Creating a Robust Volunteer Force: It’s not about free labor

Not surprisingly, one of the first objections I get for promoting and creating robust volunteer programs for long-term care communities is that it appears that I’m supporting the use of free labor. Nothing could be further from my mind! For sure, there are a lot of regulations and laws governing the use of volunteers but that should not deter you from creating and taking full advantage of a strong volunteer force.

Working Partners

For this reason, I’ve made it my mission to identify and highlight nursing home volunteer programs that have successfully created positive and sustaining partnerships between nursing home paid staff and volunteers. In these programs, paid staff and volunteers complement one another rather than compete with each other. The professional staff view and embrace their volunteers as an indispensable component for providing great and personalized care. Rather than seeing the volunteers as free labor to be exploited, the staff welcomes them as their working partners. The volunteer is an integral part of the care team and thus rejecting that “us and them” culture.

Like any great program, great volunteer programs do not happen overnight.  Successful volunteer programs like those that I’ve written about or witnessed first-hand require a careful, sober, well-thought-out, intentional effort guided by professional volunteer managers. The process of creating and sustaining a successful volunteer program involves everyone in the life of the nursing home beginning with the management team, the medical staff, the housekeepers, the dietitians, the social workers, and life enrichment coordinators to name a few.

Labor Laws

 Working with the Department of Labor, unions if they are involved, and other regulatory bodies such as Health and Human Services, in the development of your volunteer program, and the volunteer job descriptions will ensure that duties assigned to the volunteers are not in violation of labor laws and do not give the appearance of replacing staff with free labor. In talking with the Baycrest Health, Director of Volunteers, Janis Sternhill at Baycrest Health in Toronto, during my visit, she said that in 30 years of their volunteer program history, there might have been two or three times when their labor union objected to a job description, but working together they were able to resolve those issues.

 After 25 years of recruiting and training volunteers for nursing homes and witnessing first-hand the impact of outstanding and well-managed nursing home volunteer programs, I am confident in my claim that nursing homeowner/operators would do well to make serious investments in their volunteer programs. Current research shows that when you can discover and address the underlying individual needs and desires of the people under your care, you will likely be providing not only quality care but you will be maximizing their quality of life as well, and that means improving customer satisfaction and positive outcomes for them and for your professional staff.

A “listening ear”

Certainly, there is no doubt that the professional staff must be trained to garner to have this deeper level of insight into their resident’s lives and what matters to them. However, the reality is that time may not be on their side. Recently, while visiting someone in a nursing home, the hallway outside the person’s room I was visiting, was chaotic as call lights were going off, and aides were running about trying to meet everyone’s needs. Discovering underlying needs is one area where volunteers can be very effective. They can be trained to befriend and learn what matters to the person they are visiting. They, the volunteer become the “listening ear,” learning and then if appropriate and respecting confidentiality, relaying what they have learned to the professional staff.

Beyond being present for your people, staff in the exemplary programs were surveyed as to what help a volunteer could be trained to provide, again without violating labor laws and or giving the appearance of exploiting people as free labor. From the programs that I have had the privilege of studying, the director of volunteers give the new volunteer a general orientation and training. The volunteer is then asked as to what department or area of the nursing home they would like to be involved. With that knowledge, the volunteer manager then works with the staff in that area to discover what their needs are and how the volunteer may complement their effort.

Community Support

Finally, the volunteer program is not about free labor, it’s about providing community support, for an often overwhelmed care staff. The volunteer program is about exposing people from the community-at-large to the long-term care community and like me, and many other people for that matter, going on to become more deeply involved. Lastly, the volunteer program broadcasts the message, “We care. We care enough to go the extra mile to make sure that the people in our care have the very best and that includes great volunteers who have the ‘luxury of time’ to give to your loved ones.”

Let me help you!

If you would like to learn more about how I can help you create or enhance your nursing home volunteer program, please contact me. I would love the opportunity to help you.

“What to write about?”

           For the past several months, actually since the first weekend in October, I’ve been experiencing some of the most excruciating pain a back injury can offer, or at least it feels that way. Mary and I love to take walks and on Saturday mornings during the summer and into early fall, we like to walk to the farmer’s market near our home to buy our week’s supply of fresh tomatoes, cucumbers, peppers, onions, corn, and jostle and bump our way through the crowds of people on a similar mission.

