The landscape of health care has been shifting due to factors such as, an aging population, complex care needs, and increasing costs and demands. Health care organizations are challenged with tight budgets and constraints, and managing expectations to maintain quality service that is coordinated and delivered with compassion and that maintains the dignity of the health care consumer and their caregivers who are placed at the centre of their health care journey.
Bruyère Continuing Care’s Therapeutic Support Services (which includes Therapeutic Recreation, Spiritual Care, Volunteer Resources and Arts and Wellness) has created an innovative service delivery model at all our three sites across Ottawa (long-term care, complex care and rehabilitation). This model is designed to maximize our human resources, paid and unpaid, and leverage their expertise and skills. The “Volunteer Unit Model” is intended to integrate volunteers more effectively into the interdisciplinary team on the units and maximize their usefulness, engagement and impact on the patient’s, resident’s and family’s experiences from admission to death/discharge.
At each of Bruyère’s three sites the Volunteer Unit Model is adapted to reflect the needs of the program (i.e., complex care, long-term care, etc). Services provided in long-term care are different than at Bruyère’s complex care and rehabilitation programs. Although the Volunteer Unit Model exists at all Bruyère sites, Therapeutic Support Services (TSS) has focused its efforts on implementing and refining the model in long-term care due to the greater need for social engagement among residents. Residents in long-term care are at greater risk of experiencing loneliness, social isolation, and boredom which can lead to depression (Cacioppo et al., 2006; Heikkinen & Kauppinen, 2004), as well as impaired psychosocial well-being (Wilson et al., 2007), accelerated functional decline and premature death (Perissinotto et al., 2012). According to a 2011-2012 assessment, 44% of long- term residential care residents in Ontario have limited or no social engagement (CIHI, 2013). Although the model has rolled out in our complex care and rehabilitation hospitals, this application is focused on Accreditation Canada recognizing the Volunteer Unit Model as a Leading Practice based on its implementation in our long-term care home, specifically on one unit in our francophone long-term care residence. We are about to roll out the model on a second unit at the same residence.
The uniqueness of the Volunteer Unit Model is the scope of practice and consistency of volunteers assigned to a specific unit. Traditionally in health care, the role of a volunteer is narrowly defined and often limited to portering patients/residents, assisting in recreation activities and/or friendly visits; as a result, volunteers are seen as separate from the health care team and as changing faces who come and go, as inconsistent ‘helpers’. With a high turnover, volunteers do not often have the opportunity to develop a relationship and really get to know the resident as a person. However, when volunteers are encouraged to do more, there is the fine line of encroaching on staff’s workload and scope of practice, often creating union grievances and tension. The success of the Volunteer Unit Model at Bruyère is due to the regularity and consistency of volunteers on a unit, and the continual education and involvement of clinical and non-clinical staff in the development and roll out of the model over the past 3 years, and as a result we have garnered buy-in from senior and middle management and frontline staff.
Unit Model volunteers are assigned a 3-hour shift (morning, afternoon, or evening) during which they are available to support staff and patients/residents and families on the unit in a variety of capacities. Specific responsibilities are associated with different shifts; however, Unit Model volunteers may experience variance from shift to shift as the model is designed to adapt to the individual needs of the patient/resident and family and to be responsive in the moment.
Upon a resident’s admission, TSS’s recreation and spiritual care staff complete a needs assessment (based on their disciplines) and the Volunteer Resource Coordinator uses the Alzheimer’s Society’s questionnaire “Getting to Know Me / Apprendre à me connâitre” to gather more detailed information about an individual’s life history, their interests and hobbies. This information is used as a resource for volunteers to better know who the resident is and what they could offer to meet the resident’s needs/interests.
