Volunteers

1. Volunteers Horizon Hospice "You matter because you are you, and you matter until the last moment of your life. We will do all we can, not only to help you die peacefully but also to live comfortably until you die." -Dame Cicely Saunders Founder of the Modern Hospice Movement “A hospice volunteer is someone who listens to me until I hear what I’m saying.” - a hospice patient

2. Introduction • Why volunteer for hospice? • Who volunteers for hospice? • What is the role of a hospice volunteer? • How are Horizon Hospice volunteers prepared for their role?

3. Why volunteer for hospice? • To give back to the community • Learning and Education • To become more comfortable with the realities of illness and death • To develop new skills or refine old ones • Social opportunity • Beneficent utilization of time • Help make informed personal or career choices • Expression of faith/ belief/ spirituality

4. Who volunteers for hospice? • People with time: the retired, those between careers or in transition. • Students. • Professionals. • Those who seek a “comfort level” in the face of illness and death. • Family members of hospice patients who saw “hospice in action” and want to give back.

5. What is the role of a hospice volunteer? • Being there • Listening and supporting • Errands and breaks for caregivers • The “eyes and ears” of hospice • Fill roles that cannot be filled by other team members • Laundry and Dog-walking • Organizing photographs and mementos • Assist patient with “life review”/ help them tell their story • Baking

6. Reading/ recreational opportunities • Help patient fulfill their hopes and dreams before they die • Education of patient and family about home- based care / advocate for patients in long-term care facilities • Bereavement support for family members after the death • Communicate with team • Write reports after visits for patient charts • Attend hospice meetings and educational events

7. Change your view of dying persons as “sick” people. Death is a natural part of the life-cycle. It is not your role to fix things for people. Fixed people rarely feel good about being fixed, as it implies there is something “wrong” with them in the first place Hospice volunteering is more about being than doing. As we are a doing society, this can be a challenging role. There is no such thing as “just” a volunteer. As a hospice volunteer, you are equal in importance to the other team members in providing care. Helpful suggestions for hospice volunteers

8. Philosophy of Volunteerism Horizon Hospice volunteers are an integral part of our team and a fully integrated component of the organization’s human resources. Horizon Hospice was founded by volunteers, and we continue to rely on them for support in quality patient care, bereavement support and administration.

9. Volunteers are part of the team so invite them to team meetings! Provide comprehensive training and orientation Provide job descriptions Provide ongoing opportunities for education and support Provide them the information they need to be effective, including team extension numbers, and patient information. Allow them time off between assignments, and opportunities for self-care Implementing the Philosophy

10. Recruitment • Advertising: print media • Word of Mouth: other volunteers • Faith communities: church newsletter announcements • The worldwide web: www.volunteermatch.org Horizon Hospice website: www.horizonhospice.org

11. Volunteer applicantsat Horizon Hospice • Should demonstrate good listening skills and • Healthy boundaries • Undergo a “behavioral interview” to demonstrate good judgment

12. Orientation • Application process includes two reference checks and interview. • Volunteers undergo orientation and training similar to new staff and their competencies are tested. • Photo ID’s, training manuals and safety equipment are distributed to all volunteers • Volunteers are offered a Hepatitis vaccine and must undergo a two-step Mantoux test for TB • Personnel and health files are kept on all volunteers

13. Training Syllabus includes: • History and Philosophy of the hospice movement in general and Horizon Hospice in particular. • The Mission Statement • Ethics. • Scope of Services. • Therapeutic relationships and boundaries • Spiritual and Bereavement Care. • Active Listening and Communication skills. • Home and Street Safety. • Infection Control and Universal Precautions. • Social Services. • Nursing and “Hands-on” Care.

14. The primary caregiver is so relieved to see the volunteer because she is totally burned out with care-giving. It is your first telephone call to the family or patient since you took on the assignment. How do you begin the conversation? The family has left for an event and you are alone with the patient who is too tired to have a conversation or who dozes off. The family leaves and the patient tells you: ”I just wish this was over.” You are sitting at a patient’s bedside when a family dispute erupts downstairs. Voices are raised and doors slammed. The patient is visibly shaken. The brother or sister of a patient asks you out on a date. Scenarios for discussion and role–play exercises in volunteer training

15. Scenarios, continued: • The caregiver or patient ask you to volunteer a full day next week even though the suggested volunteer limit in the Horizon Hospice manual is four hours per week. • You notice the patient is in a soiled or unclean environment. • The family offers you a gift before you leave. Imagine that gift, large medium or small. • The patient tells you she has doubts she is going to get better and that she still has many things she feels she wants to do in life. She tells you it is grossly unfair that she has worked hard to raise a family and now just when they all had flown the nest and she was about to retire and enjoy life, she gets “hit by this.” Imagine your conversation. • The patient dies during your visit.

