An interview with Katherine Knoble, Community, and Volunteer Program Manager, Capital Caring Health
One of the great joys I have is hunting for and discovering great volunteer programs. Moreover, I can tell you that I have found a great one at Capital Caring Health in Virginia, led by Katherine (Kat) Knoble. The title of this article, “They are not just committed to the mission, they are living it.” is Kat’s comment about her volunteers. In reading this article, you’ll discover this is indeed, what the Capital Caring volunteers are doing. In addition, to Kat’s comments, I’ve injected quotes from her volunteers that reflect their commitment to the mission.
We cover a lot of ground in this interview, but it is well worth your time to read this article. You’ll discover Kat’s unmistakable authenticity, energy and passion for her volunteers and the people served by Capital Caring Health. I hope that reading this interview will inspire and encourage you as much as it has for me.
Paul: I am so impressed with everything I read and saw about your volunteers on your website and social media. How did you get started? I’m always interested to learn what draws people to this work.
Kat: My journey started when I was 14 years old as a candy striper. You were able to volunteer in a nursing home, and that was a big thing! You got your uniform, you starched up the hat, went in, and that was big time! That’s where I immediately fell in love with geriatrics. But, of course, at age 14, I didn’t know that word. I just knew that they were really nice older people that had all these amazing stories, and it was fun!
I worked at the nursing home for many, many years. And then, the high school I went to was very service-oriented, so we did a lot of outreach in the D.C. community for the underprivileged, soup kitchens, and things like that. The love of volunteering was instilled in me by my parents, and my school. Once that is engrained in you, I don’t think you can ever stop. Throughout my life, I have volunteered everywhere, but geriatrics was really my love.
I started as an activity director in my professional career. First, I learned the ropes of engaging older adults in meaningful activities throughout the day. Then, working through the ranks, I became a director at bigger communities; some were for-profit, some were nonprofit, and working at all levels of care, independent living, assisted living, memory care, skilled nursing, and loved it.
One of the organizations I worked with had its own hospice, so I started in hospice work and fell deeply in love with that. Then from there, a social worker who was at another organization than I’m at now said, “Can you come and just talk to our executive director?” I said, “No, that’s so kind of you. I love what I’m doing. I’m totally happy.” She said, “Please, I just want you to meet with her.”
This is a true story...
I was in church on Easter, and before mass started, I looked down, and I got a text from that social worker saying: “I really think you need to meet with her.” And then twelve years of Catholic school came raging back, “Look into this!” So, I met with that executive director, and within five minutes, I knew that this woman was something else, and she understood volunteers. She understood the meaning. She understood that they couldn’t be the best hospice in the area without volunteers.
Paul: That’s such an awesome story. What is key in your response is how your parents influenced you with that culture of giving, pushing you towards community service and caring about others. Let’s talk about the volunteers and what you’re doing now. We will talk about what you and your volunteers have been doing during the pandemic. But, first, I’d like to talk about what was happening before the pandemic hit? What were your volunteers doing? What sort of supports were they providing?
Kat: Our volunteers provide a variety of supports. Thinking about a big umbrella of companionship, that’s a really big umbrella, and the raindrops under that umbrella include respite care. Let’s say a volunteer stays with that patient while the family goes to the grocery store, or goes to church, or just gets a break to walk around. We also provide vigil care. So, when someone is actively dying, the volunteer is there with that person, so they are not alone. We provide that bedside specialized care.
We also provide grocery shopping, run errands, take patients to the beauty parlor, and really anything that patients need. Maybe they need the lawn mowed. It’s very individualized. So that’s why I like to say it’s companionship, but under that umbrella, there are so many things that we provide. Those are what we call direct patient care opportunities.
And then, we have opportunities for our veterans that are direct care, but those are more specific. We want to honor them in a very dignified and classy manner. We do not do the “Here’s your certificate and pin. Thank you for your service.” Instead, we do leg work ahead of time, getting the veteran’s bio. We have active-duty service members come in uniform, and we provide a dignified ceremony.
And then the non-patient volunteer opportunities pre-pandemic were calling patients what we call “tuck-in” calls. So once a week, we have volunteers calling to make sure they have all the supplies they need before the weekend comes. We have volunteers that come into the office to stuff envelopes, and help with administrative tasks. They are not going to have that patient interaction.
