Nursing Home Visitation
By Tom Penny and McCormick
Visitation is at the heart of any nursing home ministry. In this part you will find numerous practical suggestions concerning a visitation ministry. Much of what you read is nothing more than common sense. But it is of great value to you to contemplate some of these common sense guidelines and suggestions as you prepare for and evaluate your ministry of visitation. Use the margins and other white space to record your own observations and experiences. Take the opportunity this section provides you to become a self-conscious, teachable and –we hope-effective visitor of elderly people. The humble ministry of visitation is a ministry of great responsibility in the kingdom of God.
What Is Visitation?
When we consider visiting someone we tend to think of dropping in to say hello, or catching up on the latest news or just finding out how someone is. Our ideas of visiting often boil down to making a brief appearance or exchanging a few words.
The concept of visitation in the Bible is much more full and rich than our concept of “dropping by.” To visit implies that one wishes to show concern and interest in another person. In Exodus 3, for example, we see God visiting Moses: “dropping by” in the form of a burning bush that promises to deliver the Israelites from bondage—through the one being visited, no less! The word for “visit” is also found in Psalm 8:4, where the wonder of a mighty God caring for insignificant man is discussed. In Matthew 25:36 visiting seems to imply caring for the needs of someone who is unable to care for himself. This idea is further elaborated in James 1:27, where doing what God commands is seen in terms of being like a father to the orphan, and a husband to a bereft wife. Visitation implies a deep commitment evidenced in a practical demonstration of Christ’s love.
In the Scriptures God himself is often seen as a visitor. His visitation is his coming in blessing (Ruth 1:6; Jer. 29:10) and cursing (Lam. 4:22; Hos. 8:13). Likewise the coming of Christ is spoken of as a visitation that brings both blessing (Luke 1:68, 78; 7:16) and curse (Luke 19:44). The intention of his first visitation was gracious (John 3:17), although it resulted in judgment for the rebellious (John 9:39). His second coming or visitation (1 Pet. 2:12) will also be a time of blessing for the righteous and judgment for the wicked (2Thess. 1:6—10).
During the time between Christ’s two bodily visitations—we are told—our visitation should parallel his in significant ways (John 15:18—20; 1 John 4:17). The book of Acts, for example, is full of the deeds of the disciples as they visited various areas of their world, proclaiming the good news of Christ to many people. Although our purpose in visitation is always gracious, as Christ’s was, it will inevitably result in judgment for the unbelieving (2 Cor. 2: 14—16).
Love for Christ should be our supreme motivation for visitation of the elderly. Our concern and our desire to care for and protect depends on our love for the Christ who loves us (1 John 4:20). As we seek to learn more about visiting the elderly, let us remember that we are really learning more about loving God (Matt. 25:36, 40).
Basic Guidelines For Visitation
* Keep your personal relationship with God in good shape!
* Seek support (prayer and fellowship) of other Christians.
* Cultivate a listening ear.
* Hear what the person’s needs are, not what you think they are.
* Act in humility—don’t think you are superior.
* State why you have come.
* Give the hope that you know—not false hope.
* Talk to individuals and learn their names.
* Fix your attention on what is being said and who is saying it.
* Respond to questions and situations as well as you know how.
* Involve yourself with people-not with impersonal, distant “problems.’’
* Share yourself—your hopes, fears, interests, even discouragements.
* Be friendly, outgoing. Ask questions to start a conversation.
* Accept the individual for who he is.
* Encourage openness—don’t monopolize the conversation.
* Ask questions about what this one person is interested in-family, past employment, likes and dislikes (beware of entering into a “crab session”), friends, current events, God…
* Commit yourself to faithful visiting.
* Continue in the face of boredom, discouragement or rejection—you are not visiting to meet your own needs, but to serve others in obedience to God.
* Visit at appropriate times—not very late at night or early in the morning or around meal times (unless you are eating with some one person or helping to feed).
Relating To The Nursing Home Staff
Most likely the first people you will meet at a nursing home are the staff. It is a privilege to be in the home and to show the love and concern of God to them as well as to the residents. A humble and courteous attitude to all staff will open many doors that might otherwise have remained closed. Such an attitude will help you to be seen as a blessing to the home, not a burden.
When the occasion arises, introduce yourself. Spend time developing a good working relationship with the administrator and/or the assistant—as much as your schedules allow. Encourage them to share with you how they think you could best be of service in this home. Beware of giving the impression that you are there only to proselytize. Stress your desire to show love and friendship to the residents and to minister to their needs in the name of Christ.
