Church and Leadership: Hospital Visitation: The Ins and Outs
by Ed Vasicek
A realistic & honest approach for pastors and lay leaders
Introduction and Purpose
In many churches, the purpose of
hospital visitation is simply that it is expected. The custom of a pastor, lay
leader, or other church visitor (as opposed to a visit by a friend or relative
inside the church or without) is just something churches or pastors do.
Sometimes the issue can become
silly. Some people may want to visit if they are having simple outpatient tests.
Some people practically want you to go with them to the dentist. The demands
and expectations of people, culture and custom can cloud the reason for
visitation completely. This is especially true among rural churches.
The custom of visiting church
members in the hospital is derived from the principle of visiting and
encouraging the sick or helping people during times of distress. A couple of
generations ago, people often went to the hospital for only the most serious
situations. Babies were born at home, surgeries were done in living rooms and
doctors made house calls. When you went to the hospital, it was a truly
Hospitalization went to the other
extreme in the 1970s and early 80s. Doctors would put their elderly patients
in the hospital for two weeks just because they had the flu! When I first came
to Highland Park Church, I inherited some practices that I considered silly. I
had to visit elderly women in the hospital who merely had the flu—and I was
expected to visit them every day of the week. In those instances, the ladies
had plenty of family attention, so it was not a matter of them being without
support. Of course, this displaced more productive ministry. Needless to say,
we now have a more sensible system in place. Where do these—sometimes silly,
sometimes reasonable—rules come from?
Like an old European city that
just "happened," many churches and communities have accumulated a hodgepodge of
traditions that eventually dogmatize into expectations. A more reasonable
approach should be based upon convictions and logic.
Let's begin with the purposes of
a church (or clergy) visit to the hospital. Here are a few:
To share Christ with those who do
not know Him (goodwill ambassador)
To express Christian love to a
person who may be afraid, discouraged, or lonely (fellowship and love)
To show friendship to a member of
the Body of Christ (relational development)
To offer the encouragement of the
Scriptures and prayer (spiritual edification)
To affirm that the church family
is there to support the person (sympathy, empathy and solidarity)
To minister to the person and
family in times of death, fear and uncertainty (emotional, spiritual and
psychological support via one's presence); Paul Cedar refers to the
"sacerdotal presence" of a pastor. Although theologically questionable, to
many people the presence of a pastor psychologically and emotionally
symbolizes the presence of God's care.
Rewarding people who have
faithfully served our church by honoring them with some attention
(recognition) when they feel vulnerable. Though this may sound trite,
relationships are built around reciprocity.
When people are
hospitalized, they feel vulnerable and need the comfort of a church shepherd;
they need to be pointed toward the Good Shepherd.
Visits: From Priority to Luxury
include ministering to those who are dying, have been traumatized, or who are
concerned about the destiny of their souls. Crucial visits are priority visits.
are not as time-sensitive or immediate. I suggest visiting before a significant
surgery (usually the day before at home, since most folks enter the hospital the
morning of their surgery). A visit a few days after surgery is often
appreciated as well. For more info on frequency of visits, see section V, letter
include people who are only in the hospital for a day or two, women having
babies, or stopping by someone I saw yesterday because I happen to be in the
hospital the next day to visit someone else. If I choose to visit someone who
is not part of the church family (perhaps a relative of someone who attends),
that constitutes an optional visit. If someone from the church asks me to visit
a relative (locally), I usually do so (one time only). If they say, "If you are
at the hospital and you'd like to drop in..." I will visit them if I am in the
hospital, but will not make a special trip.
I do not feel obligated to visit
people outside our church family but will do so to maintain good relationships
with those who are part of the church family. Occasionally you might have a
church member who thinks you have nothing to do and are looking for people to
visit. In that instance, you will need to inform the church member otherwise.
involve making visits for no practical reason other than to please people, keep
the peace, or satisfy tradition. You are not really ministering; you are not
keeping people in touch with the church because token visits most often involve
irregular attenders who do not really care that much about the church. A good
example of a token visit would be when you are asked to visit a non-attending
spouse who is having a heart catheterization. This patient has no interest in you
or use for spiritual things, but his or her spouse thinks that this might
provide an opportunity to witness. In rare instances, someone might actually be
saved through such a visit, but typically the visit is token. I rarely volunteer
to make token visits, but I have made hundreds of them over the years at the
request of others. I now will only do this if the visit is local.
