Hospices Work to Recruit More Volunteers Before COVID PHE Ends

The number of hospice volunteers plunged during the first two years of the pandemic, and many are still working to rebuild their ranks.

Many hospices saw volunteer volumes dip drastically as they suspended activities during the pandemic. Roughly 78% of hospice and palliative care providers around the globe indicated “less or much less” use of volunteers since the pandemic’s onset, according to a 2022 study in the International Journal of Health Policy and Management.

Providers’ efforts to recruit volunteers could take on renewed urgency when the U.S. Center for Medicare and Medicaid Services (CMS) removes the waiver of volunteer requirements instituted during the COVID-19 public health emergency (PHE). The PHE is currently set to expire on Jan. 11, 2023, but will likely be extended through at least April.

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Volunteers fill care delivery gaps, generate savings

Volunteers help to fill gaps in patient support. They represent another arm of a hospice’s interdisciplinary team and provide an objective set of eyes to observe changes in patients’ conditions, according to Kathleen Benton, president and CEO of Georgia-based Hospice Savannah.

“Volunteers can help clinicians with the right patient reporting system and processes in place,” Benton told Hospice News. “Having access to their visits with families and patients can help clinicians pick up any pieces that were left behind – especially for caregivers. Volunteers form relationships with families and can be a big help facilitating needs during higher times of strain on clinical staff.”

Volunteers typically can spend more time with patients than clinicians, and can provide hospice staff with crucial insights, she added. Hospice Savannah’s volunteers give clinical teams another window into the patients’ worlds, helping to develop a more comprehensive understanding of their medical and nonmedical needs, Benton said.

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Volunteers also help reduce providers’ costs. In 2019, the nation’s 420,000 trained hospice volunteers generated more than $469 million in annual savings, the National Hospice and Palliative Care Organization (NHPCO) reported.

While fully monetizing the value of volunteers is difficult, their contributions in terms of cost savings can be broken down into visible financial benefits, according to Hospice of Santa Cruz County CEO Cathy Conway.

The California-based hospice has calculated these cost savings by taking the number of patient care hours served by a volunteer and multiplying this amount by average hourly staff rates. In 2021, around 200 of the organization’s volunteers provided 1,448 visiting hours that supported patients, caregivers and family members, they reported.

Their services reduced the hospice’s costs by an average of 6%, a rise from 5.5% during the previous fiscal year, according to Conway. These percentages may seem small, but the dollar amounts are in the tens of thousands.

“We calculated out $76,514 around volunteer cost savings last year,” Conway told Hospice News. “Those are services that would otherwise be performed by somebody else, some other staff member, and so that’s a substantial savings for us.”

Volunteers also generate savings for families and caregivers, according to Christy Fulcher, volunteer manager at Hospice Savannah.

Volunteers in the hospice’s senior companion program take two- to three-hour shifts sitting with dying patients who lack sufficient family assistance, essentially providing 20 hours weekly of adult day-type services that would normally be expensive for families, Fulcher said.

“We served multiple patients over the past year so that nobody has to die alone,” Fulcher told Hospice News. “We also utilize registered nurse volunteers to help with our inpatient units when we’re short staffed. They are a huge support system to our staff, our patients and their families.”

Creatively keeping volunteers engaged

Volunteer numbers are building back towards pre-pandemic levels for some hospices, but others continue to grapple with the need to do more with fewer resources. To boost recruitment and engagement, they have had to adapt.

Some hospices have leveraged technology to keep volunteers virtually engaged. Like clinicians, volunteers have connected with patients through telehealth, offering virtual art, pet and music therapy sessions, along with online yoga, meditation and spiritual care.

Hospice volunteers have also made deliveries of groceries and household supplies, or have held song vigils or “drive-by parades” outside of patient facilities and homes, among other activities.

Volunteers themselves have proposed new ways of fostering interaction with patients during some of the worst days of the pandemic, Benton said.

Case in point, one volunteer at Hospice Savannah, dubbed “the flower lady,” saw an opportunity to lift patients’ spirits by partnering with local florist, horticultural and funeral businesses willing to donate flowers and vases leftover from farmers’ markets or other events. The volunteer makes an average of five or more arrangements for patients each week.

“These flower deliveries brought a way for families to celebrate their loved ones life and offset some of the distress and negativity that surrounds a loss,” Benton told Hospice News. “It reminds them we’re here for them in more ways than they may know. This was something that had continuity and impact during the pandemic and now.”

Hospice of Santa Cruz County has turned to local educators to help shore up its volunteer resources. They partner with the University of California on a Pre-Med Volunteer Visitor Program, through which pre-medical students can gain insight into what end-of-life care looks like and how it relates to other aspects of health care.

Through the program, students have the opportunity to go through hospice volunteer training to be at the bedside with a “compassionate and skillful presence,” according to Forbes Ellis, Hospice of Santa Cruz County ’s director of volunteer services.

This allows pre-med volunteers to become “well-versed in the value of hospice care,” and can inform their ability to educate their future patients about end-of-life care options, Ellis added. Historically, about 10% of the hospice’s volunteers who visit patients are pre-med students.

“This program is so important, because we have an opportunity to be part of the education path for physicians and registered nurses,” Conway told Hospice News. “Volunteering at the bedside gives them experience of what it’s like to hold space for difficult conversations and learn how to support patients and families at the end of life. That’s something that isn’t really taught in medical schools to the level that’s needed. It’s valuable for patients and valuable for the larger health care system to benefit from too.”

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