Usually this person is the key contact in the home, especially for discovering the type of program needed—or desired—and the schedule of events to which you must adapt. (If there is no activity director, go to the administrator or the assistant.) Keep in touch with the activity director—how things are going, new ideas and problems from either side. Many homes require you to fill out a volunteer form and to sign in each time you visit. Use maturity and discernment as you share what you are doing. Don’t unnecessarily bind your freedom by trying to do too much too quickly, by using religious clichés or by entering into arguments over religious matters. Sometimes a very “neutral” or nondenominational service or activity is wanted, and often it is possible to cooperate and give no cause for offense while still being true to the gospel as presented in Scripture. Compromise is not necessary, just wisdom.
It is always good to check in with the nurse in charge when coming on to the floor, whether to visit or conduct a worship service or activity. Establish a relationship, exchange concerns and information, work together where possible, but be aware that nurses are often genuinely busy, particularly during changes of shift. Be especially courteous and respectful of them and their time. Do take to them questions of care and concern, including residents’ complaints. But remember, you may not have all the facts. Sometimes theirs is the responsibility of supervising and directing an uncooperative staff. You can help by being a peacemaker. Serious conflicts need to be taken to the supervisor or director of nursing.
The most in number on the staff, nursing assistants have much contact with residents and much possibility for genuine care. Often they are very helpful to visitors. Many may come to worship services in the home. If they do, notice them and include them in the audience. Talk with them; provide spiritual care, comfort, support and counsel for them too. Remember their families and their personal concerns in prayer. If they are unruly, un-cooperative or disruptive during a worship service or an activity, speak to them about it with humility. If they persist, speak to the activities director.
These people are not involved officially with the residents, though they do have considerable contact with them and can be very helpful in encouraging them. Pray for this part of the staff and support them in their work.
Do not interfere with meal times. Try to be helpful but be sure to ask a nurse or assistant about it first. Sometimes our “helping” gets in the way, but often the staff are most appreciative of some assistance, e.g., feeding a patient. In some places, helping with food or feeding residents is illegal. Be sure to find out from the nurse if the resident is on any special dietary restrictions before bringing in food.
For many people one of the biggest fears about visiting in nursing homes revolves around the question: “What will I talk about?” With some people you visit this won’t be a problem. They will do much of the talking, and you will find yourself listening to a steady stream of questions, reminiscences and the like but your visit with other nursing home residents may be some thing quite unusual. Many elderly people sit for hours—even for days on end—scarcely speaking a word or being spoken to. For them, there is little to stimulate either their minds or their bodies. Thus it may be up to you to carry the conversation.
We have found that those people who find it difficult to lead a conversation need not fear the challenge of conversing with nursing home residents. It is very common that the people we visit are so happy to have someone talk to them that they don’t care what the topic is or how often the topic changes. This gives the visitor great freedom in choosing topics and talking about things that he is familiar with. Through many years of using this freedom we have come to make the following suggestions.
Listening shows that you really care and accept who the person is. A good listener learns about the other person’s interests, hopes, needs and desires and gains insights for being helpful in these areas. Plan to develop your skills as a listener.
Don’t respond to feelings with facts alone. Let yourself feel what the person is going through. Genuine sympathy (feeling with someone) makes good communication possible. You will find that a mutual friendship will grow naturally out of a sympathetic relationship.
Avoid questions that can be easily answered with a simple yes or no. One- word answers stifle conversation in a hurry. Questions that seek explanations allow the other person to teach you something about himself. As he does this, be careful not to probe too deeply on the first visit. There may be sensitive areas that you should avoid until you know the person much better.
These are some topics about which you may want to converse:
1. The room—cards on display, plants, pictures, furniture, view out the window, roommate, arts and crafts, television program, music, color of decor.
2. The home—food, nurses, visitors, friends, sitting room, noise level. Although such topics may provide an excuse for some to vent their coin plaints, we think that such opportunity can be important and valuable in getting to know the person and showing your concern for him. Do not, however, encourage sinful attitudes; instead, encourage constructive evaluation and positive, responsible involvement.
1. The past—where they grew up, number in family, favorite family pastimes, favorite sports, travel, school, where they have lived, what it was like back then, job of parents, jobs they have held.