Some of these volunteers may have lost a loved one themselves. They want to give back, but it’s a little too raw to have them do it directly. So, there are those opportunities to give that are not direct care, and they are just as meaningful.
Paul: How many volunteers do you have?
Kat: In hospice, they do a grid with what is called direct care hours, a percentage. Medicare requires 5% of hours coming from volunteer services. I will say that our percentages have been high, and even through COVID-19, it’s been pretty remarkable, and that’s because our volunteers are out there doing things. We always hit that 5% or exceed that, and we need to do that as we are helping so many patients. (Note: Kat later provided to me in an email the volunteer numbers for her region. From January to July, Kat’s volunteers provided 2,942 hours, and for all of Capital Caring Health, 650 volunteers provided 10, 900 hours! For 2020 Capital Caring Health volunteers logged an impressive 20, 904 hours! She reports that the only volunteers she lost were either moving out of state or being deployed. And so far, for 2021, she has onboarded about 45 new volunteers!
And then the pandemic hit...
Paul: Of course, then the pandemic hit. What happened? What happened to your volunteers?
Kat: When the pandemic hit, that was crazy. My son had just gotten married, and then a week later, it was like the world ended. It just closed. And that is how it was for our volunteers and our industry. Volunteers had to stop seeing patients, and it really ended that quickly. I remember we thought it would be a couple of weeks, maybe a month, but it just kept on going on. So, I would say within the first thirty days, that’s when we had conversations like, “Whoa, we really need to think and pivot quickly.”
Personally, what went through my mind was, “How do we retain volunteers? And what can they do, safely?” The retention part, I looked at the volunteers to say, “Let’s come together.” That was such a horrible time in our country. People were scared. They weren’t going out. They were worried about loved ones they couldn’t see. Nursing homes were closing down.
I polled our volunteers to learn what they wanted, and what was important to them. They said they wanted a connection among themselves. We have a few volunteers that are chaplains. They started writing a weekly blog, and it was motivational and inspirational. Our team, our clinical team, our chaplain, and our social workers would meet through Zoom with volunteers to keep them connected and to come together as a community. That is what we did early on. And then we helped each other.
One of my most memorable stories...
…that I know I will always treasure was a volunteer who came to us. She had graduated from George Mason University, I think in communications, and she came to us to volunteer and fell in love with it. It motivated her to go back to school, enter the accelerated nursing program, become a nurse, and guess what? She had just finished her orientation on the floor when the pandemic hit.
Here was this new nurse in Northern Virginia with overflowing hospitals, and the death rate was really taking a toll. It was great that she relied on her Capital Caring family to say, “I’m struggling. I don’t know if I can go back. I don’t know if I can do it.” She got so many letters and calls from all of us, all of the volunteers that provided her that energy and support she needed. And now, she is doing a great job. She’s still a nurse. She’s doing a fabulous job. I would say that we came together as a community, and then we looked at what can we do. This is going to go on longer than we thought.
We started pen-pal programs. We have a couple of volunteers that make cards. They are professional-looking. Our goal was that each nursing home resident because those were the most vulnerable, the most isolated, would get at least two cards a month. We extended that to our home care. We also did phone calls. We did a ton of care packages. We did flower deliveries. We really pivoted from the companionship umbrella to a delivery system.
We are delivering tons of stuff, meals, flowers, or anything that could bring someone a little bit of joy and connection. Families would answer the door, of course with a mask, we had a mask, we kept our distance, and they would wave and say a few words. Those few moments meant a lot to people. They were not forgotten. Our volunteers were tearing up the roads, in their cars, delivering everywhere. So that’s how we pivoted very, very quickly.
Overwhelmingly, volunteers said, “Yes! When?”
Paul: How are things looking for you now? Are things started to return to normal?
Kat: In early June, it seemed like things were getting better; restrictions were being lifted. It seemed safer. People were being vaccinated. All of our volunteers have to be fully vaccinated. We said, let’s start resuming in-person visits continuing to use our personal protective equipment (PPE) but to have those more important in-person touches. So that worked well. From my perspective, I can’t make a volunteer do anything, nor would I. But the first question in my mind was are they going to want to go back. It’s still a little scary; there are a lot of unknowns.