            On this particular October Saturday morning, I woke refreshed, got dressed, had my cups of coffee, and with my large green reusable cloth bag folded under my arm, headed off to the market with Mary. As we have many times in the past, we filled our bags with healthy goodies and started our trek back to our home. As we approached the not-so-steep hill that leads to our house, I began to feel a gnawing pain in the lower part of my back. The further up the hill we walked, the worse the pain became.

By the time I was at the top of the hill, I could barely walk.

            For the remainder of the walk home, even though it was on level ground, every step I took triggered a sharp pain in my back that was now radiating down my leg. I was able to make it home on my own accord, but by then my back felt as if someone had hit my back with a baseball bat. My leg was cramped and felt as if it was on fire. Confused as to what was happening to me, I wondered how heavy were the bags of vegetables? Yes, they were much lighter than other things I have carried. I concluded that I must have pulled a muscle.

            The long and short of it is, I did not pull a muscle, confirmed by weeks of physical therapy and then finally an MRI. The MRI clearly showed that a synovial cyst had formed in the lumbar region of my back and was pressing, without mercy on the nerves of my spinal column. The images of this offending “alien”triggered visits to the pain management clinic and a consult with a neurosurgeon.

This story is far from over, as I have a long way to go.

             After ten weeks of enduring this pain, the recent transforaminal epidural steroid injection has provided me with some modest relief, while the scheduled surgery to remove the cyst is still several weeks away.  It’s been a long three months. Standing is still very painful, and walking is even more painful. Getting from the couch to the bathroom and back to the sofa is quite an accomplishment for me these days as is any of the other activities of daily living that I need to perform.

          Through this experience, I have learned how to create coping strategies.For example, I have a countdown timer on my phone set first to the date of the epidural injection (now complete) and now set to the time of my surgery. Also, I have forced myself to continue to work, teaching online courses and writing. Fortunately, I work from home. And finally, I have used my sense of humor to lighten the atmosphere to what could be a very dark time for Mary and me. But what has struck me the most is what I am learning as a care-receiver. Not being able to do things for myself at the drop of a hat is a real eye-opener. Becoming dependent is a humbling experience. Mary has been a real saint through this time making sure that I have what I need, in addition to her caring for our home.

          So, today, as I was thinking about what to write, it occurred to me that I would share my experience with you but then go on to ask you to remember the many, many people living in our communities, that are living in nursing homes, that are depending on someone to care for them. And with that said, I would ask you to remember the men and women who are providing that care.

I would ascribe to them the title as I have to Mary, “Saint.”

           Through this holiday season, while many of us will be in our comfortable homes enjoying the company of family and friends, and good food, the people working in nursing homes will be on the job. They will be selflessly caring for people who have little choice but to depend on them for their day-to-day needs. It makes me wonder what that level of dependency feels like and it makes me grateful for the “saints” who are willing to make sure we have what we need.

           If you know someone who works in a nursing home, I will encourage you to thank them for what they do. For just as I went from being independent to being dependent during an ordinary morning’s walk so might that be with you. Who will be there to care for you? And how grateful might you be for their help?

          If you work in a nursing home, then please accept my heartfelt gratitude for caring for our loved ones living in nursing homes and I wish you the very best for the coming year.

Recognizing the Value of Volunteers

Helping hands

When you think about a volunteer what comes to your mind?

I see someone who is engaged, aware of his or her community needs and committed to helping others.  Not remaining mere spectators, they step up to the plate to contribute their time, skills, and their knowledge to meet those needs.

They have the ability to lend a helping hand without any expectation of payment for their efforts but they will likely walk away from the experience with a deep sense of personal satisfaction of having helped someone.

However, what about the volunteers in a nursing home do they really add anything to the environment or are they just “…another thing to manage?”

Anne Gross wrote one of the earliest articles I could find concerning the value of volunteers.  At the time, she wrote the article “Why Nursing Homes Need Volunteers” in 1961, she was the director of volunteer services at Mt. Zion Hospital and Medical Center in San Francisco.

At the hospital she observed that the obligation of the facility goes beyond just providing shelter, and medical care and extended to providing for the emotional support of the “involuntary patient” (Gross, 1961).

According to Gross, the volunteer can offer something that the care staff cannot offer, i.e., the “luxury of time.” 

Daily activities of living such as deciding for oneself what to wear each day and getting dressed can be transformed into a hectic impersonal routine (Claxton-Oldfield, Gosselin, & Claxton-Oldfield, 2009) when performed by care staff who may be responsible for picking out clothes and dressing several dozen people each morning.

laughing together
“…relational care.”

