Closing a Volunteer/Patient Relationship

[Kelly Keller]

Occasionally we have patients who are discharged from hospice because they have stabilized to the point they no longer qualify for hospice. As odd as it sounds, my volunteers have a much harder time with this separation than that brought on my death. They feel they are abandoning their patient. Part of this comes from the boundary crossing that happens from time to time from volunteer to friend. This is especially true for our volunteers who are visiting patients who reside in nusring homes or assisted living facilities. I would appreciate any and all suggestions to help volunteers with this process, both words of wisdom to help the volunteer emotionally as well as wording suggestions of how the volunteer can handle that final visit.

[Greg Schneider]

This goes beyond the government regulation. Corporate fears about litigation are also stifling this true human connection. I have a vision of an "alternative" hospice that will evolve out of hospice that will take care back to what it used to be.

[Kelly Keller]

I appreciate this discussion, Greg and Frances... I resonate very much with your thoughts. It does make me sad when all the regulations and guidelines seem to have the effect of stifling true human connection. The more I work in hospice, the less I like government regulation because of its effects on things like this.

Frances - I especially appreciate your perspective of inner-city nursing homes. I am like you in that I most enjoy being with the more marginalized people in our world. As the volunteer coordinator, I can attest it is the rare person that actually grooves on being with, shall we say, "the least of these."?

[Frances Shani Parker]

Kelly, I'd also like to add that hospice volunteering for me in an inner-city nursing home required a lot of flexibility, depending on circumstances. Greg is right about experience being an asset. During the day I was principal of a school located in one of the highest drug, prostitution and HIV/AIDS rates in Michigan. I went to the nursing homes after work, and I enjoyed both experiences.

In terms of patient boundaries, volunteers should always make sure that the hospice patient assigned to them is their highest priority. I did that, but, when I was feeding my patient at a table in the dining room on a frequent staff shortage day, I couldn't ignore the six other patients with dementia. When many of my patients shared rooms with three other people, I couldn't act like they weren't there. This didn't bother me at all, but I know of another hospice volunteer who was miserable in these situations. She transferred to doing hospice office work and is doing well. The beauty of hospice volunteering is finding a service where one can do the most good while being open to improving personally. One person can make a difference somewhere and feel good while doing that.

[Greg Schneider]

I admire your perspective, Frances. This a sad part of today's hospice care in my opinion. As hospice moves further into mainstream medicine, it seems that volunteers are permitted to do less and less for liability reasons. The ones who suffer then are the patients and their families. I would like to see this trend reversed but that is not likely unless "alternative hospices" decide to take hospice back to those times when staff & volunteers could do more and had more time to do it.

[Greg Schneider]

In my experience I find the patients have a more difficult time with this transition than volunteers, as Frances has just demonstrated. If volunteers can be made aware of the fact that the patient's improvement, which is allowing them to come off hospice care, can often be attributed to the loving care they received from hospice, perhaps the separation will be more acceptable. Some might question volunteer-patient boundaries with Frances decision to see the patient as a friend but I think that is dependent upon the nature of the relationship with the patient and the experience level of the volunteer. Frances has considerable experience and is aware of what she is doing. Such a move is probably not recommended for volunteer who has less than 1 year experience.

Also, letting the volunteer know that if the patient's condition once again requires them to be under hospice, that they will contacted for re-assignment to that patient can be helpful as well.

[Frances Shani Parker]

This actually happened to me as a volunteer at a nursing home. My male patient (I'll call him Ted) who was being discharged from hospice care, but not from the nursing home, was elderly, in need of a wheelchair for mobility, and had no other visitors (family, friends). He clearly was disappointed when he knew I would not be his volunteer. For one thing, he knew his outdoor wheelchair rides would become irregular if he had to depend only on busy or absent staff members. At the same time, I was also volunteering with another man at the nursing home. He was younger, mobile, and had a wife and adult child who visited regularly. He was even well enough to leave the nursing home for periodic weekend outings. But he still qualified for hospice care and a volunteer.

Obviously, this put me in a very awkward position because I knew I would always be aware that Ted would be sad, especially if he saw me there visiting the other man and possibly a new person assigned in his place. Ted and I talked about this. I told him that I would still drop by to visit him as a friend and take him for rides when I could, even though I wasn't his volunteer. I also spoke to other staff about this so they would know Ted needed some extra attention and wouldn't assume I was still his regular volunteer. The first time I went to see him after I wasn't his volunteer, I found him sitting alone in his room staring at the walls. (He and his roommate didn't get along, and his roommate owned the TV.) He looked up grinning and said, "You came back to see me! Let's go!" And we did! That was all I needed to keep on visiting.

Regarding suggestions for you, I would have to say that each situation is unique. The situation I just described had special circumstances. By request, I volunteer in inner-city nursing homes. I would probably not have felt as compelled to continue visiting if Ted had supportive family and friends or if he lived at a location away from the other patient. But even his mother refused to go to the nursing home neighborhood to visit him. Basically, I just use common sense and listen to my heart. That's where you'll get the "words of wisdom."


Frances Shani Parker
“Hospice and Nursing Homes Blog”

[Kelly Keller]

Thanks, Frances! I always appreciate your perspective!!!