Pastor John Richter of Atonement Lutheran Church, Wyomissing, Pa., and Atonement Health Ministry Advocate Jill Heidel movingly described the challenge of representing aging and ill patients in what sometimes becomes an adversarial health-care system.

They were the keynote presenters at “Health Ministries Advocacy – A Matter of Love and Justice,” an event that drew about 80 pastors, nurses, health ministry professionals and concerned people of faith to the Lutheran Theological Seminary at Philadelphia on March 13, 2004.

Pr. Richter documented the complex and dramatic changes in the health-care system with personal stories. He began by recalling the health decline of his grandmother in the late 1970s. “She was dying of cancer, but really she was dying of old age. She was winding down, becoming older and more frail, slower, showing signs of dementia.”

He went on to describe the assistance provided by a social worker at the Lutheran Medical Center in Brooklyn after his grandmother was moved there, including figuring out what nursing home to select. “When it came time for my grandmother to go to a nursing home, my mother told the social worker she could use a few more days to get prepared, and the social worker saw that the hospital granted that extension,” he said.

“Fifteen years later my father was dying,” he continued. “He was also in his 90s and slowing down and becoming more frail with dementia. He was in the same medical center that had cared for my grandmother. This time, however, the social worker assigned to my father was regarded as an adversary. Things seemed different. There was tension, strain, and there were tears.

“The rules changed,” he said, “and I could understand this intellectually, but at the same time I was sitting across the table from my mother, and I was hearing her cry. There was no one in the hospital to help her with her perception of how things had changed.”

These experiences helped open Pr. Richter’s eyes to the changes in health care, changes driven, he said, by spiraling costs, rising health insurance premiums, all resulting in a health-care system in need of reform.

He began to think about the dozens of folks in his congregation on Long Island who were elderly or who lived alone. “I thought, if my mother had trouble, what about the members of my own flock?”

At first the Long Island congregation thought about engaging a parish nurse to deal with issues like health education, wellness and preventative health care. “But we were concerned about providing for our members someone concerned about advocacy, someone prepared to see a patient through the system. The ideal mix of skills may be a parish nurse with social work or case management experience, or a social worker with a nursing background,” he said.

Those two roles have come together in Jill Heidel, Health Ministry Advocate at Atonement.

Ms. Heidel described herself as “a registered nurse with a background in case management.” She portrayed her role as “meeting a child of God wherever he or she is at a time of vulnerability. We help people live with the tensions of that time, often in the presence of limited resources.”

Helping people discover their health-care options, often when they do not know what they are, is a key role for Ms. Heidel. “The options simply are not made clear otherwise,” she said. The support may also involve looking after caregivers who administer hospice and other kinds of care to loved ones.

Pr. Richter noted that an appropriate role for a health ministry advocate might be to seek changes in public policy. “That hasn’t happened at Atonement yet, but it may be something we are heading toward,” he said, adding that Ms. Heidel is serving an ever-widening circle of people in need, beyond the congregation. “All are served at no financial cost or obligation,” he stated.

Ms. Heidel said she frequently cooperates with willing hospital professionals to work on treatment plans of patients to be released. She assists with discharge planning and informing patients about their prognosis and options. “Sometimes people and their relatives just don’t know what is going on. I help them learn answers to the questions they have.”

At Atonement, Heidel also oversees a wide variety of health-care forums and educational events, such as stewardship of the body programs, teaching about eye care, Parkinsons, dementia and Alzheimers; running vaccination clinics; sponsoring a caregivers support group; helping people cope with chronic pain; and sponsoring a chronic diseases group.

“We try to teach that healing can occur even when a cure is not available,” she told the group.