Levels of Authority
Clergy (Pastor) are
generally acknowledged by hospitals and are typically able to gain entrance
anywhere at anytime (if the patient wishes). Pastors who are local are
sometimes urged to view a video, etc. to orient them, but this is becoming
Elder in lieu of a pastor
may have a more difficult time getting into intensive care (other than
during family times) or getting admission apart from visiting hours. If you
are in this situation, it is good to explain that the pastor is out of town
and that you are a member of the church's ruling board. It doesn't hurt to
mention that you have received some training. If possible, visit during
standard visiting hours to avoid complications.
Elder who is just visiting
may find it easiest to work within visiting restrictions.
Layman (same advice as
Note: privacy laws are
goofy. If you go to the information desk and ask, "Is Joe Cacutza
here?" they will tell you that they are not allowed to say. But if you
say, "I would like the room number for Joe Cacutza," they will give it to
you, but not if you asked that first question first! So go with
confidence as though you are sure the patient is there. If he has
gone home, all they will tell you is that, "We have no one here by that
Silly, ain't it?
Description of A Typical Visit
You drop by the hospital and ask
for the room number of John Doe. You take the elevator and locate his room.
His door is opened, and so you find John's half of the room. If his curtain is
pulled, you should ask him for permission to come in. If John's life is not
hanging in the balance and he is sleeping lightly, you call his name or gently
touch him. If he does not wake up, leave a note. If you have traveled a long
way (e.g., Indianapolis), ask a nurse to wake him if it is advisable.
If he does not know you,
introduce yourself and tell John that you are from Highland Park Church (do not
just say, "The Church;" don't assume he knows). You mention how you came to
hear that he was there, and then you ask, "How are things going today?" Do not
ask, "Why are you here?" John may or may not tell you about his condition (maybe
he has been castrated or has STD, or maybe a woman is having a partial
hysterectomy, for example). Discuss what he wants to discuss. If he wants to
tell you all the gory details, listen. If he seems uncomfortable with you, cut
Then I offer a brief prayer,
praying for God's blessing upon him, the medical team, for God to prosper
the treatment and to encourage his heart.
Important Considerations and Etiquette
During the first few years of my
ministry, I would pray with people in their rooms the day of surgery. I would
try to get there about 6 a.m. before they started injecting them with
tranquilizers. As insurance companies and the government cut back, the entire
equation changed. Patients now arrive in the surgery area that morning and are
usually eager to be ushered right into wherever it is they must go. The pastor
or visitor is often in the way, a person who delays the admission process.
Besides the fact that I hate to
get up early in the morning, this change forced me to adjust my previous
routine. I now try to meet with the patient at home the day (or sometimes two
days) before surgery. Why sometimes two days? For some surgeries, the patient
has to get an enema and take laxatives to clean them out. The resultant
situation is not conducive to a visit!
If a surgery is particularly
dangerous, I might stay with the family—or, if local, I check in and out.
Otherwise I rarely sit with the family during surgery.
How long should you visit? That depends.
The average hospital visit is probably 15
minutes. Here is a possible guide:
A stranger or person you barely
know: 10 minutes or less
In intensive care: 5 minutes or
A person you know who is in pain,
sleepy, or has company over: 5 minutes or less (You might stay longer if the
person is feeling well and has company, particularly if you know the
A person you know who is alert,
not in great pain and feeling social: half an hour
Vary with the situation: a widow without family who is feeling well
might enjoy your company more than someone who is getting more company than
they can handle....
Pay attention to clues: yawning,
heavy eyelids, or verbal clues; as a rule of thumb, it is better to
under-stay than over-stay
How often should you visit?
For local hospitalization, I
visit patients twice a week (always at least once and sometimes three or
If they are out of the area
(more than a 30 minute drive), I'll visit them once a week. If they are
in Indianapolis, I usually do not see them unless they are going to be
hospitalized for more than 4 days.
If they are in an extended
care unit (a sort of in the hospital recovery/rehab facility), I'll
visit them once a week.
If they are in a bad way or
near death (in intensive care, for example), I will usually visit them
daily and, if near the end, two, three, or even four times a day. If
death is at hand, I stay there.
If people choose hospitals
(or nursing homes) out of our area, the consequence is that they are
less accessible. On the other hand, if they must be elsewhere (e.g.,
car accident, life-lined, need a specialized treatment etc.), then we
must be willing to bite the time bullet.
The visitor must flex with
the situation. It is good to have minimal guidelines, but one must be
willing to visit more often when one senses it is making a significant
difference (or the need is greater).
Do not sit on the bed
Use caution in shaking/holding
hands; I often avoid doing so unless the person wants to; I might touch a
hand in a distressing situation. You do not want to interfere with IV's,
etc. and you don't want to spread germs to a person whose immune system
might be compromised
Mealtimes happen. Cut your visit
short (less than 5 minutes) if the person is eating (unless they are nearly
done); you might offer to come back in 15 minutes, find a lounge and have a
devotional time, check out the gift shop, or read the paper.
