## 15 Hospice and palliative care volunteers

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### Hospice / Palliative Care Volunteers

In many countries there is a long-standing tradition of people volunteering to work for a few hours each week without remuneration in a charity of their choice.In others such use of unpaid workers is seen as exploitation – "if someone is worth employing they are worth paying." Others claim that using volunteers is keeping someone out of a paid job and just a means of saving money. This section describes how volunteers can contribute to palliative care services from the early planning stages. Whether or not the service should use volunteers must be a local decision, based on local traditions, laws and needs

### “Employee” or Volunteer?

It is important to understand that volunteers are not, in the legal sense, employees working without pay. Employees, and those who employ them, are subject to a range of laws in all developed countries.Volunteers are not subject to them but there might be legislation specifically for volunteers. However, it must be emphasised, most of the moral principles underlying “employment laws” laws apply .to volunteers (eg good working practices and conditions, fairness, equal opportunities, no racial or sexual discrimination etc). In practice this simply means that volunteers must NOT be termed employees in any documents, particularly legal ones.
In all other respects they should be recruited, trained, supervised, supported, and (rarely) dismissed like anyone else working for the palliative care service. Put succinctly they should behave professionally even though their volunteer role is not that of a professional. Those who supervise and support them should treat them, and expect of them, as if they were professionals.

### What work do they do?

This may be divided into ‘hands-on care’ such as bathing, feeding, mobilising, moving them in bed and ‘indirect care’ many examples of which are listed below. Before planning to use volunteers it is prudent to ascertain what other units / services do, what laws relate to the use / work of volunteers in your country. What you decide will affect how the volunteers are managed and led, finances, professional staff numbers, legal issues and, last but not least, insurance.
As a general rule volunteers do work that helps to create the friendly, homely, caring atmosphere that it is hallmark of a hospice / palliative care service. Some examples are:

1. Receiving and welcoming patients and visitors when they come to the unit
2. Manning the telephone switchboard ‘out-of-hours’.
3. Transporting patients to / from Day Hospice or hospitals
4. Working alongside the professionals in the Day Unit
5. Flower arranging throughout the unit
6. Sitting with patients at home to relieve relatives
7. All manner of work related to fund-raising
8. Working in the charity shops of the charity
9. Staffing the coffee rooms in the unit
10. Running the patients’ library and, if suitably experienced, the education library
11. Public speaking on behalf of the hospice
12. Taking grieving relatives home after a death
13. Organising and helping to run the bi-annual Memorial Services
14. Helping patients with their hobbies (chess, draughts, modelling etc)

### Volunteer Service Manager –VSM

This post is the key one if a unit intends to use volunteers. The care needed for selecting such a person is no different from that for the medical or nursing directors. The appointee must be in post before volunteer recruitment starts.
This person must be salaried, be on the senior management team or reporting directly to one of that team or the CEO. Regular contact with senior nursing and medical staff( eg at weekly team or senior management meetings), as well as fund-raisers, and the volunteer leaders of all the teams into which the volunteers are divided. It is a position which demands a unique blend of skills and attributes – management, sensitive leadership, deep understanding of, and sympathy with, palliative care and knowledge of how to weld so many different people from varying backgrounds into an effective team, sometimes so large that it might be an army.

### Recruiting volunteers

The intention to appoint volunteers will normally be passed on by word of mouth, announced in newspapers and church newsletters, and within hospitals. As for the appointment of a salaried member of staff there must be a ‘Job Description’, in this case not about a specific job but about

1. the overall work of volunteers within the organisation,
2. the ethos and objectives of the unit,
3. where and how volunteers will contribute,
4. what expenses will be paid,
5. the range of work / service that is done by volunteers
6. what hours will be worked,
7. line management and accountability
8. how they will be supervised and supported;

and, most importantly, what they will not be expected or allowed to do – hands-on patient care, counselling, offering practical advice etc. This same document will advise that if a personal with professional clinical training and qualifications (medical, nursing, therapist etc) wishes to offer their services they will be invited to see the head of the department in which their skills might best be used.

### Interviewing and appointing volunteers

Most units invite interested people to visit the unit, possibly spend a few hours seeing where volunteers work and whether or not they feel they could work there. Only after that do they come for formal interview by the VSM and one of her deputies / assistants.
What they will look for is personality, the ability to work alongside others, and a genuine understanding of what hospice / palliative care is. They will try to find what the volunteer feels they can contribute to the ethos. Those unlikely to be useful as volunteers are

1. those who cannot work with those of a different social ‘class’ or ethnic group
2. those who enjoy organising others
3. those who enjoy counselling others
4. those who enjoy talking about their own problems, illnesses and grief
5. those who see working in the hospice as a chance to evangelise
6. those who cannot respect confidentiality
7. those who have had a major loss in the preceding 12 months and are still working through their grief

