with a wonderfully kind lady from Ireland. I will call her Miss M. She was on service for around 2 months. She moved home with family to live out her final days. She avoided television and media and asked me to bring her some children’s books to read to her. We read a few fables with spiritual insights together. Miss M loved them. She missed her husband who passed 3 years previously. There was a heart connection made and as she began transitioning, she saw him in a dream, and he was asking her to come. At my next visit, she said she was going to him. We prayed together, and in a couple days she was gone.”
Michael Sparrow

“I had a patient once at a facility with a lot of agitation at the end of life, but no one was sure what was causing it. As I spoke with his son during my initial assessment, he told me the patient had been part of the Hitler Youth in Germany as he was growing up. So I identified that as a possible source of spiritual distress. I met with the patient on a Friday, and indeed he was trying to convince himself that he had lived a good life and hadn’t cheated or wronged anyone. We talked about the fact that no matter how hard we try, we all fall short in life in certain ways, and that rather than trying to justify himself, which clearly wasn’t working, perhaps surrendering and asking forgiveness for being part of something that systemically had caused great harm would bring him some measure of peace. He agreed, and we said a prayer about this. We then received a report over the weekend that he was transitioning, so we alerted his children, and I went back to see him on Monday. When I entered his room, he was lying there peacefully, with his hands clasped beneath his head like he was on the beach in the French Riviera. The facility nurse asked me what I had said to him, because they didn’t even have to give him his anti-anxiety medication over the weekend; he didn’t need it anymore. I told her I felt he had been trying to justify himself, but that it hadn’t been working, so we discussed surrendering and asking for forgiveness. It feels risky to take a chance and confront issues like that, but in this case it allowed him to let go and brought him some peace at the end of life. In those situations, as spiritual counselors, sometimes all we can do is follow our instincts.”
Berkeley Johnson

Thank you to our Spiritual Care Team for taking the time to share their thoughtful insights with us. To learn more about our spiritual care services, give us a call at (805) 782-8608 or visit our website.