Conversely, the volunteer has the “time” to talk with the person, asking what they would like to wear, picking out the clothes and then getting dressed.  The nursing home resident’s sense of control is restored and now they have the opportunity to express their personal tastes, likes and dislikes.  This “luxury of time” extends to many aspects of the resident’s daily life in the nursing home.

Volunteer groups such as the “Silver Spoons” (Musson, Frye, & Nash, 1997) showed that volunteers could be trained to feed residents.  For the nursing aide mealtime can mean sitting in the middle of a circular table surrounded by residents that need help with eating.

The experience becomes a mechanical effort for everyone involved in getting the chore completed as quickly as possible in contrast to a volunteer who transforms the chore into a leisurely meal filled with conversation.

These are only two of many examples I could give showing how a volunteer can contribute to the nursing home environment.  However, does the staff recognize the value of a volunteer?

I bring this up because volunteers that have not been trained or have received little training may not be a help to the staff but rather may create more work for the staff.  When this happens the staff become resistant to the presence of volunteers seeing them as “one more thing to manage” (Berta, Laporte, & Kachan, 2010).

Volunteers want training; they enjoy the sense of mastery, i.e., believing they have the skills to provide real help.  The difficulty is of course is that far too often volunteers receive little or no training.  Because of this, staff is likely to have a dim view of the volunteer.

With increasing demands on the long-term care community and their staff, volunteers can play a key role in providing real and valuable help, if they receive quality training.

In addition, staff needs training to recognize the value of the volunteer realizing that the volunteer can complement the care staff by offering “personalized” help in many of the non-medical tasks.

This level of training needs to be emphasized in the long-term care community.  In the end, the nursing home becomes more than just shelter and food; it becomes a place where volunteers working along side professional care staff provide for the needs of the whole person.

I welcome your thoughts on this topic.

References

Berta, W., Laporte, A., & Kachan, N. (2010). Unpacking the relationship between operational efficiency and quality of care in Ontario long-term care homes. Canadian Journal on Aging, 29(4), 543–556. doi:10.1017/S0714980810000553

Claxton-Oldfield, S., Gosselin, N., & Claxton-Oldfield, J. (2009). Imagine you are dying: would you be interested in having a hospice palliative care volunteer? The American journal of hospice & palliative care, 26(1), 47–51. doi:10.1177/1049909108327026

Gross, A. (1961). Why nursing homes need volunteers. The Modern Hospital, 97(4), 101–103.

Musson, N., Frye, G., & Nash, M. (1997). Silver spoons: Supervised volunteers provide feeding of patients. Geriatric Nursing, 18(1), 18–19.

Down Under: Relationship-Centered Care – Part II

As promised here is Part II, sharing what I’ve learned from Daniella Greenwood’s work at Arcare located in Australia.  What is becoming very apparent to me is that caring for someone is not a one-way street.  In fact, the way person-centered care is currently being implemented really only addresses one side of the equation – the care receiver. Read more…

Down Under: Relationship Centered Care

picture of daniella greenwood
Daniella Greenwood

It all started when someone tweeted the link to a video entitled, “It Takes a Community.”  Curious, I clicked on the link to watch it. The video starts off like many promotional videos but about 30 seconds into this video, I realized there was something very special going on here.  The sincerity and authenticity of the people being interviewed was very real. Their passion and love for the people they are serving was riveting. Read on…

Kristiansund kommune

As promised, VolunCheerLeader.com will highlight great volunteer programs and promote the idea that volunteers, i.e., “super” volunteers can take on increased responsibilities to become a trained and meaningful support for professional care staff who are often stressed and overworked, with residents, patients who suffer from what Dr. Bill Thomas calls the “Three Plagues: boredom, uselessness and loneliness.”

Daily, I’m on social media watching for hints of such programs and to my great Emilie Strømmen Olsendelight, this title appeared in Twitter: “Volunteer Service for Nursing Home Residents.” I immediately clicked on it, and Kristiansund kommune (2)discovered Emilie Strommen Olsen, senior program designer for DesignIt.  She and her team developed a nursing home volunteer program for a facility in Kristiansund, Norway.  I immediately emailed heKristiansund kommune (1)r and arranged a Skype interview with her and the administrator of the nursing home, Stephanie Helland. Stephanie Helland

Dr. Bill Thomas talks about the “Three Plagues of the Nursing Home, boredom, uselessness, and loneliness.”  This is exactly what was happening at Stephanie’s facility.  The residents were not engaged, they sat day in and day out with little or no activity.  The staff observing this, felt frustrated and sad as they were only able to meet the very basic needs of the older adults under their care.  Because of that Emilie says they would  express remorse, a sense of guilt because they felt as if they were not doing enough – that they couldn’t give the people what they really needed – time and friendship.  The families of the residents expressed the same sense of helplessness and ask:

Can’t someone do something about this?