16. Volunteer Training Social Work • Boundaries • Active Listening Scenarios • What to do with Suicidal Ideations/Abuse or Neglect Scenarios • Social Work Role on the Hospice Team

17. What are boundaries? • Boundaries are understood, sometimes unspoken, physical and emotional limits of the relationship • Boundaries are a framework that give patients and hospice team members a range of acceptable behavior.

18. Boundaries, cont’d • Boundaries are an excellent way to care for yourself as a hospice volunteer. • We ask our volunteers to give their assigned patient no more than 4 hours of their time in any one week period • Role Play: The caregiver of a patient asks you to return tomorrow for another eight hours, even though today you already completed your four hours for the week.

19. Friendly Volunteering vs. Friendship • A hospice volunteer relationship is an important part of the therapeutic process • As patients and families face end of life issues signs of intimacy may appear. Patients and family members often want to talk about really personal issues. An untrained ear might interpret this as an invitation to friendship.

20. Scenarios • Brother or sister of patient asks you out on a date. • You give your personal home phone number to the patient/ family. • The family offers you a gift before you leave. Imagine that gift: large, medium or small. • The patient asks you to bring him to the bank and then to the gambling boats.

21. Casual friendly or romantic in nature Serve the interests of both parties Are for mutual interest and pleasure An agreed upon purpose and time frame Hospice Volunteers devote self to interest of patient carry the authority of specialized knowledge and skill maintain objectivity Social or Therapeutic?

22. Boundary Crossings and ViolationsHow to know when they are happening? • Blurring of boundaries can occur one small step at a time and almost without warning • Be aware of your feelings • Ask yourself can I share this with the volunteer coordinator or the hospice team? • Are you making special exceptions to the plan of care? • Do you feel a sense of entitlement or that this is “your” patient?

23. Are my boundaries clear? • How would I feel if my actions were published on the front page of the Tribune, or if someone told my friends and family about them? • Ashamed, embarrassed, proud, accomplished, helpful?

24. How to know if you are crossing the boundary line • Be aware • If I feel uncomfortable telling the other team members what happened, then it is quite possible that boundaries were violated. • If I am unsure how to behave or about the ethics of a situation, it is always best to ask advice from a team member. • Always act in the best interest of the patient

25. Why is this an issue? • Hospice volunteers are caring people and want to do what’s best • In hospice work, boundaries can easily become blurred due to the nature of what we do and the setting (We are in patients’ homes and in their world.) The population we serve is vulnerable and may not be aware of interpersonal boundaries.

26. Active listening scenarios • The family leaves and the patient says “ I just wish this was over.” • (Segue: suicidal ideation) • The patient tells you she has doubts she is getting better and that she has many things she still wants to do in life. She tells you that it’s grossly unfair that she’s worked so hard to raise her family and now just when they have all flown the nest and she is about to retire, and enjoy life, she gets hit by this. Imagine your conversation. • The primary caregiver is relieved to see the volunteer because she is totally burned out with care giving.

27. More Scenarios • You go to patients home and discover the patient has bruises and is fearful and uncommunicative during your visit. This is totally out of character from previous visits. • You notice the patient is in a soiled/unclean environment • Nursing home staff remain unresponsive to your suggestions for relieving patient’s discomfort.

28. Role of the Social Worker in Hospice • Provide emotionally supportive counseling • Advocate for community resources • Connection between patient/ family expectations and volunteers • Assists with advance directives, benefits and funeral planning • Ensures Patient rights respected and self-determined

29. Case study • Sarah is a young, single hospice volunteer who is assigned to a patient with stage IV Lung cancer. Recently, the patient—who is actively declining-- has been asking her questions of a very personal nature that she feels uncomfortable answering. The questions relate to her religious and spiritual views as well as her dating history! When Sarah asks for guidance, what might you say to her as a team member?

30. Invitations to attend weekly team meetings, Quarterly educational in-services and support groups Communication with team members while on assignment: each volunteer is provided with the telephone extension of the nurse, social worker, chaplain, and volunteer coordinator. They in turn, are provided with the volunteer’s Annual Recognition event with the presentation of Awards Discounts for annual benefit and other fundraising events Invitations to memorial services Biannual newsletter Team skills Volunteer Retention

31. Volunteer Community Network • Trained volunteers bring these skills to their families, homes and workplace • Knowledge of hospice allows trained volunteers to help their communities make informed choices about end-of-life care and the hospice option

32. “Hospice patients and their families give me so much more than I could ever give them.” “I have volunteered with many helping organizations but with hospice I feel especially valued as part of the team.” I enjoy being on the team. I never feel alone and it’s good to have comprehensive support.” “ Volunteering for hospice is more about being with people than doing things for them. It is truly a ministry of presence.” “Each case is so unique. In over 20 years as a volunteer with Horizon Hospice, I haven’t been with two patients who were similar.” What volunteers say: