Music: Because visitors had asked about including music, it became a focus point for one meeting. Singing can be an important link for elders. Singing together is a good action that pleases many visitees, but is not every visitee's desire or every visitor's gift. Portable, electronic music systems can provide a full range of music in any space.
Encouragement: Discouragement about isolation and life circumstances may mar a visitee's life, and mar a visit. A visitor must recognize discouragement. Once aware that discouragement is present, deliberately seeking to provide encouragement brings a positive energy to a visiting situation. Encouragement can be fostered through words. Scripture and prayer often are sources of encouragement to elderly church folks. Simple, positive feedback, suggestions for change, and promises of prayer and personal affirmation (Emblen, 2014, p. 40) are other ways to provide encouragement.
Active listening is a nursing skill that can be taught to visitors. Visitors can listen to visitees' stories about the past and concerns about the present. Allowing visitees to share their pain validates their experience and helps decrease the loneliness of chronic pain (van Loon & Legge, 2013). Visitees also are likely experiencing loss, as they find themselves unable to engage in prior activities. Visitors can learn to be present, listen to visitees, help them process their feelings, and explore healthy responses. In the Informed Friend Program, Australian nurses Antonia van Loon and Vicky Legge encourage those supporting someone with chronic illness to be empathetic, reflective listeners. “You must practi[c]e paraphrasing the person's responses back to [him/her], reflecting the feelings and emotions behind the responses, so the person can hear/see [him/herself] and work out how to move forward with life” (p. 33). When a visitee says, “I am totally worthless; I can't do anything,” the visitor might gently reflect back, “You are feeling worthless. Tell me about the things you do,” and help the visitee see what activities they continue to engage in. Giving the visitee time to reminisce and review his or her life can be helpful.
Occupational Activities: Introducing activities can help visitees pass lonely time and extend the benefit of the visitation program. Carefully chosen activities can extend the impact of the visit, especially if the visitee continues working on the activity after the visitor is gone. Three examples of conversations leading up to introducing an activity are included in the sidebar, Meaningful Activities.
Understanding Impaired Communication: Speech difficulties and short-term memory impairment are common challenges. See Table 4 for visitor guidelines on how to adjust speaking and other interactions, when visitees struggle with impaired communication.
Nutritional Issues: Assessment of the visitee's health status and food preferences is needed prior to sharing food with a visitee. Note food allergies and chronic illnesses, such as diabetes. Fresh garden foods are an excellent choice, along with a favorite treat. Baking items at the visitee's home increases appetite and adds warmth. Visitors are encouraged to eat with visitees to enjoy fellowship and increase bonding.
Death of the Visitee: When visitors noticed their visitees becoming more fragile, they began asking questions about how to help their visitees and oneself cope with oncoming death. I was surprised at the profound grief and sense of loss I felt, when my first visitee died.
One of our focus times helped visitors deal with death. Our pastor provided useful suggestions for visitors to use when visitees were near death:
- Be quiet and listen in the presence of a dying person
- Express emotion sensitively
- Express joy for/with the person, who is going into the presence of God.
Our pastor also described ways visitors might develop comfort with death:
- Spend time with God
- Focus on heaven, rather than on death (1 Corinthians 15)
- Consider the joy of eternally living with God, rather than death being the ending of life
- Spend time with Christians anticipating death, who are rejoicing to go to be with God (Emblen, 2014).
We discussed having a plan for hard questions. Some homebound people need special counseling and guidance. Pastoral referral could help with questions about salvation and other faith questions, and to provide counseling for deep discouragement. Pastors can use their judgment about meeting alone with the visitee or with the visitor present. Visitors can also seek the pastor's counsel.
PROGRAM STRUCTURE AND ORGANIZATION
Over time, we developed a structure for the Compassionate Visitation Program. It is helpful to have a Visit Facilitator to coordinate the program and be someone to whom visitors report. The facilitator is typically the FCN or a church pastor. To recruit visitors to the program, we make announcements in church bulletins, newsletters, and Sunday-school classes. Visitors are encouraged to visit their visitee biweekly. A phone call is used to arrange and confirm visits. We initially planned to have visitors change visitees yearly, but some visitors wanted to keep their visitees.
In the beginning, we received a list of visitees from our senior pastor. Visitors chose one or two people they would visit. In succeeding years, we learned to pick up new visitees from announcements made about people who were ill, or discussion with other church members who knew someone had been absent from church. Sometimes family members requested visitors for a homebound family member.
Some visitors stop to interact with several people, having short conversations with visitees to whom they are not assigned. Having several people drop by during a week makes time pass more quickly for the homebound. Visitor overlaps on different days are usually a good thing, unless the visitor appears tired.
We developed these important visitation guidelines:
- Contact Visit Facilitator/FCN regarding questions or problems arising during a visit (i.e., food assistance, medical or other needs).
- Do not provide transportation for homebound person; contact church staff/FCN.
- Do not make suggestions to visitee about changing residence.
- Do not sign checks or initiate medical or legal assistance.
- Contact Visit Facilitator immediately regarding any evidence of abuse or neglect.
- Do not directly assist with medical care needs.
- Avoid lifting or manually handling the visitee, without proper training and help.
- Do not give advice about changing treatment or go into lengthy discussion of what visitor did to treat a similar problem.
