Would you like to reduce your weekend calls by 66%?
Volunteer programs enhance care in cost-effective manner
[Editor's note: This is the first of a two-part series that looks at the increasing importance of volunteers to hospice programs. This month, we look at how volunteer programs can positively affect hospice outcomes with innovations such as a Tuck-in Program and attention to volunteer expertise. Next month, we'll examine 11th hour volunteer programs and provide more details on a community-based flower delivery and visitation program.)
How can you reduce your weekend calls from patients by 66%? Do what Covenant Hospice in Pensacola, FL, did: Set up a volunteer project that ensures patients have supplies, medications, and information they and their families need for the weekend.
Not only has the hospice been recognized for the "Tuck-in Program" with an Award of Excellence in Program Innovation by Florida Hospices and Palliative Care, but also the program has shown a wide range of benefits ranging from about 500 fewer non-emergency weekend calls annually, increased physician coverage for emergency calls during the weekend, family satisfaction scores that improved almost 10%, and improved volunteer recruitment and retention.
The idea for the Tuck-in Program came from discussion at a hospice leadership meeting during which patient satisfaction scores were discussed. "Our scores for satisfaction with weekend and evening care were not where we wanted them to be, so we talked about the types of calls received during the weekend," says Sandra Huster, director of volunteer services for the agency. Because many calls were routine calls that required the weekend on-call nurse to deliver supplies, medications, or explain use of equipment, the suggestion was made to call patients prior to the weekend to make sure they had what they needed for the weekend. "I knew this was a perfect job for a group of volunteers so I offered to set up the program," Huster says.
Covenant Hospice's program is just one way hospices can use volunteers to supplement their staff in a way that improves patient care, says Greg Schneider, founding director of Hospice Volunteer Association in Occidental, CA. "Congress mandates that hospices have volunteers, but hospices have historically used volunteers to supplement services, and hospice began as a volunteer-based organization in most areas," Schneider says. The Centers for Medicare and Medicaid Services' (CMS) Conditions of Participation (COPs) for hospice require that volunteer hours represent the equivalent of 5% of clinical hours provided by the hospice. "This means that for every 100 hours of clinical service provided, volunteers should provide five hours of service," Schneider explains.
Although the COP requirement is good, he is concerned that some hospices might view the 5% guideline as the standard rather than a minimum. Recruiting, training, and supervising volunteers requires time, and for many hospices, the idea of funding a volunteer coordinator seems like an unnecessary use of funds, Schneider says. "If a hospice is going to use volunteers in more positions and exceed the use of the 5% threshold, a volunteer coordinator is important," he says. "I've seen reports that a well-run volunteer program with a paid coordinator actually generates up to a 600% return on investment."
A volunteer coordinator can enhance and focus use of volunteers, says Schneider. A formal, well-planned program that uses volunteers in ways that support clinicians can not only improve patient and family satisfaction, but also reduces costs, he says. A volunteer coordinator can take steps to identify talents and skills of individual volunteers to place them in positions to best help the hospice, and the coordinator can make sure that training and documentation of volunteer activities provides an accurate picture of their service, Schneider says.
Medicare COPs require hospices to document the number of volunteer hours as well as the types of care and the amount of training for hospice volunteers, Schneider points out. "In fact, the documentation requirements for hospice volunteers are similar to clinicians," he says. "Volunteers must note in the record what services they provided to the patient or family." Thorough documentation of time and services provided enables the hospice to determine the cost savings of using volunteers, Schneider adds.
Educating volunteers on the importance of documentation must be included in all orientation or training sessions, Schneider advises. In addition to initial orientation sessions that introduce the hospice philosophy and general information to all volunteers, other classes that are focused on special services must be offered, he says.
For example, volunteers in the hospice's 11th hour program receive training specific to sitting with a patient in the last hours of life, Huster says. Volunteers sit with patients who are dying until family and friends can be with them, or until the end if there are no family and friends, she explains.
"We teach these volunteers what symptoms to expect as the patient is dying so they will be prepared. We also teach simple comfort measures to take, such as a gentle hand massage or an extra pillow, to make the patient more comfortable."
Look for partners
Although each hospice should develop volunteer programs that fit the hospice mission and the needs of a community, look for community programs that the hospice might partner with or incorporate into the program. This is the situation in Cairo, GA, where Marie Ansley started a program to deliver flowers to hospice patients.
"I started this service because my husband received hospice services before his death, and I knew he would have enjoyed seeing someone bring him flowers each week," she says.
Ansley started Flower Angels by asking local businesses and friends for donations of flowers and vases and by asking for names of community members who were receiving hospice services. "Because I was not part of a hospice program, the only way I could find hospice patients to receive the flowers was through word of mouth from family and friends," explains Ansley. "I'm not sure how everyone is learning about the program, but I've been contacted by a hospice volunteer manager who wants to make Flower Angels part of the hospice volunteer program." [Editor's note: At the time of publication, Ansley and the hospice are working out the details of the partnership.]
"Flower Angels volunteers will be able to help the hospice by visiting patients and families on a regular basis and bringing them beautiful flowers," Ansley adds.