Hospice Getting Creative in Leveraging Volunteerism Post-PHE

The roles of hospice volunteers have morphed during the pandemic in ways that could have lasting impacts on how providers mold care delivery models – including increasing clinical capacity.

Volunteer recruitment and retention has been a challenge during the pandemic, with hospices pivoting around shifting regulations and safety protocols. The reduced capacity has some hospice providers furrowing their brows with the return of the requirement that volunteers provide a minimum of 5% of hospice patient care hours.

Reaching the 5% threshold represents one of the biggest stressors as hospices navigate the new normal of shifting volunteer roles and preferences in the pandemic’s wake, according to Lori Showalter, manager of volunteer services and community outreach at Augusta Health’s Hospice of the Shenandoah, based in Virginia. She stated this during the National Hospice and Palliative Care Organization’s (NHPCO) Interdisciplinary Team Conference.

“For many folks, that’s the landscape of change, that they are stressing over – that the mandate will be back and that we will be expected to show the 5% by the end of 2023,” Showalter said. “There are some volunteers that just only want to work from home now, they have become very comfortable working from home, and that’s where they want to stay. And it makes it challenging not only in how to use them, but also in how to use them in a way that their hours count towards the 5%.”

The U.S. Centers for Medicaid & Medicaid Services (CMS) in 2020 temporarily waived the requirement that volunteers provide a minimum of 5% of hospice patient care hours during the COVID-19 public health emergency (PHE) due to providers’ reduced service capacity amid the need to socially distance.

Though the PHE ended on May 11, CMS will reinstate the volunteer rule as of Jan. 1, 2024.

Surveyor determinations of hospice provider’s compliance with the volunteer requirement also will resume on Jan. 1, 2024, CMS noted in recent guidelines.

Preparing for the reinstatement has hospices getting creative in solving the volunteer equation, according to Shelley Wagener, volunteer coordinator at Willamette Vital Health, a hospice provider in Oregon.

“An interpretive guideline is that they need to provide assistance in office activities and direct care services, and volunteer services must also be included in the care plan,” Wagener said during the NHPCO conference.

This means it’s up to hospices to determine which specific volunteer tasks fit into the 5% mix, she added.

“We can expand the capacity of our hospices through volunteers,” Wagener said. “We’ve been focusing a lot on direct patient care volunteers, but there [is] a whole world of ways that volunteers can help expand our capacity as hospice organizations. Are there tasks that could be handed off to a trained and capable volunteer? If you look carefully at the tasks that some of your clinical staff are doing, perhaps somebody else could do [these] for [them] — and perhaps that could be a volunteer task.”

The pandemic may have shed light on more versatile ways that hospices can address challenges in rebuilding their volunteer ranks and roles, she stated.

Ideas that hospices formed around low-contact, high-impact tasks can be carried forward in new ways with the PHE’s end, Wagener indicated.

For example, volunteers can assist with certain activities associated with patient care, such as in-between visit phone calls and other virtual check-ins with caregivers and family members, she explained.

Volunteers can also help perform administrative tasks related to daily care, such as assistance with patient charting audits.

“During COVID, all of us had to get very creative to find ways to meet needs effectively with less direct contact,” Wagener said. “And a lot of those ideas turned out to be really great ones for patient care, and they’re going to be carrying on. A big part of that is phone and video support, or tuck-in calls that many hospices do as a way to check in with patients to see how they’re doing and to see if they have a need for supplies or medications. If there is anything to communicate to the clinical staff on a regular basis, that’s a great customer service that your hospice volunteers can do.”