- Use good hand-washing and safety precautions.
- Do not visit if you are sick or coming down with something.
Regarding record-keeping, on the initial visit, the visitor should complete a form and file it with the Visit Facilitator. Note special food needs, past and current hobbies, and other pertinent information. Following each visit, send a brief note to the Facilitator regarding the visit and the general response to activities that were part of the visit. Records are essential to provide the FCN with the number of visits and particular events that occur related to the visits.
Making homebound visits is an important part of the ministry of the church. Matthew 25:31-46 addresses our calling as Christians to visit those who are ill or in prison; certainly this means visiting our elders who, like prisoners, cannot leave their homes. A visit can encourage and lighten some of the lonely hours for those who have little to do during their long days. It takes time and planning on the part of the visitor, particularly if doing special activities. But the time pays off bountifully, as the visitor leaves with the visitee calling out, “Come back soon! I really enjoy our time together.”
Indoor Gardening. On his second visit, Ted*, a visitor, found Rives* disinterested in general conversation. Gardening had been a favorite hobby in past years, but Rives would be physically unable to do much gardening. So, Ted brought up the idea of setting up a mini flower garden near a window.
After discussing with Rives about what he'd like to watch grow, Ted purchased a pottery planter 14 in. in diameter. Rives agreed to try growing a bonsai tree and a few orchids in a sunny window. On the next visit, Ted brought garden supplies. Ted moved a table, covered it with old newspapers, and put the garden things on the table for Rives. For the next 10 minutes, Rives worked at assembling his garden. When he finished, Ted brought a watering can and opened the fertilizer bag. Rives stirred in fertilizer and carefully poured water around the plants. “I really like my little garden. I can watch it every day and check it for moisture,” Rives happily told Ted. “Before you know it, I'll be giving you an orchid for your wife.”
A Reminiscence Box. Liz knew Adelle pretty well, and in reviewing the hobbies Adelle enjoyed, Liz had an idea. She explored a toy and craft shop and a discount paper store to gather things to put into a reminiscence box. She recalled that Adelle had sent many cards to people over the years, so she got paper they could use to write notes to people. Adelle also had baked lots of cookies for church events, so Liz thought a miniature mixing spoon, bowl, and plate from a toy store might jog Adelle's memory of her previous activities and even help her get interested in baking cookies.
Liz dusted out an old shoebox she had in her closet and found pretty paper to cover the box. She decorated the lid with a miniature set of measuring spoons labeled “pinch, dash, and smidgen.” Liz pasted a ribbon on the side of the box, tied several ball-point pens into it, and put the miniature kitchen tools and paper inside. When she carried the box into Adelle's room, Adelle was in her wheelchair with her back to the door—her usual spot. “Hi, Adelle,” Liz called loudly enough to awaken Adelle, who seemed to always be asleep when she arrived. “I've brought something to show you.”
“Hello,” Adelle responded, a bit less than enthusiastically. She looked sleepily at the box Liz placed on her lap.
“I have made a remembrance box for you,” Liz explained. “You can look at the things in it and think about how you used them, and when visitors come, you can tell us stories about using these things. Your friends and family can add to the box.”
A Visitor Book. “Did you have any visitors come to see you this week?” Hazel asked Betty. “You are the only one who ever comes to see me. All I do is lie here all the time and hope that someone will come.” Betty expressed her sense of being alone. Hazel talked more with Betty, and when she left, she went to the nurses' station and asked if Hazel's family or friends came to see her. “Compared to other residents, Betty holds the record for visitors,” the desk clerk told Hazel. Hazel realized that Betty probably forgot a lot of the events occurring in her day. Then she remembered that she used a guest book to help her to remember who had been to her home. She decided that Betty needed a guest book.
On her way home, Hazel stopped at a stationery store but found that guest books did not have the right kinds of spaces for visitors to write much. So she bought some card stock, paper, and ribbon. At home she made a sample page with the headings “Date/time,” “Visitor's Name,” and “Note of Conversation or Activity.” She put in five lines and repeated the heading and was able to put records for six visits on a standard sheet of typing paper. Using the church copier, she made 30 copies of the page and punched holes through the paper and the colored cardstock she chose for a cover. She tied ribbons through each hole and attached a pen so visitors could sign the book. She put a paper flower on the front of the book with a note that read: “Please sign this book when you visit, so Betty will remember and her family will know you stopped in to see her. Thank you for helping us know that you were here.”
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Musich S., Wang S. S., Hawkins K., Yeh C. S. (2015). Homebound older adults: Prevalence, characteristics, health care utilization and quality of care. Geriatric Nursing
, 36(6), 445–450.
Quiring Emblen J. D. (2014). Visiting Mrs. Morgan: A handbook for visiting aging, homebound and hospitalized people
. Abbotsford, BC: Mill Lake.
Van Loon A. M., Legge V. (2013). Becoming an informed friend: Participant workbook for the “Still Me” program support volunteers
. Wayville, South Australia: Baptist Care.
Webb M. W. (1989). Building a ministry for homebound and nursing-home residents
. Nashville, TN: Discipleship Resources.
* Names changed to protect privacy.
Keywords:© 2016 by InterVarsity Christian Fellowship
elderly; faith community nursing; homebound; lay ministry; visitation