Pastoral Care

My intuition and experience suggests that among the many societal changes that affect ministry, there has been a shift in the ways in which we need to be ensuring pastoral care. I have written what follows to stimulate a conversation at our next vestry meeting, but am sharing it more widely as a blog entry in the hopes of inviting wider conversation, and seeing if, and to what degree, my intuitions make sense to others.

I sometimes have an expectation of myself that I will know of people with needs for pastoral care and should be able to make referrals to pastoral care givers and care teams. When I think about the past few years that has not been true at All Saints’ and has led me to think about whether my expectations are realistic or whether this is an area that has really changed.

There used to be an expectation that clergy would visit their parishioners unannounced and without appointment. By the time I began ordained ministry in the early 1980s this idea and practice of pastoral care was having its last death throes in many places. While older parishioners still thought that clergy ‘dropping in’ was something good and pleasurable, the younger families who were my primary constituency would be more likely to wonder who had died if I was to appear on their doorsteps.

Those were also the days when one of the clergy would make a round of the three major hospitals in Raleigh every day. We knew that it would be a rare day in a parish of over a thousand people when there would be no one from Christ Church in one or other of the hospitals. While we appreciated someone calling to let us know that they were ill, our expectation of ourselves and our parishioners’ expectation of us was that we would simply find them, have a brief visit and say a prayer. We did not have ‘business cards’ filled with our contact information and job titles. We had ‘calling cards’, simple elegant cards bearing only our names. I remember when an assistant even more newly ordained than me was hired who questioned the value of these cards for our day and age and was told that he could have any kind of card he wanted, but it was pretty clearly understood that what he wanted was a tasteless, if not bad, idea.

It was around that time when it was becoming standard to talk about ‘lay ministry’ and to talk about it in ways that assumed ministry to be something done by the clergy and ‘lay ministry’ to be something done by people trained to do some of what the clergy did. Lay Eucharistic ministers were introduced to assist with the administration of communion by serving (only) the chalice, initially as an expedience in growing parishes with only one or two clergy, the increased centrality of the Eucharist assumed and encouraged by the 1979 Book of Common Prayer, and the continuing desire that Sunday worship last no more than one hour. This was expanded to include Eucharistic visitors who would take communion to those not able to attend church, but only immediately after the Sunday service. In time and certainly by the 1990s the illogical restrictions were being dropped. Licensed Eucharistic ministers could serve both bread and wine, and could take communion to the homebound at any time during the week from the consecrated and reserved sacrament. It was increasingly only the homebound who were served by these ministries and programs such as ‘Stephen’s Ministries’ and ‘BeFrienders’. Alleged managed, alleged care, together with advances in medicine such as outpatient and laparoscopic surgery had radically changed hospital ministry to the point where today in a parish of 3,000 we cannot assume that there is anyone in the hospital on any given day. It was not that long ago that I found myself telling a newly ordained associate that when we are on call and learn that someone is in the hospital, my expectation is that they be seen. And that means immediately. The chances are that the person will have gone home by the time it is ‘convenient’ for us to visit.

The advent of HIV/AIDS and the extraordinary needs of those suffering from this disease that was usually understood as a death sentence led, eventually, to the development of care teams for people with a whole range of practical and spiritual needs and those teams were busy for years providing critically important pastoral care. Changes in the whole scene in the past twenty five years or so, notably the development of increasingly effective ‘cocktails’ or combinations of medicine and other treatments have meant that a person testing positive for HIV can often expect to live a long life while managing a difficult illness. In that sense AIDS has become more ‘normal’ or within that range of human experience of living with chronic and long term illness that afflicts many people with a variety of medical issues rather than an extraordinary and epidemic plague. Those changes have meant that care teams have had to adapt to a slightly different understanding of how it is that we offer and provide care to people with long term needs and increasingly available societal resources. Many such teams have simply disappeared and the caregivers found their ways into other ministries.

Today we find our selves working with shifting models for providing pastoral care. The ideal is that every Christian is in a community of some kind, a formal small group or informal social network, within which she or he will receive care when it is needed. In the non existent ideal church, every person would know in general who it is that they are going to care for in a crisis and who it is that will care for them. Everyone will understand that they are being cared for by ‘the church’ even before clergy know what is going on. In that same ideal church, of course, the networks would let clergy know quickly. Whether the clergy response is that of an intimate friend or a stranger in a clerical collar, the member of the clergy is serving a representative function of the rest of the church or the whole community of which this smaller community of friends is a part.

When ‘lay ministers’ by whatever name were introduced into the areas of pastoral care, many parishioners resisted their ministry. That appears to be no less true with a new generation of aging parishioners who frequently have enough to manage without a ‘formal church friend’. Again, whether the relationship is intimate or essentially new, the ‘formal’ part of church ministry, to the degree that it is welcomed, is represented by the clergy. People say they have needs but rarely want those needs met programmatically. Take the desire that someone provide a ride to church. We find that the idea is a good one, but that we often do not want to have to beholden to another, or committed to doing something at a particular time each week, or unable to decide that we might like to go to Sunday School or that we might prefer to skip it and so on. Suddenly that person offering a ride in advance and on a planned basis is not such a great idea after all.

As our vestry has found ways to discuss what kind of church we are and what are the realties of the world we are serving, we have talked about Christendom and post-Christendom. What has emerged for me in those conversations is a sense that the way our parish actually works best is through social networks, relationships, friendships, connections and so on. Our parish life ministries are designed to bring us together in varying combinations in the service of developing those networks. This means that the most effective pastoral care occurs when we are connected and have real friends that care rather than what we might call ‘official’ friends. My expectation is that there will always be people who fall through he cracks for one reason or another, but often because they have not really connected with a network at church. That fact makes it harder to know of their need and it is just as likely that the clergy will be as unaware as everybody else in a large parish since we depend on the networks, especially those of which we are not naturally a part, to let us know what is going on. We have wonderful people currently involved in offering pastoral care who each have a heart for this kind of ministry. In many ways those involved are themselves a caring network for each other of exactly the kind we are thinking about. My instinct is that the ways in which we deliver care in the future will be more about creating and using networks than individuals with an assignment to care for other individuals.

I have some ideas about what pastoral care focused on networks, friendships and connection might look like, but for now would welcome thoughts, responses and other intuitions about what is going on. Let’s talk.