Overwhelmingly, volunteers said, “Yes! When?” So, I had all of these volunteers ready to go back. Nursing homes were pretty much opened up again. Now we are seeing a withdrawal from that. A long-term care center where we have 20 patients is now going to be on lockdown again. So, we’re seeing those outbreaks now. It’s disheartening.
But we have to keep up with the work that we are doing. We can’t weaken; they are counting on us. We might see a slowdown in our long-term care communities this fall with the flu and the variant: All-in-all, we are kind of teetering. We went back strong, and now people are pulling back, mostly the long-term care centers. They have to protect their residents. We’re a guest in their home, so we have to go by their rules.
We never stopped our pen-pal program because we anticipated this might happen, and we never stopped our delivery program. We can continue those things without any bumps in the road or delay in care or service because we’ve kept them in place.
Paul: Thinking ahead, has the pandemic caused you to think about having a contingency plan in place if this sort of thing would happen in the future?
Kat: In healthcare, we have tons of disaster plans. Usually, you think of a disaster as being a flood or hurricane or something like that. So yes, definitely. All of that is being revamped. And our volunteers are getting a lot of education about infection control, safety, and about PPE. We really didn’t focus on all of those things before the pandemic. At least, not to the level we do now. Our commitment to our patients is just as strong to our volunteers to keep them safe. We have to look at that constantly.
Paul: Ok, let’s move on to talk about what sort of feedback are you getting from the people you are serving?
Kat: It’s overwhelmingly positive! It’s beautiful, some of the comments that we get. We like to go back and look at those, and sometimes people put them in writing, sometimes they tell you in person, or sometimes they will call us. What they often say, is that the volunteers were fully present, that they did these things I didn’t think of with my mom or my dad, my wife, or my husband, and it meant a lot to them. For example, we had delivered flowers to an 18-year-old person that was passing, and her dad, after the patient had passed, sent a beautiful note saying how much those flowers meant to his daughter because she loved flowers, she loved gardens, she loved nature and at the end that was the one thing she could still enjoy. That was so meaningful for our volunteer to hear.
We had a patient who had a hard time eating, and the wife was so loving and caring, and at the end of the day, she was exhausted, and she was starting to lose weight. The volunteer would call her to check in on her and support her during COVID-19 and picked up on this. So, they got a volunteer to bring her food so she could enjoy that, and she loved it. She invited those volunteers at the very end to the funeral. A lot of times, our volunteers are invited to funerals. That shows you the connection.
I would say that people, overwhelmingly, deeply appreciate that the volunteer can see their patient as the person they are.
Paul: Let’s talk about your screening and your onboarding process. I want to talk about this because there is some talk about volunteers who are increasingly looking for episodic rather than long-term opportunities. But where the volunteer is visiting with someone in hospice, to me, that’s a long-term commitment. So, what sort of screening and onboarding process does a volunteer have to go through?
Kat: Extensive. For the reasons that you note. We are entering someone’s life at a very sacred time. Our volunteers need to have all the tools in their toolbelts. We don’t want to send a volunteer out to be overwhelmed or not equipped to help someone that is already in a difficult phase of their life. They do go through a lot of training. The training involves bereavement, family dynamics, and what you might see at the very end stages of someone passing away.
They need to know what they can do to support someone, what they can and should not say, privacy issues, HIPAA, infection control, and boundaries. For example, we don’t want volunteers going into someone’s home, and maybe a caregiver says, “Can you take mom to the bathroom?” That could be an awkward moment, and no, they cannot take mom to the bathroom. They are not allowed to provide hands-on care. That would be nursing care.
Navigating conversations and supporting families during the transition and even in bereavement requires about 32 hours of training. And then they receive hands-on training. Dementia training is a big key. You can read a lot of articles and educate yourself that way. But each person is different, even each time of the day is different for each patient. We’ll bring a small group of volunteers to a memory care neighborhood. We will interact with patients and show them some tools for their toolbelt, and that’s really quite helpful.
When a volunteer is assigned to a patient, we want to make that experience great for the patient and the volunteer. If they’ve never done this before, we will team them up with a very experienced volunteer to go with them or with the volunteer manager. The purpose of that is to support the new volunteer to walk side by side with the volunteer. And they will see how we interact with the patient and the family.