Emilie took on the challenge and began with assigning some “homework” to the staff, the residents and the families.  She ask them: “What kind of volunteer services do you want?”  The answer was crystal clear:

“We want just one person to talk to and do “normal” stuff, not big activities where everyone participates at once.”

With that, then Emilie’s team went to work using the input she received from the three stakeholders.  It was critical that the staff be involved in this process early so as to get buy-in from the staff.Kristiansund kommune (5)

“It was really one of the success factors, that at the start, the staff was involved all the time during the process…so that they felt that they owned it.”

Emilie developed a matrix with staff member positions in rows and responsibilities in the columns.  Everyone had a role to play, in the process from interviewing the volunteer candidate to orienting them to the nursing home environment to Kristiansund kommune (1)assigning them to an area of the nursing home and finally staff and volunteers meeting periodically for followup.

Stephanie said that the implementation was very smooth. She laughed and said: “It was almost done without anyone noticing!”  A large chart was posted to inform both the staff and volunteers of their responsibilities, who would be volunteering that week and who they would be visiting.

During the test period, Stephanie did hear concerns from the staff that the volunteers might be taking over their tasks and thus eliminating the need for staff.  She assured them that this was not the case.  The volunteers were there to provide emotional support and meaningful activities that would promote their sense of well-being and quality of life.

Once the staff understood what was happening they began to realize that the volunteer was indeed opening up more time for them by occupying the residents.  The staff felt welcomed relief.

Kristiansund kommune (8)

Emilie and Stephanie highlighted some important lessons learned so far:

  1. Volunteers want to feel welcomed and appreciated.
  2. Volunteers want to be guided by the staff

As a result, one of the volunteer positions is to be the “volunteer greeter.”  As volunteers arrive for their visit, a veteran volunteer greets them!

Kristiansund kommune (3)Volunteers wear a button that has a red heart on it.  This way the staff and older adults know that this is a volunteer. The professional staff wear a button with a blue heart.

I asked Stephanie to describe the typical volunteer.  She explained that they are getting people of all ages, from 16 years of age and up, mothers on maternity leave who want to still feel like they can make a difference, and retirees who bring their skills and expertise to their volunteer experience.

One volunteer explained that he was in the process of looking for a new job, one that wouldn’t interfere with his nursing home visits.

“Volunteering is an emerging concept in Norway,” says Emilie.  “Places like Britain have a long rich history of volunteerism but for us it is a new trend. People are asking: ‘How can I be a resource?’ ‘How can I give to my society?'”

Kristiansund kommune (6)Finally, I asked Stephanie if the volunteer program has made a real impact.  “Definitely! We’ve seen changes in our residents. One of our patients with dementia will talk even hours later about the visit she had with her ‘buddy.’  Other patients will say:

Today my buddy is coming to visit me, only me, just to me…”

For the staff, Stephanie says there has been a definite change in the way they think about volunteers. They told me, “If we are going to prioritize some positions, we have to prioritize a volunteer coordinator, because that is such important work.

We’d rather you prioritize the volunteer coordinator than a nurse.”

For me, it was a great thrill to see this group discover the positive impact volunteers can have on the staff, on the people for whom they care, and their families and loved ones.  It’s important to note that the success of this program is due to querying the stakeholders, collecting their ideas, careful program development to address the expressed needs of the stakeholders, and then gaining the confidence of the staff through their involvement in program development from the beginning.

Thank you Stephanie for meeting the challenge and for being an important factor in the emerging idea that volunteers can make a real difference. And thank you Emilie for guiding them through this process. I’m sure there will be follow ups to this story!

If you known of a great volunteer program, please let me know.  Let’s come together, here at VolunCheerLeader.com to promote an expanded role for volunteers and the creation of what I call the “super” volunteer!

Feel free to email me with your VolunCheerLeader story at: paul@voluncheerleader.com