Pastoral Care in a Time of Coronavirus
One of the most difficult things for clergy and church leaders during the coronavirus crisis is the challenge of providing pastoral care in a time of physical distancing. As we are learning, many things remain possible with adaptations, and pastoral care is no different.
Below are guidelines, recommendations, resources and information related to several areas of pastoral care. Before you continue, take a moment and reminder for yourself: Try to practice self care, and set boundaries around your exposure to grief and heartbreak. This is going to last for a long time so please care for yourself knowing that this is a marathon and not a sprint.
CONCERNS RELATED TO PASTORAL CARE
As those used to ministering to those in need may remain willing to risk health to provide pastoral care, what needs to be understood is it's not as simple as a risk to the provider. The risks have a far greater reach than any one person.
- Concerns for Clergy: Pastoral Care in a Time of Pandemic
- Caring for Caregivers and Managing Grief (Webinar Recording: Episcopal Relief & Development)
- Planning and Response Recommendations for Churches for Coronavirus (COVID-19) Pandemic in North Carolina and the United States
- Guidance Regarding Positive Tests for COVID-19
- Emotional Life Cycle of a Disaster (Episcopal Relief & Development)
Many churches have already set up a system for staying in touch with parishioners via phone calls. For those still considering it, take a look at this sample letter and script to help your callers to get started. We've left in a Word document format so you can adapt it as works for you.
CONCERNS RELATED TO ISOLATION
LISTEN: From Episcopal Relief & Development - Addressing Isolation and Quarantine (from webinar recorded March 20)
For many, especially those living alone, the challenges of being in isolation during this stay-at-home order extends far beyond boredom and the stress of a dwindling toilet paper supply. Stress, decreasing self-care and in-place stresses like mental illness, substance abuse issues and thoughts of suicide can all be exacerbated in isolation. Everyone, even those without prior histories of substance abuse, family violence or mental health conditions, may very well be struggling with those issues now or in the coming weeks. Please ask everyone about their substance use, family relationships, and mental wellness in your pastoral check-in calls. This will help normalize that these issues might emerge and that their church community is a safe place to bring them.
- Tips For Social Distancing, Quarantine and Isolation During an Infectious Disease Outbreak (SAMHSA)
- How to include marginalized and vulnerable people in risk communication and community enagagement
- Crisis Text Line (Text SIGNS to 741741 for 24/7, anonymous, free crisis counseling): serves anyone, in any type of crisis, providing access to free, 24/7 support and information via text. A live, trained Crisis Counselor receives the text and responds quickly.
Though you are not likely to be involved in the treatment or management of mental illness, you can be helpful by becoming familiar with your local service providers. Which ones are still open? Which mental health providers have telemedicine options?
- Substance Abuse & Mental Health Services Administration (SAMHSA) Helpline: 1-800-662-HELP (4357)
Many churches have struggled with having to close their buildings to substance abuse recovery meetings. You can still help support those in recovery by helping direct them to alternate resources in place, including many online options. If you have closed meetings temporarily at your site, be sure to leave signs on your doors letting people know how they can get in touch with the local Central Service Office to find alternative locations/methods of connecting.
When it comes to addictive substances, be sure to check in with parishioners and yourself during this time. Are you drinking more? Is alcohol affecting your mood in a negative way? Are you relying on medication more than usual? Be on the lookout for substance abuse developing during this stressful time.
- AA Meeting Locator 1-844-334-6862
- Substance Abuse & Mental Health Services Administration (SAMHSA) Helpline: 1-800-662-HELP (4357)
THOUGHTS OF SUICIDE
When checking in with parishioners, or should a parishioner reach out to you, be aware of some of the warning signs related to suicidal thoughts. Risk factors for suicide include: 1. Do they have a plan? 2. Is there a history of attempt or relative who has died by suicide? 3. Do they have access to means? If you do not feel comfortable assessing risk for suicide, this is a good time to reach out to a colleague to refresh those skills.
If you discover someone is thinking about it, ask the question, "Are you thinking of hurting/killing yourself?" Ask about their plan, history and means, and immediately connect them with a community resource (now is a good time to familiarize yourself with and know those resources). Get them to promise to get help, and follow up. Help them think through people they can call. Most people who are suicidal are not acutely suicidal every minute, so help buy them time to get past the tunnel vision that says this is the only way out.
If you encounter this situation, remember to take the time afterward to care for yourself as well.