We look around at the walls of people’s homes, looking at pictures, awards, and things like that, so there are many talking points. You learn about the person and the family that way. That’s great support for volunteers. And then we teach them how to end that visit, so it’s not awkward.
 Health Insurance Portability and Accountability Act
Paul: I really appreciate the mentoring piece. Because I have seen, and I’m sure you have as well, people put into positions that they are not prepared for, or something comes up that wasn’t necessarily in the training. So having that experienced volunteer beside them is important.
As far a recruiting, what are people’s reactions when they see everything they have to do to become a volunteer? How many people actually get through the training?
Kat: A high percentage. It’s ok to say, “No.” The volunteer may have an agenda different from what you need. You want that match. We get these calls all the time, “I have 20 hours of community service I need to do by two weeks.” So, no, that’s not a good match for us. We do take episodic volunteers for certain things but not for patient care. For patient care, they have to be fully trained.
Part of our job is to educate the community.
We network with a lot of schools to give students an opportunity to work with our staff and also patients on a more event-based experience. So, if we have a big Veteran’s Day event and go out to one of our partnering nursing homes, that would be an episodic volunteer opportunity. But to be alone with a patient, you have to have a full background check, fully vetted.
Paul: Do you have a demographic? Could you describe your typical volunteer?
Kat: Yes, sure. It’s changed since COVID-19. It’s interesting, and it’s really kind of cool. COVID-19 opened up an opportunity to be really innovative, to think outside of the box. Typically, we would say volunteers seeing our patients would have to live around here. With COVID-19, we said, “Wait a minute. Why do you have to live around here to make a phone call to check on patients?”
We have what we call our: “tuck-in” call. It’s a scripted call. Some said, “We’ve always done it that way.” I said, “Ok, let’s do it different!” So, we reached out throughout the United States. We got a bunch of experienced college students who are on track to medical school or graduate school. Well, hello! What talent! We still have those volunteers. They are amazing! Wisconsin, California, all these different places that’s way outside of Virginia. It’s been a great experience for them. And we have Zoom, so it’s not like we never see a face. That is definitely outside of our normal demographics.
Our typical demographics are 55 and up; about 60% of them are retired. The other 40% tend to be young professionals in their 20’s and 30’s. Then we have subsets of people who do multiple things. They are retired, but they are really interested in veteran’s affairs because they are a veteran themselves. They help with our veteran’s ceremony. You do have to be 18 or older to be a hospice volunteer.
Students that are under 18 are usually episodic, and they help in the office. They don’t necessarily see patients. They might help at a camp we have, but we are going to supervise them.
Paul: You have a fantastic program. You sent me an email with your volunteers explaining what they value about volunteering and other feedback. I thought their responses were amazing. I was just “wowed” by all of their responses. They were great. So, what do you think is key to creating a sustainable volunteer program?
Kat: You have to be authentic. You have to be you. I’m me. Someone else’s style is going to be different. But if it’s authentic, then it’s going to work. People want to work with someone who is genuine, who’s honest. I had a volunteer one time tell me something that really stuck with me because I thought, “Wow, that’s interesting!” She said to me, “Katherine, I just want to let you know that I sent an email to your boss wanting to point out that you don’t do the ‘Tuesday thank you’s.’”
My first reaction was, “Oh my god! What did I do? What did I miss? Oh my gosh, what is the ‘Tuesday’ thank you?” She said, “I’ve worked with so many volunteer organizations, and the ‘Tuesday’ thank you is when they send out this generic thank you, “Hi everyone, you all rock! You’re great, blah, blah, blah.” But you don’t do that. You send out thank you’s to the individual after they do something noteworthy. And it’s just real.” I thought to myself, “Gosh, thank you!”
Being authentic is very important. Everyone doesn’t want the group thank you, and really, it’s kind of meaningless. Giving individual thanks and acknowledgment is important and keeping volunteers in the loop, not seeing them as “less.” They are an equal partner at the table here, and you have to treat them as such. You are getting their input, asking for their ideas. You would be surprised how much retention you get if you actually include them. Don’t give them the answer; ask them for the answer.
One time we had a patient the mom was out of town, they really needed help, and we asked the volunteers, “How can we help this mom?” A volunteer came up with the solution. She was able to raise $3,200 for the mom to stay in the same apartment complex with her daughter, as she passed. So don’t always come with the answer; come with some questions. Be willing to be open-minded. Keep volunteers in the loop. They know so much more than we do. They’re out with the patients.
