“Timely, Not Counter-Intuitive”

As many of you know I strongly believe and have witnessed first hand how volunteers providing in-person companionship in nursing homes are key to providing quality of life for the people living there and while raising the morale of the people working there.

But, for the past several months, actually, since about March 15, I’ve been (I’m sure like many of you) trying to understand how the pandemic got so far out of control, and how it was impacting everyone in my life, e.g., family, friends, students, colleagues, along with just about every other aspect of my life!

woman wearing mask with arms folded


No one seems to be exempt, from the very youngest to the very oldest. No one seems to be invulnerable to the ravages of this horrific virus. At the same time, watching what is happening in our nursing homes across the United States is equally distressing as thousands of nursing home residents and direct care workers are contracting the illness. Far too many of them dying as a result and most terrible, dying without the presence of family and friends.

If all this uncertainty isn’t enough, the ageist remarks are beyond upsetting.

It became very apparent through comments from a variety of sources that people over a certain age, i.e., 65 are expendable or should willingly sacrifice themselves, accepting the fate of premature death. If COVID-19 has done anything, it has indeed highlighted how deeply embedded ageism is in the psyche of our society.

Through all of this, having lost the opportunity to get out in the community to meet with nursing home staff personally, I now find myself trying to connect through social media and other online platforms. Zoom has been a lifesaver. However, technology is helpful it is not a substitute for person-to-person contact.

And finally, I have been struggling to understand what my message should be during this time. After all, promoting the idea of expanding the role of volunteers in nursing homes during a pandemic seems a bit counter-intuitive.

Today, approximately forty percent of COVID-19 deaths have occurred in nursing homes. Direct care workers do not have the supplies and protective gear that they need, and families are suffering the reality that their loved ones are dying alone in isolation.

Trying to digest all of this, I’ve come to the realization, it is not counter-intuitive to promote robust volunteer support. I have come to the opposite conclusion.

Promoting a robust volunteer workforce for nursing homes is more important than ever. It is most timely.

With the increased attention on the poor conditions of people living and working in nursing homes and the impossible challenges they are facing, now is the time to rethink how we use volunteers in nursing homes. Volunteers can be screened and trained to provide person-to-person companionship in nursing homes. Volunteers providing in-person companionship in nursing homes are key to providing quality of life.

 Having screened and trained well over 600 volunteers for nursing homes, I can say with confidence that people living in our communities, if presented with the opportunity, would step up to volunteer. They would undergo the screening process and training required to provide in-person comfort and, in particular, to nursing home residents that have no living relatives or friends.

It’s been so encouraging to see how volunteers are providing much needed and meaningful support such as delivering meals, groceries and medication, hospice and palliative care, disaster response teams, the list is long. And for sure, there are truly notable efforts to provide some sense of connectedness for the nursing home resident, but it’s becoming increasingly apparent that “virtual” is not enough.

We are starting to realize that the ravages of social isolation may be more deadly than the virus itself. People living in nursing homes who do not get visitors are twice as likely to die in the same period as those that do get visitors. People that do not get visitors that do not have meaningful relationships shut down.

While visiting with a woman living in a nursing home, she commented,

“I have a lot of people around me, nurses, aides, but there is no one here just for me.”

Addressing social isolation, loss of connectedness, loss of meaningful relationships  takes more than just a 30-second “Hello and, how are you?”

It takes time and consistency while building trust. It takes sitting with someone, getting to know them, and further, becoming vulnerable enough so that they come to know you. These conversations need to go beyond weather chat to discussing deeper concerns that have meaning to both parties.

I’m well aware of what nursing home workers face. I’ve witnessed it for years. Many of my students are direct care workers, and I have heard their stories. So, this isn’t about the nursing home staff not doing their job or not trying to give that personal attention. I know that they want to but likely do not have the time. The direct care worker’s day is packed, providing even basic cares.

nursing at patient's beside wearing mask

               

So, this isn’t about denigrating nursing home workers. I place them among the greatest heroes of our society. It’s not about replacing paid workers with free labor. Instead, this about cultivating a workforce whose sole mission is to provide for that basic human need, that is, having someone to love and having someone that loves them.

There’s a great movement now to persuade nursing homes to allow families back into the nursing homes. Without a doubt, that needs to happen. But I’m thinking about the thousands of people living in nursing homes that have no surviving family. What about them? Are they not suffering that same pain of separation and isolation as well?

Volunteers providing in-person companionship in nursing homes are key to providing quality of life.

Recently, I attended a webinar hosted by the Long Term Care Community Coalition (LTCCC, nursinghome411.org). The guest speaker, Catherine Unsino, LCSW, psychotherapist, and nursing home reform advocate, shared that when people move into a nursing home, it does not “erase dreams, preferences, and desires.”

She shared that during her visit to a nursing home on the Fourth of July, she observed there was no celebration of any sort in the nursing home. A nurse explained that the staff were up to their neck and could not stop to celebrate. So, in an impromptu fashion, Catherine began singing “My Country Tis of Thee.”

The residents joined her in singing with her. Seeing their response and how it lifted their spirits, she made the sing-along a weekly event. The staff later observed that the residents “…were in a better mood and easier to care for.” I’ve heard similar comments from staff. To me, this indicates that volunteers not only impact the quality of life for the resident but also impact staff morale as well.

The challenge is that nursing homes struggle financially, making hiring a director of volunteers, providing a non-reimbursable service, not an option.

Unsino observes that nursing homes are reimbursed according to the acuity of the residents. Residents with high acuity (requiring more medical and nursing care) are desirable because it results in increased revenue for the nursing home.  But when the resident’s acuity scores go down (their health status improves), the nursing home loses revenue, and this creates a disincentive for the nursing home to provide proper care.

I believe (and I do not think I’m alone) that like hospice, a percentage of services should be provided by volunteers. That percentage is to be reported and impact reimbursement rates to the nursing home. If managed by a certified volunteer manager, the volunteer workforce creates a valuable and reimbursable service, i.e., companionship and personalized activities that are meaningful to the resident improves their health status while having a positive impact on staff morale.

Further, Unsino adds that décor does not provide an adequate substitute for the absence of relationships.            

I can attest to this personally as I have been in “opulent” nursing homes with outstanding décor, but while visiting with the residents and asking how they were doing, they would frequently respond with, “I am so lonely. I feel so alone.” Décor is not a suitable substitute for meaningful relationships.

If COVID-19 has taught us anything is that we need each other. We need to feel the presence of another human being, to feel loved, to engage in meaningful activities together, to enjoy one another’s company.

So rather than thinking that promoting a robust volunteer workforce during a pandemic is counter-intuitive, I now am fully convinced that with the increased public attention on nursing homes brought on by COVID-19, now is the time to advocate for increased community involvement through volunteers.

Volunteers can be screened and trained to provide person-to-person companionship in nursing homes. Volunteers providing in-person companionship in nursing homes are key to providing quality of life.

The residents win, the staff wins,
and the community wins.

I discuss all of this in great depth in

“Creating the Volun-Cheer Force.”  

   Contact me for your volunteer training needs and webinars.

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Author: Paul Falkowski

Dr. Paul Falkowski is an advocate for  expanding the role of volunteers in long-term care settings. Using state-of-the-art training techniques, Dr. Falkowski has trained and placed hundreds of volunteers in nursing homes.  Paul has recently moved the training program online to make the training accessible to everyone. He has a passion for life and living, he values owning our responsibility to others and having the courage to do the right thing. His vision is discovering volunteers as a work-ready resource to enhance the quality of life for people living and working in nursing homes.

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