Medical people enter to do a
procedure from time to time; it is best to exit. If a therapist is coming
for therapy, etc, they will often give you 3 minutes to pray if you ask.
Bedpan issues can be
embarrassing; if someone says they need to go, get out of there; do not make
them cringe. If the curtains are drawn as you enter the room, ask a nurse
if it is okay to go on that side of the room. If the person on the bedpan,
see #3 above.
Appropriate and inappropriate
questions/comments. Do not ask them what their condition is, why they are
there, or if they think they are going to make it.
Never minimize the comments
people make as though they have no right to have the feelings they have.
Encouraging denial is encouraging lying or going underground with one's
tell you they think they are going to die, they might be right (but they might
be wrong). If someone says they are miserable, please, do not say, "Well, it
could be worse," or, "Mrs. Jones has it worse." Finding comfort in another's
misery is plain foolish.
Comment: I think I am going to die. Response: I hope not, we would all miss
you. I know you are ready to meet God (if the person is saved), but we would
like to keep you with us longer.
Comment: Sometimes I wish God would take
me. I'm no good here. Response: I don't blame you. A lot of
people feel that way, and you are not wrong to think that. Even Paul said he
preferred to be absent from the body but present with the Lord. But God has
reasons we do not understand, and God's ways are not the same as ours.
Comment: Sometimes I get mad at God
because He allows me to go through this. Response: Don't feel guilty about that.
David wrote a lot of Psalms complaining to God because He felt the same way.
Tell God exactly how you feel; He can take it.
Sleeping patient issues are
common. If a person's life is not in the balance, I usually try to wake
them by calling their name or lightly touching their arm. If this does not
wake them, I assume they need the sleep more than my visit and I leave a
note (see section IV for exceptions).
Visiting out of town? Call first
to be sure the patient will be in his/her room and is up to company. Why
drive an hour and a half to visit a patient who is so heavily sedated that
he or she will not even remember your visit?
When you pray for the patient,
ask God to bless, comfort and heal his or her roommate as well.
Things to pray for: God's peace,
wisdom for medical personnel, prospering of treatment, alleviation of pain,
God's will for healing.
Do not visit if you have a cold
or contagious condition. A phone call is better in such cases. A patient's
health is more important.
Focus on the patient unless the visit is long (longer visits might be
appropriate for old friends who are feeling well but are bored).
Work around test and bath
schedules: afternoons or early evening are usually the best time to visit,
or very early morning 6:30 or 7.
Avoid being a medical
know-it-all and do not put down a patient's doctors.
Be alert. If patients eyes are
heavy, cut it short. If patient is nauseous, cut it short. If your
presence might embarrass a patient, make it short.
If the door is closed, check at
the nurse's station before entering: someone may be on the bedpan or
receiving a bath or change of dressing.
Privacy laws limit what they can
tell you at the desk or over the phone. Never ask, "Is so and so there,"
but I'd like the room number of..." (or if on the phone, "I'd like to speak
to a patient, Jack Sprat.")
Volume issues: do not talk too
loudly, but loud enough for the patient to hear you.
Number of visitors is sometimes
limited by hospitals to two at a time although this has become less common.
Intensive care visits are usually
restricted to family only (except when death is imminent) for five minutes
on either odd or even hours; clergy can generally visit any time. But
remember, people who are in intensive care are there for a reason; keep
Standard room, before surgery
Standard room, after surgery
Emergency room: Sometimes, in
dire situations, I will stay with a family in the emergency room or waiting
room; often I have a 5 to 10 minute visit and leave; it depends who is there
(someone alone may appreciate your company) and the situation.
Intensive care means limited
access except for clergy; you really want to avoid getting in the way here.
Hospice care is a section for
those who are in the process of dying often of cancer.
Deathbed situations are hard to
call. I mostly visit in and out during the day/night and take my best guess
as to when death is near; I try to be present when the person actually dies
and for maybe an hour afterward (while the family grieves). Laymen, in a
pastor's absence, would be expected to stop in several times for maybe 15
minutes at a time. He might return (depending upon his schedule) when
called in at the point of—or immediately after—death. He should pray,
perhaps reading from
Romans 8:18-39 or
1 Thessalonians 4:13-17
and then offer prayer. I sometimes leave at that point, at other times I wait for the
undertaker. Every family expects or needs other things. Sometimes a
minister can be in the way or, while not in the way, not necessary either.