When a Unit Model volunteer arrives on the floor, the first thing they do is “Volunteer Rounds” which involves going room to room to introduce themselves and ask if the patient/resident and family have any special requests with which the volunteer can assist. Examples include: family respite, accompaniment off the unit (to an activity, to the garden, chapel), asking if resident/patient would like to listen to their customized music play list (music and memory program with individual iPods). Throughout their shift volunteers can: assist with meals, facilitate small groups on unit, provide one-on-one friendly visits, tidy patient/resident rooms, help to organize the unit, answer call bells and respond as required to non-nursing related needs (e.g., getting a glass of water, helping with the T.V. remote, turning a light on/off, opening/closing curtains). These are special touches that can impact quality of life in a significant way. In our Volunteer Unit Model evaluation, in the volunteer survey we asked volunteers assigned to that unit if they enjoyed what they are doing; 97% of respondents said they enjoyed the tasks/activities they performed on the unit.
Throughout the residents’/patients’ stay Unit Model volunteers develop a relationship over time with residents; being assigned to the same unit creates regularity and routine for residents, which creates comfort and consistency and builds trust. Over time, volunteers on the unit really get to know their residents well and can further customize services provided and respond ‘just in time’ to meet immediate needs. In our survey, 93% of volunteers have expressed satisfaction with their volunteer experience as they are made to feel useful, part of a team and that they have a direct impact on the quality of life of the residents/patients and families they are serving, which contributes to volunteer retention.
To further enhance the services we provide we offer specialized training to interested volunteers and volunteers we deem as good candidates to work more closely with the TSS staff (spiritual care, therapeutic recreation and arts and wellness.) Specialized training has included palliative end-of-life care, spiritual care, Music and Memory, dementia care, dignity therapy, Java Music Club and Java Memory Care programs, Ambassador (Admission and Goodnight), communication, group facilitation, mealtime assistance, Cycling Without Age, and Snoezelen. Volunteers with specialized training use their acquired knowledge and skills to enhance service delivery on an as needed basis. Working collaboratively with Therapeutic Support Services staff, these volunteers become a rich resource that expands our ability to reach more residents/patients. This resource enables TSS staff to focus on the more clinically complex patients/residents, ensuring that the right person is at the bedside at the right time.
The infrastructure of the Volunteer Unit Model is made up of different components, including: Communication Corner where staff are encouraged to make special requests regarding patient/resident needs, where information about patients’/residents’ personal story is kept (i.e., what is meaningful to them, how the volunteer could help make a difference for that particular individual) and where volunteers record who they have seen and what they have done during their shift; this information is helpful for staff and other volunteers. Having a space on the unit, especially dedicated to the volunteer team is essential. An incoming volunteer is encouraged to reach out to anyone who hasn’t been seen that day, this ensures all patients/residents have come into contact with a volunteer and have been able to express their needs. In long-term care, one of the key elements used to communicate with family and staff is a Guest book placed in each resident’s room. Volunteers record their visits and also take photos of the resident engaged in meaningful activities; photos are then pasted into a Scrapbook, also placed in the resident’s room. Both books are available for staff and family reference. These books also mitigate potential complaints/concerns from family members when a resident with a cognitive impairment, for example, doesn’t remember that volunteers came to visit her today. The family can refer to the two books to see that in fact three volunteers spent time with their mother earlier today.
The Volunteer Unit Model includes the Volunteer Ambassador program, which has been recognized as a Leading Practice by Accreditation Canada. The Volunteer Ambassador greets all new admissions, provides a tour and supports the integration of the resident and their family on the unit. In long-term care within a week upon admission, the unit hosts a Social Tea to welcome new residents and families. We started the Goodnight Ambassador program in our palliative unit at Elisabeth Bruyère Hospital to help reduce delirium, and have implemented this program on the long-term care unit to also help reduce delirium and anxiety at bedtime (we will be seeking recognition as a Leading Practice for the Goodnight Ambassador program in the near future).
In long-term care, our vision is to accompany all residents through to the end of their journey. We are integrating a palliative/end of life care volunteer team on the unit that will provided comfort care services, family support and bereavement resources.