- National Suicide Prevention Hotline: 1-800-273-8255
- Suicide Prevention Lifeline: 1-800-273-TALK (8255)
CONCERNS RELATED TO DOMESTIC VIOLENCE
LISTEN: From Episcopal Relief & Development - Addressing Isolation and Quarantine (from webinar recorded March 20 and includes discussion related to domestic violence)
Unfortunately, for some, the mandatory "stay-at-home" order is asking them to stay in a place that is not safe, adding yet another layer of stress and anxiety to an already stressful time. If you know of someone at risk of domestice violence, encourage them to work on developing a safety plan, including having a bag stored away, knowing who you can go to, having important papers and prescriptions ready to go. Shelters and other essential operations are still open and follow guidelines to help keep people healthy.
For those who have struggled with anger or whose stress might escalate, know the triggers and identify actions that can help diffuse them.
MINISTRATION OF LAST RITES
In this time of pandemic, it can be deeply disturbing to both clergy and laypersons alike to realize that priests will not be able to be physically present with their dying parishioners. More than ever before, Christians are being called upon to trust that the risen Christ, through the power of the Holy Spirit, is very near to those who call upon him; that indeed, he lives and breathes within us, and he is capable of bridging any physical gap between a dying person and those who minister to that person.
Normally, the rite of Ministration at the Time of Death (often called “last rites”) is offered in person, like all sacramental rites. As the Church seeks to do our part to slow the spread of the novel coronavirus, such in-person pastoral care has become impossible for the moment. As this recent Episcopal News Service article shows, however, Spirit-filled care is still possible at a physical distance. Therefore, we direct clergy and laity of our churches to adapt the rite in the following ways.
- As directed on p. 462 of the Book of Common Prayer, family or friends of the dying person should contact their priest (or, if their congregation has no priest, their senior warden, who will obtain the services of a priest).
- Family members who have been living with the dying person (and therefore are not subject to physical distancing rules) should gather around them. If physical distancing and hospital protocols make this impossible, a hospital employee (e.g. chaplain) should be asked for assistance.
- The priest leading the Ministration at the Time of Death should telephone the family member, or hospital employee, or other person present with the dying person, and conduct the rite over speaker phone or video call. Anyone present with the dying person should join in as they are able, whether using a physical BCP or https://bcponline.org/.
- If the priest can travel to the building where the dying person is, the priest can position themself outside that building, in a place visible (e.g. through a window) to those who have gathered around the dying person.
- It is customary to make the sign of the cross on the dying person’s forehead at the “commendatory prayer” on p. 465 of the BCP. In these circumstances, someone present with the dying person can do so on the priest’s behalf, or the priest may make the sign as they speak over the phone.
In these challenging days, we are being asked to place all our trust in Jesus’s assurance that “I will not leave you orphaned; I am coming to you.” We are being asked to trust that the loved ones for whom we desire the Ministration at the Time of Death were, in fact, marked as Christ’s own forever at their baptism, that the Holy Spirit breathes in them even in their last hours, and that the Triune God will, indeed, receive them into the arms of his mercy and the blessed rest of everlasting peace, even if a priest cannot be physically present with them as they pass from this life to the next. As all of us, ordained and lay, pray and minister together while doing everything we can to protect our neighbors from harm, your bishops give thanks for all the faithfulness you are showing.
A constant question in this difficult time is how you can be helpful to your parishioners. As the number of those infected with COVID-19 continues to grow in North Carolina, so does the number of deaths. We are asking all diocesan clergy to focus on their theological and canonical responsibilities around instructing those in our care about preparations in the event that death. These are teachings we should offer at all times, but they are even more pressing in our current medical crisis.
In the coming weeks, the Diocese will gather and add materials here that we feel will be helpful in making end-of-life decisions, and many of these materials will be specifically designed to assist the laity and will include sample forms and suggested details to consider. We assume many of your parishes may already have burial instruction forms, but we will publish the forms so they are available to parishioners across our diocese. Also to assist you in this work, and especially to reach folks without benefit of access to a member of the clergy, we asked the Rev. Miriam Saxon to assemble a team to prepare and offer a webinar series on planning for the end of life. We will send out details and dates soon, as we anticipate starting the series in early May.
- Bishops Share Thoughts on Responsibilities of Clergy in Guiding Those in their Care about Preparing for Death
- Webinar: The Facts About Advance Directives (Recorded April 30, 2020)
- Advance Directive forms (NC Medical Society; fillable)
- Downloading your state's advance directives (National Hospice and Palliative Care Organization)
- Advance care planning & forms in English and Spanish (Cone Health)
- Instructions for Burial (form)
Funerals present a particularly difficult challenge, and there are no easy solutions. Please be in touch with your local funeral director as well as hospice providers. Postpone any public gathering for a memorial service at a later time, and no one should travel for either memorial or private burial. Graveside services can probably be conducted with appropriate social distancing and other precautions. We hope to be providing clearer, more specific guidance soon.
ADDITIONAL TOOLS AND RESOURCES