Paul: You’re touching on something from my own experience. The volunteers that are willing to go through this rigorous screening and training; they are also “thinkers.” They’re creatives coming just as you’ve mentioned with their ideas for new ways to connect with people.
As I mentioned earlier, you sent out an email to a few of your volunteers asking them what they thought was the key to volunteer program sustainability. Their responses really reinforced my opinion that training is not an afterthought. The training, in my opinion, is the lynchpin for the whole program. And several of the volunteers said that the training and the ongoing training was excellent. Would you talk about that for just a moment?
Kat: Sure. There are regulations that state you have to have so much training. It is so minimum. The training is going to retain your volunteers. They are going to be stronger, and also, the training connects volunteers with other volunteers. When you’re training in person, they get to meet other volunteers when we don’t have a pandemic. It’s fun!
Even if it’s through Zoom, we start out by having everyone introduce each other. They see each other’s energy and that they are learners. But the content of the education is so important because then they can implement that. If you just do an onboarding education and then have them see patients, they will not be fully equipped. Nobody is going to remember every single thing they learned. You have to keep it ongoing and keep that energy. And quite honestly, things change. New education is out there—new techniques for dementia. We educate our volunteers on medications as well, not just behavioral interactions. If you learn about medications and how they may affect a patient, that helps you be a better volunteer and a better person interacting with them.
Paul: One thing that comes through the volunteer’s testimonials is that your passion, Kat, is really contagious.
Kat: Thank you.
Paul: It goes back to your earlier comments about being real. And I think, particularly these days, people are looking for authenticity. We’re good at saying things, but then the follow-through may not be there. So, in addition, to the training, you need someone passionate at the steering wheel. They care not only about the mission, but they care about the volunteers. I think that is what is coming through these comments.
They are expressing what goes into a great volunteer program. It seems that you have great support from your leadership. What would say to someone that might say, “I just can’t seem to get my leadership to see the value of volunteers.”
Kat: It’s in the stories. I’m a visual person. I think a lot of people enjoy the visual part. So, I always try to capture those stories with a picture or in writing. I’ll have a social worker tell me something that a patient told them. I listen, and then I say, “Will you please email that to me.” So then, I keep those, and that’s what I’m constantly giving to leadership, with the photographs, here’s a real-life moment, here’s what we’re doing. The stories are what matter. They are not made up, they are real stories, and that is just the best-selling tool.
You can tell your leadership that your volunteers are so valuable, but you have to show them. You have to walk the walk. You have to show them, “Here is what happened last week.” So, I am always, at least weekly if not more, sending out some story or stories.
We have two vigils going on right now. We are hearing what the volunteers are learning about their patients and how they honor those patients during the last hours of their lives. They are sending me notes, and so I send that on. Those are real moments. This weekend we have a veteran’s ceremony set. We always have active-duty service members in uniform to take pictures. The daughter is through the roof, excited that her dad will be recognized for all his service. He has a whole wall of awards that he is so proud of.
You can get your leadership to know what is going on if you have the stories. If you just say, “They’re doing great things,” it won’t be enough. Gathering and reporting the stories, taking pictures, and tracking them takes a little extra time, but it does pay off. You can always pull them out later. You can use them again. They are real-life events, and they don’t become obsolete.
Paul: Speaking of stories, is there one story that really stands out in your mind that made you stop and say, “Yea, this is worth the effort.”
Kat: Oh gosh, (sighing), I will be honest when I tell you that there are so many. One of them was part of our bereavement program. It was just beautiful. Our Caring Bear team is a bereavement team comprised of sewers and Caring Bear Ambassadors. A Caring Bear Ambassador is someone who has been trained in bereavement care. They know how emotional families can be when they’ve lost someone. So, the ambassador will go out with the family and gather clothing from the loved one, and we make a bear out of the clothing.
We met with one mother who had lost her three-year-old son. It was really hard for her to give up anything. Everything was sacred to her. So, we had to show patience and support. We did and said, “You know what, it’s ok, we’re here, you don’t have to do this today. We can come back.” But she really wanted to do it. But she really couldn’t give up any clothing.