2. The present relationships—married? How long? Spouse’s name, children’s names, where they live, whether they visit, any grandchildren?
Weather, recent events in the news, how their week was; activities in the last week in the home, in the week to come?
What church they attended, what it meant to them. Did they like singing? Favorite hymns, faith of their parents, how they think of God, what they ray about, how they think of Jesus Christ.
The Visitor And His Resources
We have previously mentioned several necessary personal qua1ificati of the visitor. Here, in more detail, are three key resources which the visitor has at his fingertips—himself, the Scripture and prayer.
The Use of Self
You are one of your big resources as a visitor! Look to God for help as you strive to become a person who is more and more fitted to serve. The following characteristics—humility, vulnerability, commitment, empathy and the capability of listening—these are of special importance in a nursing home ministry.
If we have a proper sense of self, then we will not suffer from either pride or false humility. This will enable us to be ourselves and allow the elderly to be themselves. How can we actually be humble? By recognizing that we don’t have all the answers, expecting to learn from others. By treating them as if they are worthwhile—because they are!
To the extent that we know ourselves and have a proper sense of worth, we can open up to others—and to the possibility of rejection, criticism, pain and sacrifice as well as to the possibility of pleasure and praise. As we share thoughts, feelings and hopes with others, they see us as “human too” and will more readily open up to us.
If we are not willing to sustain a deep level of relationship with a person as long as he needs it, then we are not letting ourselves be used as fully as we could. It is through our continued humility and vulnerability and our continued empathy and listening that we really care for the individual.
This process involves both our mind and our heart. To empathize we must be able to understand what is happening to the individual, feel sympathy for what he’s going through and then put the two together in helping him deal with the situation.
Much of the above takes for granted that we know how to listen. Listening is an art that is not always as easy as it seems. Listening.
• expresses love. It recognizes the importance of the individual. It shows a willingness to spend time and energy on another’s behalf.
• brings understanding. This takes time—there usually are no instant solutions to problems and no shortcuts around the need for personal sharing. Whether it’s a person or a situation that we’re endeavoring to understand, listening requires giving up our own interests and concentrating fully and actively on his (Phil. 2:3, 4).
• participates actively Listening is not merely not talking. It encourages the other person to say more, without prying; it seeks to formulate a response, without thinking of self; and it strives to hear what is not said as well as to understand what is said.
“Listen to me, do but listen, and let that be the comfort you offer me” (Job
The Use of Scripture
While the resource of self is often unreliable and imperfect, the Scriptures offer a stability and hope to which both we and the elderly can turn. In a changing, fragmented world, the word of God directs our attention to a perfect God who never changes and who can put order and meaning into our lives.
When to use the Scriptures
1. Find an appropriate time.
Referring to Scripture too soon can give the impression the Bible has only pat (and therefore irrelevant) answers. Referring to it too late makes it seem like an afterthought. Be sure you really understand—then share Scripture. Remember Job’s comforters!
2. Comfort the suffering.
A word of comfort in the context of personal relationship, and at the right time, can be a deep blessing. Often the purpose and meaning of suffering need to be seen.
3. Meet their needs.
Don’t read Scripture merely to meet your own needs; nor should you read your problems into their situation. But be ready to share Scripture through which God has spoken to you, if it is fitting.
4. Respond to the Holy Spirit.
Don’t share from the Bible out of a sense of duty or compulsion. Let the Holy Spirit be your guide.
How to use the Scriptures
1. Select the appropriate content.
Your choice should be guided by the residents’ needs—give yourself time to find out their needs. Some of these needs are discussed in the charts found in Part II.
2. Help the person to identify with Scripture.
Share passages with which the individual can identify. This helps self- acceptance before God and enables him to express himself.
3. Choose the appropriate translation.
For residents who are versed in the Bible, you might stay with the familiar or expected (usually KJV). For those who are unfamiliar with the Bible, consider using a modern version—one they can read with ease.
4. Share with one another.
Let them share with you what they are learning from Scripture and their experience. But feel free, also, to share what God has been teaching you.
