The new healthcare: spiritual counseling to keep hospital bills lower

As a chaplain who provides care to patients, much of my work is not about religion so much as saving patients’ lives – and savings

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A growing trend in the US is that keeping hospital costs down also means providing spiritual care for patients Photograph: Blend Images / Alamy/Alamy

I was parked in front of a patient’s home before my visit, running through my checklist.

Patient’s diagnosis and prognosis. Any known family members or friends supporting the patient. Religious affiliation, if any. Patient’s name – you should always recheck the patient’s name.

It’s good to know little about a patient’s medical concerns, but as chaplain, my concern is not what the patient’s illness is, but who the patient is. I want to address their spiritual needs and see how their spiritual health affects their overall health.

Do they have loved ones who care for them and support them? How is their illness affecting their work, their home life, their image of themselves? What are they living for? Where do they find spiritual support and strength? These are the kinds of things I want to know.

I go to people’s homes, because there is a need for spiritual care outside the hospital. It is a huge gap that only recently has started to be filled. Spiritual needs affect our ability to heal – and also affects our healthcare costs.

I’ve often found that people who are lonely and isolated with no one to care for them, who feel they are worthless, who see no point to their lives – they end up in the hospital sick, again and again. There’s no real healing without addressing their spiritual crisis.

Providing basic healthcare outside of hospitals is a growing trend; I work for MissionPoint Health Partners, which is an “accountable care organization”, or ACO. These organizations are responsible for the quality and cost of healthcare for a given group of patients.

The trend started because one of the biggest ways to get better care and to keep costs down is by regularly seeing your primary care doctor. This is especially true for patients with chronic and terminal conditions.

ACOs get paid for their work through shared savings. An ACO gets a portion of the difference between what the healthcare costs would have been without the care management and how much lower the costs are with the ACO’s help.

A priest, a rabbi, an imam, a Buddhist or an atheist could provide the spiritual side of healthcare. Photograph: The Guardian / Alamy/Alamy

Originally, MissionPoint was a Catholic organization that started by focusing on a patient’s medical issues – it quickly became clear that that wasn’t going to work.

As we got into the nitty-gritty of managing patients outside the hospital, it became clear that a lot of times a patient’s primary health issue wasn’t actually medical. It was social. Or financial. Or spiritual. And those issues partly made the patients’ medical issues uncontrollable – and expensive.

By providing really great care coordination that was patient-focused, patients could be healthier, for less money. That included spiritual care.

Essentially, the idea is to stave off the expensive hospital visit except for when you really need it, as during a heart attack or after an accident.

As a Catholic organization, MissionPoint was founded on the idea that holistic healing meant caring for everything that affected the patient, rather than purely physical conditions.

But that also means we now have medical services. We have nurses who visit homes to check in and explain medications and treatments. We have coaches who try to help smokers quit. We also help people get to doctor’s appointments, and we work with pantries to provide food for the needy, give assistance with insurance issues and much more.

In a sense, we keep people healthier by bringing the hospital to homes, so that inpatient visits for major treatments are fewer and farther between. Spiritual care is just one of many ways to help.

Traditionally you find chaplains in the hospital, because serious illnesses often cause existential crises. Health and illness, life and death, joy and suffering are part of a shared human experience. Chaplains are there to help patients address the human condition.

But patients’ spiritual issues – just like their medical issues – don’t end after discharge, and sometimes, they worsen, compounding medical issues and sending people back to the hospitals.

It’s to prevent this problem that I visit patients at home, call them and sometimes drop in on doctor’s visits. I get to bring spiritual care to the patients, rather than waiting until the patients walk back through the hospital’s door.

The support of extended family tends to lead to better health and lower hospital bills Photograph: Wavebreak Media ltd / Alamy/Alamy

For example, I’ve visited many patients with life-threatening illnesses, such as cancer or heart disease, who could benefit from home-based palliative care. Palliative care relieves the pain and symptoms of an illness, but doesn’t cure the illness; it’s usually used in addition to a treatment that tries to cure.

Patients receiving home palliative care can often stay at their own houses for treatment, and if there’s a trained nurse checking in regularly, medical issues can be prevented before the patient ever has to be hospitalized.

However, a lot of those patients and families decline palliative care, even when the doctor recommends it and the patient would clearly benefit. It’s often a spiritual block, as when a patient does not want to confront that she could die, or when a spouse doesn’t want home care because he or she feels that responsibility lies only within them – as if to do any less would fail the vows of marriage and obligations of family.

These are health issues, but to deal with them, patients have to make decisions that can’t be answered by medicine. The meaning of our wedding vows, the roles of our loved ones will play in our times of need, whether we will accept or refuse palliative care – these are spiritual questions.

As their chaplain, I’m there to be with the patient and their loved ones, and help them work through the decisions that affect their overall health.

Maybe the patient who is afraid of dying needs to figure out what she’s living for. If the goal is to watch her grandson play baseball in the state championships, then maybe palliative care could control her symptoms well enough that she could get to the baseball game.

Then the palliative care isn’t about dying, it’s about living.

Until a cure for cancer is found, offering palliative care to patients helps them focus on living rather than the fear of dying. Photograph: PASCAL PAVANI/AFP/Getty Images

Medical care is essential, but it often takes a back seat to our fears about illness and death and suffering, and what it means to love each other.

In many ways, the pastoral care I provide is kind of like stopping at a spiritual waystation. After our patients leave the hospital, the goal is help them become spiritually healthy. Otherwise, their spiritual issues will get in way of their overall health.

And by a healthy spiritual life, I don’t mean that everybody needs to attend a church or a synagogue or a temple. To me, having a healthy spiritual life means being surrounded by people who love and care, to have purpose and meaning in life, and to understand that each person, self included, is holy and worthy of respect and dignity.

Sometimes my patients can find love and meaning in a religious community. Sometimes they find that meaning walking in the woods.

But for all of them, their spiritual health impacts their overall well-being, in mind, body and spirit. As their chaplain, I’m there to help them find spiritual healing, and move on to their spiritual home.

And hopefully, by healing spiritually, our patients heal physically too. Outside the hospital. At home, with people who love them, just as we all hope to be.