We looked at a picture on the wall of her beautiful son in this cute little sweater vest, and we talked about that and how he would get so excited wearing the sweater vest. We suggested that we make a bear with the sweater vest on it. The skilled sewers did this, and the healing was so powerful when we brought those bears back to her. The whole room was powerful.
The Caring Bear volunteer was kneeling, holding that woman’s hand as she sobbed and held that bear just as she would hold her son. Our grief counselors will call that item a “linking” item. It’s needed for grief, so they can hold it. It is a reminder of their loved one, and it helps them heal. You have to go through all those emotions to move on and to really go through that grief cycle.
Paul: I agree! My experience is similar. The caliber of people that get involved in this area are what I have called “diamonds.” They are just amazing.
Kat: I agree with you!
Paul: I am convinced that there are thousands if not millions of people like this that are just waiting for an opportunity if someone would just open the door and let them in. I’m hoping, that through these interviews and articles that we can convince the nursing home providers to embrace their volunteer programs beyond just entertainment and games. And that is not to dismiss entertainers and games. We need volunteers of every cloth.
But what we really need in long-term care are what I call “companion” volunteers who will make that long-term commitment, receive training and go on to create meaningful relationships with the residents. There are, just as you have described here, real human connections being made in hospice. So, what is happening in nursing homes to create “authentic” partnerships?
Kat: Yes. Having worked in nursing homes for so long, I think there is a mindset. But we are talking about innovation, and I think there is an opportunity to be innovative when thinking about volunteers in long-term care instead of always thinking about your groups and that big old calendar.
Instead, use and train volunteers to meet individual needs. Each one of those residents are individuals. They are not just the group. Groups are great for socialization but maybe have a group of volunteers that can spend the time with those individuals, just one on one doing really incredible things.
Paul: And I want to be clear too, this isn’t about being an ombudsman either. The ombudsman is necessary, but the ombudsman is coming with an agenda just as the nurse or others that come to the resident. They have something that they need to do. The volunteer we’re talking about isn’t coming with an agenda or a task. They come as an open book, ready to learn about that person they are about to visit engaging them without the “I’m here to do something to you.”
The “companion” volunteer sitting with the resident comes with no agenda other than to be there.
Kat: I wonder because the staff is so overworked in nursing homes and underpaid; I wonder if the answer lies in creating a nonprofit entity that trains volunteers for long-term care on an individual basis. They would train them similar to how we train in hospice, such as dementia, family dynamics, and include staff dynamics because there are a lot of staff dynamics in nursing homes.
The population is very diverse, so the volunteer would have to understand that as well. They would need to understand the role of the CNA and how overworked they are. I think it takes a whole division to train the volunteer properly, and I don’t know that the nursing homes are equipped for that.
Paul: No, I don’t think so either. It’s interesting that you bring that up. As a stand-alone organization, my purpose is to recruit, train and place volunteers in long-term care communities. I meet with staff to show them our training program to garner their feedback and their buy-in.
When we send them a volunteer, they have a pretty good idea of how we trained that volunteer. Legally they still have their requirements that the volunteers have to meet, but the foundation is in place. My goal is to give them a pretty good idea about what to expect when they arrive at the nursing home.
Kat: Yes, they are so overworked. It’s not like they don’t want volunteers. They just don’t have the time to support them. I think it’s worse to take volunteers on and not support them.
Paul: That is part of the training, letting the volunteer know that when they arrive at the nursing home, they may encounter people who are burned out. That’s just part of the landscape and has been for some time. One thing that is encouraging are the current conversations about addressing social isolation in nursing homes. Because of the pandemic, I think it is now pretty well understood by everyone including the long-term care community that human connections are a basic need and critical to the care of the residents and the staff as well.
Kat: And you’re not just taking anybody to fill a box. These are real people, and we can have conversations, throw ideas out and problem solve. It’s just a really good community of like-minded people. So, accepting just anybody is not the answer. It’s ok to say, “No, this isn’t a good fit.” And then try to help them find another organization that’s a better fit for them.
Paul: Yes, and you need to know the other volunteer managers in your area and who they are looking for and offer people other opportunities that may be more suited to their needs. Well, Kat, thank you so much for taking the time to share your volunteer program with me. It is so encouraging to learn about great volunteer programs such as yours! You really are living it!
Kat: You’re welcome!