Suggested Scripture passages
1. Forgiveness—Pss. 32, 51, 103; Is. 1:18; 53:4—6; Mic. 7:18—20; Rom.
8:1—4; Heb. 4:15, 16; 1 John 1:6—10
2. Comfort—Pss. 4, 23, 116; Is. 40:28—31; 41:10; 43:1—5; Matt. 11:28; Rom. 8:35-39
3. Hope—Pss. 42, 139, 145; Rom. 5:1—5; 1 Cor. 15; 1 John 3:1-3; Rev.
4. Love—Deut. 7:6—10; Is. 43:1—4; John 3:16—18; 14; 15:9—17; 17:9—26
5. Trust—Ps. 23; 37:3—7; John 14:26, 27; 2 Cor. 4:16—18; Phil. 4:4-7; Heb.
12: 12—15; 1 Pet. 1:13—21
The Use of Prayer
Prayer is another great resource since it taps into our greatest resource of all—God. Our prayers are important, not just as a comfort to the person we are praying with, but as a communication with the living God who hears and answers. In prayer we not only draw close to God but to one another.
When to pray
1. Find an appropriate time.
For each resident the appropriate time may be different. It is important not to pray with someone before adequate communication has taken place. Then the prayer can reflect to God the concerns that have come out of a conversation. One must be careful not to use prayer to end conversation. It may well be that after a time of prayer you will want to continue a conversation. Often deep feelings are triggered in response to talking with God. Be willing to stay and respond to these thoughts and feelings.
2. Be alert to “anxious times.”
Pray before potentially stressful situations such as surgery, tests, and unfamiliar changes.
3. Strengthen believers’ faith.
Pray with those who show some evidence (verbal, written material, etc of faith.
4. Examine your motives.
Ask: Am I praying to meet my needs or theirs? Have their needs in the forefront of your mind—often God will give an added blessing by ministering to you too!
How to pray
1. Focus on God.
Praise God for who he is and what he has done—prayer and supplication with thanksgiving.
Focus on needs.
Focus on what you think the individual would want prayed for—health, friendship, finances. Discern his hopes, fears and desires. Adjust to the person’s background.
Be aware of the denominational and ethnic background and adjust your style of prayer accordingly (e.g., formal vs. informal).
Expect God to respond.
Only by expecting God to respond can you teach others that prayer is real and is heard by God.
Give resurrection hope.
The power of the resurrected Christ is active both in this life and the life to come. Help the person to see that power as active in his life.
Remember that the elderly often have a shortened attention span, so keep your prayers short.
The material in this section (“The Visitor and His Resources”) is adapted from Spiritual Care: The Nurse’s Role by Sharon Fish and Judith Allen Shelly. © 1978 by Inter-Varsity Christian Fellowship of the USA and used by permission of intervarsity Press, Downers Grove, Ill. 60515, USA.
The following pages are meant to be guidelines. Since the first visits are often the most difficult, it is good to be as spiritually and psychologically prepared as possible. However, don’t be bound to the suggestions outlined below. Read through the next few pages, meditate, pray and open your heart to various possibilities.
There is no need to try to remember numerous details. After reading and meditating on this section, be free to branch out on your own—trusting God to prepare you, to guide you and to give you the flexibility you will need for the particular situation you encounter.
Before you go to the nursing home for the first time, and in successive visits as well, ask yourself the following questions:
1. Have I taken time to pray?
• for myself, what I will do and say
• for those I am about to meet
• for the staff of the home
• for others going with me
2. Do I have a goal?
• help write a letter
• talk about God
• chat with three people
• lead a worship service
3. Do I have the material I need?
• Bible, tracts
• games, puzzles
• small gift(s)
• writing materials
• musical instrument
4. How do I look? How do I feel?
• dress—usually not-too-casual is appropriate
• cheerfulness—would someone want to talk to me?
• motives—am I trying to serve God? To serve the elderly?
• breath—in all likelihood many will be hard of hearing and I’ll have to talk “close up”
The First Visit
Contact the nurse in charge of the unit you are visiting. It is wise to have your presence officially recognized, although that may not always be necessary. There may also be a check-in point at the front desk or in the activities office. Find out the rules and abide by them. Although checking in may seem unnecessary after a while, contact with those in charge not only is courtesy to them, but also provides an opportunity for you to find out who sick, depressed, lonely and in special need of a visitor.
When arriving at the door of an individual’s room be sure to knock and wait permission to enter; or enter slowly and tentatively, especially if the person is hard of hearing. This is probably the only private space this person is—don’t violate his control over it.
You may wish to begin visitation by meeting the person in an open lounge. This setting is also good for general conversation, but often presents too any distractions for deeper, more personal talk.
