Gleaning Insightful Historical Contexts About Jewish Health-Care Chaplaincy [Chaplaincy Reflection]

Having mentioned previously that I am commonly asked by chaplain colleagues “Have you done CPE?”, I would be interested to engage in CPE training…when they become available to do so, as long as my current job allows me to do so. One thing I came across that I have found helpful for providing an historical context is Robert Tabak’s article, “The Emergence of Jewish Health-Care Chaplaincy: The Professionalization of Spiritual Care”, which appeared in the American Archives Journal (vol. 62, no. 2), on pages 89–109.

Tabak does an intriguingly good job tracing the history of Jewish health-care chaplaincy, which he contextualizes as there being “a long-term trend toward professionalization in a number of areas that were originally avocational” in Jewish life (89). He mentions that while “most professional Jewish chaplains in the United States are rabbis, a significant number are not, including cantors and professionally-trained Jewish lay people” (90).

One of the curious aspects of chaplaincy in America was that “the makeup of CPE, and its professional group, the ACPE, was changing by the 1980s. Established and led by white Protestant males, the field significantly shifted, as many women, Catholics, African Americans, other minorities, and eventually non-Christians entered CPE programs and some became CPE supervisors” (95). However, in 1990, the National Association of Jewish Chaplains (NAJC) was created in 1990 (98-99), which “represents Jewish chaplains and the Jewish community in health care and other wider audiences. It provides a Jewish organization that is a peer with other North American professional pastoral care groups” (101).

One of the interesting aspects is that, in 2003, NAJC

made the designation of CPE as the only recognized clinical path for becoming a Jewish chaplain. In that year, the NAJC and five other North American pastoral care organizations approved joint outlines for procedures for certification, education, and ethics. At the same time, the NAJC became more specific in the training requirements to become a professional member, a stage prior to certification. In earlier years of Jewish chaplaincy and the NAJC, various formats (often social work, but sometimes another area of psychology or marriage and family therapy) were recognized; but beginning in 2003, new chaplains would need at least two units (total eight hundred hours) of CPE as well as rabbinic or other graduate-level Jewish study, to become full voting members of the NAJC, the initial step for professionals. (99)

Certainly my lack of CPE units is something that is a curious hindrance, yet NAJC (which changed its name in 2014 to now stand for Neshama: Association of Jewish Chaplains, in a move to encompass those Jewish chaplains working outside of the US) does currently offer a general membership which does not require having any CPE units under one’s belt.

I was also fascinated by this historical observation:

Since the 1980s, two wider trends have occurred that have affected the field of Jewish chaplaincy. One is the greater societal emphasis on spirituality as well as on ritual aspects of religious life in health care; the other is that the emphasis on spiritual care is also reflected in regulations by accrediting agencies. (96)

Apparently, owing to this emphasis on spiritual care, hospice programs began to be “required to provide pastoral care” (97), which is incredibly helpful context for me working with residents who are currently under hospice care, as to why they have chaplains attached to them. Of course, I think it’s a wonderful offering.

There is much more to say about this article, but I found it a very helpful historical contextualization of my current professional field.

 

 

A Challenge With Developing Relationships [Chaplaincy Reflection]

Working with different generations in different stages in life is, as you can imagine, quite a different experience for a rabbi. Of course, there are similarities, including conversational skills and approachability, amongst others. Yet, having previously worked with those in the Millenial Generation while they were college students [and young adults] is quite different than working with the Silent Generation while in a senior living facility.

While there are perhaps many, many differences, one stands out to me at this moment, which is developing relationships with them. While working with college students and young adults, my ability to develop relationships with the people whom I was serving was considerable, as I would have conversations with them and we would speak and I would learn about them and they would learn about me and we would develop relationships. However, the demographic I am currently serving, residents at a senior living facility, it’s not the case. I can have a conversation with the residents, I learn about them, they learn about me, and the next time I see them, they’re meeting me for the first time, as they don’t remember meeting me and we have to start over. And this can happen multiple times, where every single time I speak with them, they are meeting me for the first time.

In fact, I have even experienced this within a single conversation with a resident who has dementia where they have asked me multiple times within the course of a conversation who I am. We haven’t even departed from the conversation and yet I’m being inquired as to what my name is, who I am, and what what my role is at the senior living facility. This is, as you can imagine, a deeply significant roadblock in developing relationships with the residents. Of course, I can get to know them and understand them and have a relationship with them, but it may not necessarily be reciprocated from there, and they may literally just meet me time over and time again.

This can be embarrassing to me, sometimes, when there’s someone else around and they say, “Oh, I have never met you”, and I feel embarrassed because it makes it seem to the other person as if I have never made the effort to have met this resident before this present moment, when I may have met them a half-dozen times and spoken with them.

And, yes, I acknowledge that part of the challenge is that I began working at this senior living facility amidst the COVID-19 lockdown, so residents may struggle in recognizing me due to me always wearing a surgical mask in their presence, yet, there are not many other people where I work who look much like me (and, yes, I’m one of only a few people in the building wearing a kippah, so that further serves to identify me).

Going forward, it’s certainly a stark contrast to serving this demographic, whose population is in contrast to the previous populations I’ve served. It will be interesting as I continue working with them, and figure out how to navigate these hurdles of developing relationships with them.