Contamination hazards may require
you to wear a robe, gloves, and/or a mask. As you leave, dispose of them in
the appropriate container and wash your hands with disinfectant soap. In
these instances, a sign is posted on the door. You can ask a nurse for
Psychiatric wards are tough to
get into. Even family and clergy are only allowed to visit at the request
of the patient and then at certain hours (since patients are often
participating in group sessions). Laymen should probably not even attempt
to make these visits. Pastors should work through a family member for
Maternity ward visits are great
if you have time to make them, but I do not stress out my schedule to do
so. If there is a problem with the baby, they obviously become a
necessity. Because of issues like nursing babies, etc., I have long felt
that women friends are the best visitors in the maternity ward. When I
visit, I always knock first and I keep my visit brief. I never ask to hold
or touch a newborn. I offer prayer for mom, the family and the newborn.
The question still remains,
"Where do these rules come from?" There is no ultimate authority when it comes
to hospital visitation. Customs vary between regions and expectations vary from
one congregation to another, from one generation to another. Unfortunately,
much of this ministry is defined by the expectations of tradition and culture
rather than reason and actual spiritual impact. Nonetheless, much (perhaps
most) of the ministry of hospital visitation is valuable, in my view.
When people are
hospitalized, they feel vulnerable and need the comfort of a church shepherd;
they need to be pointed toward the Good Shepherd.
James 5:13-16 is a text that
raises many questions. It reads:
Is any one of you in trouble? He
should pray. Is anyone happy? Let him sing songs of praise. Is any one of you
sick? He should call the elders of the church to pray over him and anoint him
with oil in the name of the Lord. And the prayer offered in faith will make the
sick person well; the Lord will raise him up. If he has sinned, he will be
forgiven. Therefore confess your sins to each other and pray for each other so
that you may be healed. The prayer of a righteous man is powerful and
Like the style of Jesus when
preaching the Sermon on the Mount, the book of James reduces things down to
black and white and is far from complete in what it addresses. This is part of
the Rabbinic "Hot and Cold" style of teaching and this style of teaching often
raises more questions than it answers. It presents truth but not whole truth.
Very quickly, my understanding of
the "prayer of faith" is that God gives that prayer (it is not conjured up by
our own willpower or adrenaline). If He gives that prayer, the person will be
healed. Some sickness may be a result of sin and so confession of sin to God—and
a confession to a Christian confidant—may itself prevent some (though not
But our focus is the use of
anointing while visiting in the hospital. I would suggest doing so as follows:
The sick person (or a close
family member) should request it.
The elders of the church
should administer it. This would not necessarily require ALL the elders but at
least two and preferably more.
Some interpreters understand
oil to be one example of medicine and that James is talking about a combination
of medicine and prayer. Although it is right for Christians to take medicine
while also praying, I do not think that this is James' point.
Others see the oil as symbolic
of the Holy Spirit. I believe this is more accurate. But some say that since
the oil is symbolic, it is unnecessary. I have a problem with that reasoning.
I am among those who believe that both baptism and the Lord's Supper are
symbolic. Yet, because the symbol represents something greater does not mean we
should eliminate the symbol. It is true that the symbols seen in the Law
foreshadow the work of Christ, but we are not talking about Old Testament
symbols. If God commands us to use the symbol, we should assume God knows what
He is talking about and that the symbols are important. God is not out to
entangle us with busywork.
How we do it, when we are
called in (usually for a serious illness) is as follows: I (or any elder) rub a
little olive oil on the forehead of the sick person. The elders lightly lay one
hand on either the head or shoulders of the sick person and we each pray for
God to heal that individual, according to His good will.
In my experience, I have noted
one instance where God has miraculously healed a man with an irreversible
disease (interstitial fibrosis). In other instances, I have noted no difference
between prayers with anointing and other prayers. Still, it is important for us
to obey God for no other reason than to obey. But there are other
reasons: the rare instances of healing that may not occur otherwise, the
blessing it is for the sick person to feel loved and the way it ministers to
all (the sick person, his/her family and the elders themselves).
The Lord's Supper
Many churches have their
own traditions regarding the Lord's Supper. I am writing primarily for independent
churches who hold to 1) the priesthood of all believers and 2) the symbolic
nature of the Lord's Supper.
In my view, any believer is free
to celebrate the Lord's Supper with any other believer at any time. I have
rarely celebrated communion with someone while in the hospital, though I have
partaken of the Lord's supper many times with shut-ins at nursing homes or in
their homes often around Good Friday.
Simply bring a couple of paper or
disposable cups, some grape juice (or wine, if that is your custom) and some
matzo (or oyster crackers).