A helping hand from the community
Volunteer program steps in where home care can’t
In an era when reimbursement for home care seems to be getting cut to the bone, many home care agencies are finding it difficult to provide the services their patients really need and still get paid. Yet the very nature of home care — and of the nursing profession — makes that reality hard to stomach.
Forsyth Home Health and its related hospital, Forsyth Medical Center in Winston-Salem, NC, have come up with a way around that: the Neighbors volunteer program. It has provided needed services to mostly elderly patients, improved patient and staff satisfaction, and may improve outcomes, too.
Service, but no cost
Because Novant Health, the parent organization of the hospital and home health agency, had a mission to promote health in the wider community, the hospital auxiliary brainstormed for something it could do to achieve that mission, explains Elizabeth Warden, RN, CNA, MS, director of nursing at the hospital. "We wanted to provide social contact for those patients in home care that didn’t have daily contact with people."
Velma White, RNC, the home health nursing supervisor for Forsyth Home Health, says that while providing a service without incurring a cost was definitely a positive aspect of Neighbors, more important was making sure the patients got as much care as they could for the funds available. "Our nurses were getting increasingly frustrated," White says. "There were waiting lists and a lack of funding for things like chore workers."
Neighbors was created by a group including members of the hospital auxiliary, the hospital chaplain, the hospital vice president for patient services, and one of the home health supervisors.
Volunteers go through an orientation that includes discussion of issues such as how to say no to requests that are outside their purview, how to provide emotional support, and communicating in difficult situations. They also receive training on common health conditions, such as diabetes and congestive heart failure and are also schooled by a physical therapist in body mechanics so that they can safely and effectively move and transfer patients.
After some of the initial visits, there were some changes to the orientation, says Warden, including more information on dealing with situations that can’t be changed and how volunteers can respond to situations "when they really don’t know what to say." The chaplain was instrumental in this part of the training, adds White.
The home care agency refers most patients to the program, which currently has about 15 volunteers. Others come to Neighbors through word of mouth. Area houses of worship and volunteer organizations have been notified of the program as well.
Most of the volunteers’ work involves simply talking and visiting with patients. They might do some light housework, prepare a small meal, or play a game with the patient.
The impact of this simple program has been great in many cases. Warden worked with one patient, a 61-year-old who had had a stroke. "She was very depressed and despondent. She didn’t want to eat or exercise," recalls Warden. "Home care thought with more social contact, she would be more cooperative with her exercise program."
The first couple of visits didn’t produce much improvement, Warden admits. "But on the third visit, we talked about how important it is to follow the instructions the nurse gives her," she
Positive results for all involved
White says the home care agency nurses love the program. "They are real patient advocates and like to get all they can for their patients," she says. "This has increased their job satisfaction, and they feel they have another set of eyes and ears on their patients. They feel a lot less helpless and a lot less like they are leaving people in the lurch."
Warden first got involved in Neighbors as part of a master’s project that required her to look at and analyze data. Her project has provided some statistical proof that this program works, too. Among the findings:
• Fewer patients were depressed after they started participating in the program than before it started. While more than a fifth of patients said they were sad or somewhat sad before the program, none did after.
• Patients felt physically better after their volunteer visits started. Forty percent of patients felt bad or somewhat bad prior to the Neighbors program. After, none felt bad, and only 17% felt somewhat bad. Those feeling OK increased from 20% to 68%.
• Patients not only believe that their volunteer will make a difference in their lives, but they feel that they will have a positive impact on their visitor’s life, too. Prior to the program, two-thirds of the participants believed that they would make some difference to their volunteers, and the remainder thought they would make a lot of difference. After the program, 17% of patients thought they would make some difference, and a whopping 83% thought they would make a lot of difference in the lives of volunteers.
• Home care nurses reported several positive outcomes. They noted that their patients seemed to have an improved sense of well being and they had positive comments to make about the program. Nurses also noted personal satisfaction with how patients were served by the volunteers, and that they were very comfortable sharing the plan of care with them.
Other impacts of the program include getting patients hooked up with other needed services, such as Meals on Wheels or respite care, and making physical changes to the home environment, like adding a shower attachment and bench to a bath to ease personal care chores.
"This kind of community outreach is really priceless," Warden says, noting that much of the success of Neighbors is predicated on the notion that human contact — even something as simple as human touch — is important to physical and emotional well-being.
While Warden would make few changes to the program, she wishes she had gotten the word out to area churches and volunteer agencies more effectively. "At first, there were some who were a little leery of going into a stranger’s home," she says. "I would have liked to have found a good way to overcome that."
White says there is a need for more volunteers — especially more male volunteers — but she quickly adds that there is little that could be done to improve on this program. "This builds on great relationships. It meets a need, particularly when there is no family around."