In brief, those who might easily upset others because of insensitivity or wrong motivation, or who are themselves vulnerable because of their own recent loss.
In most units the volunteers undergo a training course (about 3 hours per week for 12 weeks) during which they have lectures, talks, discussions and demonstrations. The appointee is then put on probation for a period of 2-3 months so that they may leave without any embarrassment if they do not enjoy the work. In that time they work under different team leaders and in different parts of the service depending on their skills and aptitudes. If they stay in post they will be given a copy of the Staff Handbook or, if there are sufficient volunteers to merit it, a copy of the Volunteer Workers Handbook specially prepared by the unit. The VSM will always keep in close touch with new recruits, spend some time with them at the end of the probation period and again at every anniversary of their appointment.

### Management Issues

Ideally the volunteer service needs a small office of its own. If that is not possible then space must be found for the VSM and a room for private meetings and interviews.
A data base must be developed for all volunteers showing personal information, availability, aptitudes, particular skills and areas of interest, tasks they should not be asked to do and areas of the unit they do want to be in.
A pin board accessible to all volunteers is useful, listing the different teams (flowers, reception, coffee shop, drivers, Day Unit etc) and who is on duty at any one time. Most units produce a news sheet exclusively for volunteers

#### Expenses

It is usual for volunteers using their cars in the service of the unit (eg. bringing patients to and from) to be given an nationally-agreed mileage allowance. Other out-of-pocket expenses are usually met on presentation of receipts/ tickets

#### Uniforms

Volunteers seldom wear uniforms except perhaps an apron or overall but all usually have name badges. Long service is usually marked by the presentation of a badge, worn every time they are on duty each succeeding 5 years being marked by a ‘bar’ to the ribbon or special badges.

#### Supporting Volunteers

Though volunteers are not always providing ‘hands-on’ care they nevertheless see much suffering, distress, grief and family sadness. Inevitably they are affected by it. They need sensitive, informed support from their team leader and the VSM.
Volunteers should have available to them the same levels of support as any member of the paid staff. Like them, they may need some time off, a few weeks break from their duties, opportunities to cry and ventilate their feelings. Like them they may have to be told that the work is not for them and be allowed to leave without any disgrace or embarrassment.

### Problems encountered using volunteers

1. Many come to the work eager but, understandably, apprehensive about what they will see
2. Some want to help the patients with advice or, worse still, recounting their own experiences. They see themselves as counsellors or therapists in spite of what will have been said to them, in their orientation.
3. Some, on learning that a patient or visitor has a legal, financial or religious problem offer to out them in touch with a lawyer, accountant or minister they know “ who will be delighted to help you without charging anything!”
4. Many find it difficult to maintain confidentiality – believing that if they have not actually used a patient’s name outside the unit they have not breeched confidence. This is a very common problem
5. There may be personality conflicts with other volunteers in their ‘team’.
6. They may not respect the decisions and authority of the VSM
7. If they begin this work within a year of a bereavement they may break down with their re-awakened sadness

### The advantages of having volunteers

They probably do not reduce the running expenses of a unit because, in most cases, they are not taking the place of salaried staff.

1. They help to create a homely atmosphere, in contrast to most hospitals
2. They are not professional carers so seem less daunting to patients and visitors
3. Their air of relaxed, genuine friendliness helps to create an atmosphere of peace and calm

### "Professional" volunteers

This term describes the nurses, doctors, physiotherapists, occupational therapists and any other health care professionals who offer their unpaid services for a few hours every few weeks – working in their normal professional role. For example a nurse might offer to work one night a week, a doctor be on call one night a week, a podiatrist come in one afternoon a fortnight and so on. Their contributions can be very considerable but

1. they must report to and be accountable to the senior staff member of their profession (nursing director, medical director / senior consultant etc – not the VSM though she may have been responsible for recruiting).
2. they must adhere to all agreed clinical protocols and procedures in the unit
3. they must be insured by their professional defence union for the work they will do.

Finally it has to be remembered that patients and relatives will not be able to distinguish an unpaid (professional volunteer) from a paid member of the professional staff. And will speak to them as they would to any other nurse, doctor, therapist, podiatrist etc.
These “ professional volunteers” will need the same support as is being offered to the salaried professional on the staff, and every effort made to ensure that they get the same "job satisfaction" as the rest of the professional team.

### Is it worth having volunteers?

Before deciding to use volunteers the hospice / palliative care unit must accept that though they undoubtedly enhance the homely, friendly, safe, caring atmosphere of the unit what money they may save on telephone operators, flower arrangers and fund raisers will be offset by the salary of the VSM and the considerable organisation and management needed. They can be a very great asset but need as skilled supervision and support as members of the salaried staff.

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