Introduce yourself and start alight, friendly conversation. Tell the person little about yourself—your name, relationship to the home, and some possible background in common, such as job, church or family. If you have no such common background with the individual, just state your purpose in visiting. Be honest, concerned and direct.
The environment in which the resident lives is very important, not only for effect on him but for what it tells you about him. The external situation, the room, other people, noise, flowers, the person’s physical condition) can open up areas for conversation, as well as give clues to the internal condition mental spiritual state) of the person you are visiting. Be prepared to adapt your goals to the needs—but don’t necessarily abandon your purposes together!
Though you do have a decidedly spiritual interest in these elderly people, beware of focusing too much—even exclusively, perhaps—on “religious” things. Be ready to be involved in the whole of life.
Leave any literature that may be helpful in a particular situation. This may not always be appropriate, for example, with some Jewish people, with those who cannot understand or with those who cannot read English. In h cases it would be better to let your words and actions leave the lasting impression.
If possible, tell the people you visit when they may expect you next. Don’t get carried away and promise more than you can realistically do.
Faithfulness to your word is especially important to those who have so little this earth to look forward to. If you do say you will return at a certain time on a certain day and are unable to make it at the specified time, be sure all the home and leave a message or ask to speak to the person directly on phone.
After you leave, write reminder notes, reflect on your visit and pray. As you await your next visit, make a note of any Scripture that may apply to the person’s situation, and meditate on it, praying for wisdom as to how and when to help meet his needs. Ask others to pray for you and your “new friend”—this is a great way to involve others in the ministry to the elderly! Make some tentative plans for your next and following visits, including the possibility of relating to the individual’s family or involvement in other activities.
The Second Visit
Be sure you have reviewed your notes from the first visit. Pray and meditate on the response you think would be appropriate for the visit. Follow the same basic procedure as you did in the first visit, noting especially the following:
1. Be ready for any changes that may have occurred—new roommate, death of a friend, good or bad news, change of mood, and so on. Adapt the response you thought would be right to fit the new situation. Don’t hold to a rigid agenda, but be flexible.
2. Enter again with an introduction that assumes neither too little nor too much recognition. Give gracious clues to your identity as needed. Stimulating people to remember provides good mental exercise and helps establish a proper sequence and time-consciousness. There may be some resistance to this due to laziness, neglect and/or physiological disability. As best you can, try to decide which of these reasons applies. Don’t push too hard for fast recall, whatever the cause.
3. Try to undo any misunderstanding that may have arisen from the first visit. And plan not to repeat your early mistakes. Did you monopolize the conversation? Be prepared to listen more. Did you come across too force fully in sharing the gospel? Be more sensitive this time. Were you too in formal with someone from a more formal background? Be more adaptable—and apologize if it’s appropriate.
The Third and Following Visits
As you spend more time with an individual you may not feel the need to take notes. If you’re spending a fair amount of time (twenty to thirty minutes at least) with your friend, note taking is probably not necessary. If, however, you are visiting a large number of people for short periods of time, it’s probably best to stick with a few notes in order to keep everyone straight in your mind. Be guided by your own needs.
The following hints are offered as suggestions. They are by no means exhaustive nor meant to be followed with strict rigidity.
1. Since elderly people are close (relatively speaking) to death, and some may be sick and actually very near dying, make every visit count. Be there for the person—give each one your full, loving attention.
As before, don’t leave false expectations about what you can or might do, or when you might visit again.
Move toward dealing with particular problems or concerns. If confrontation or exhortation is needed, be sure you have established a sufficient basis of trust and friendship first.
Encourage spiritual examination and life review (i.e., meditation on past life, its successes and failures, with a view to dealing with unresolved feelings or conflicts). Move toward a continuing program of personal, meaningful examination of self—issuing in service to God and others. Avoid dwelling on the past that can’t be changed; concentrate on learning from mistakes and improving present attitudes and behavior.
Seek ways other than visits to be involved in their lives and to involve them in your life. Consider their needs and plan constructively and creatively to meet these needs. This may mean writing letters for them, taking them to a potluck, arranging transportation to a church service—the possibilities are endless. What would they like to do? What are they able to do with help?
Excerpted from ‘Nursing Home Ministry’
By Tom Penny and McCormick
This article may not be written by an Apostolic author, but it contains many excellent principles and concepts that can be adapted to most churches. As the old saying goes, “Eat the meat. Throw away the bones.”