[The First] Tisha b’Av During Coronavirus Season

I don’t know what Tisha b’Av is typically like at the senior living facility where I am presently working, but I suspect that this year’s Tisha b’Av was certainly markedly different than any that had preceded it.

In my email to the department heads at the senior living facility at which I work, I mentioned that it was the saddest day on the Jewish calendar and a day in which we are not supposed to be involved in joyous activities. I then made the comment that it’s actually oddly and gloomily easier this year than typical, not only on account of social distancing, but due to our facility not having opened up to small group [and socially-distanced] activities (although the facility was to have opened up already, a surprise Coronavirus case happened at our facility). So, there were no activities at all, which was oddly appropriate for the somberness of the day.

Of course, as programs begin to take place and with social distancing, I’m quite confident that the mood will change amongst the residents, but, for now, it’s been it’s been still quite emotionally gloomy, especially as there had been a resident who recently contracted the virus, so there’s still a great deal of uncertainty moving forward – not only about residents’ physical health, but also their own mental and emotional health going forward.

To make Tisha b’Av even gloomier (on top of the literal gloom, as there was a gray and rainy day (that had broken through the many consecutive sunny days we had been experiencing)), there was even a death of a Holocaust Survivor in the building, which felt sadly appropriate for the day.

In future Tisha b’Avs, there will certainly be much more to deal with, including programming, but, for this year – the first Tisha b’Av in the Coronavirus era – it was gloomily quiet, and that felt uncomfortably appropriate.

Passwords [Chaplaincy Reflection]

Having written previously about technological issues in a broad sense when it comes to the Silent Generation, many of whom make up the generational demographic in senior living facilities, a specific instance of a technological barrier comes in the form of passwords.

Yes, passwords – that staple of contemporary adulting of knowing your login information – usernames and passwords – is a significant challenge to those in the Silent Generation. On the one hand, it is simply a matter of knowing what it is, where you can even track it down, and find such login information. And if someone has some sort of dementia or other memory loss issues, that becomes a further struggle in finding where these are.

I’ve visited residents in the senior living facility where I work and they have tablets, which is really great (since it’s not a common phenomenon for folks here to have such devices), and I mentioned you know getting onto a particular app (e.g. Zoom, Alexa) and they say okay. Yet when I ask them for their log-in information, residents (this has happened at least three times with completely separate residents) have gone to a notebook or Rolodex and looked where they have written these things down and, in these instances, have struggled mightily to find and figure out what their password was.

As mentioned in my earlier post, those in the younger generations – anywhere from Baby Boomers all the way down to Gen Z – tend to know login information, as it is an important part of living in this world. But, for those in the Silent Generation, who really haven’t had much of a need for most of their lives to deal with this accessibility, it’s a real challenge for them. Of course, let’s be honest: it’s been no minor frustration for those of us (myself included) who go and help them out with a very simple task using a particular easy-to-use app and getting something going functionally – whether it’s the Echo Dot or Zoom -and, yet, it takes so long, as these seniors do not know their passwords nor where they have written them down.

This aspect of helping out those living in senior living facilities with accessing technology under COVID-19 health precautions is a fascinating (and, let’s be honest, frustrating) limitation of accessibility for this particular generation, especially in connecting with their loved ones beyond their buildings.

Lacking Historical Context: Covid-19 Lockdown as the Baseline for Knowing Residents

Generally, Lacking Historical Context Coming Into a New Situation
One of the interesting limitations of starting at a senior living facility is meeting residents where they are, without any historical context of their mental health, emotional health, or physical health. True, one could talk to people and gain a familiarity with how healthy they were prior to starting in that position, but it is not part the chaplain’s experience with the person at that time.

COVID-19 Lockdown Serving as My Baseline for Understanding and Knowing the Residents
The lack of historical context is something that is all the more curious having begun this chaplaincy amidst the COVID-19 lockdown. One thing I hear about certain residents is how much the lockdown and isolation have exacerbated their dementia. It’s a really tough thing to hear, as they may be able to leave their rooms and perambulate around the grounds of the senior living facility’s campus, but otherwise remain socially isolated (unless they write notes or call friends (or, for the minority of residents, FaceTime or Zoom with family)), mostly either staying in bed all day and/or watching television. Of course, there is widespread depression, which is acutely felt in the assisted living side, less so on the independent living side, and the least felt on the healthcare units, but still noticeable on certain units moreso than other units.

Catalyzing Concerns
Another thing that I had heard was that the rate of death was higher than pre-pandemic – not because any residents had died of COVID-19, but because of the lockdown, stoppage of programming, and the social isolation causing them to worsen. Furthermore, when there is a COVID-19 case on the floor and residents are really not permitted to leave their rooms, much less their unit/floor, then, as one resident put it to me, their rooms are “their cages” or “cells”. I can’t imagine that it helps their situation.

Looking Forward to Post-Lockdown
For me as a chaplain, I don’t have that kind I don’t have the prior context to know how the residents functioned pre-lockdown, as I have only known them in this era, which is my baseline for knowing who they are and how they function. It would be really fascinating for to see when the lockdown is lifted and the Coronavirus is no longer a problem on the horizon to see residents’ mentally, emotionally, and/or physically improve, which would be a really fascinating phenomenon. Until then, of course, there will still be limitations on what takes place in this facility. How much longer the safeguards will be in place and how much further decline in the mental, emotional, and physical health of the residents remain to be seen.