Innovations in End-of-Life Care
an international journal of leaders in end-of-life care

St. Thomas Hospice:
A Member of the Adventist Health Care System, Midwest Region
Address as of July 27, 2000:
8230 Madison
Burr Ridge, Illinois 60521
Volunteer Coordinators: Kay Hammer and Barbara Zerby
Volunteer Junior Trainer: Wendy Tinnon
Tel.: 630-850-3990 (current)
Tel.: 630-856-6990 (as of July 27, 2000)

[Citation: Romer, AL. St. Thomas Hospice Junior Volunteer Program. Innovations in End-of-Life Care, 2000;2(4), www.edc.org/lastacts]

A Summary of the Junior Volunteer Program

Recently, Patrick, one of the junior volunteers at St. Thomas Hospice, was on the Oprah Winfrey Show, for a program entitled "Unlikely Friendships" with his hospice patient Mariam. Mariam is a 90-year old blind woman who loves music and plays the piano. Mariam had been assigned Patrick after telling her hospice nurse that she, "missed the voices of youth." After some visits together where Patrick accompanied Mariam's piano with his guitar, Mariam was discharged from hospice because she no longer qualified. She was too healthy. For her going away party, Patrick's mother had bought some hand lotion for Mariam, which Patrick dismissed as inappropriate and then went off to get her a real present. Patrick reappeared some time later with an electric keyboard that Mariam could play on her lap, in her bed for the days she couldn't get to the piano. He then taped the C-notes so that she could find them and play.

Even as hospice staff like telling this story, Kay Hammer reports that Patrick, the teen volunteer does not feel he did that much. It is clear, however, that he listened to Mariam, realized what was important to her, and then acted on the basis of this attentiveness to bring her a gift as unexpected as it was just right. When the two were on Oprah, Mariam joked, "We're going to start a band."

Marijo Letizia, PhD at Loyola University Chicago School of Nursing, with Kay Hammer and Barbara Zerby, staff at St. Thomas Hospice in Burr Ridge, Illinois, have developed a junior volunteer program, which contrasts in size and scope with that of the Featured Innovation. Staff at St. Thomas consulted with Sandra Mahood from The Hospice of the Florida Suncoast [See Featured Innovation] to design this program, which started with just 14 teen volunteers two years ago and now has 27 junior volunteers. The small size of this program allows the volunteer coordinators to match individual teens with carefully screened patients and families. Volunteer Wendy Tinnon, interviews the family and patient to confirm that the existing needs are a good match for a particular junior volunteer as well as to assure that the teen will be welcome and safe in that environment.

St. Thomas is perhaps typical of smaller hospices across the United States in terms of size and available resources. St. Thomas has an average patient census of 60 patients, of whom approximately 75 percent are in their own homes.

The goal of this program was to increase the scope of services offered to dying patients in the community as well as to engage youth in a palliative care effort while developing these young people's skills and connection to the community. Dr. Letizia wrote a grant to the Community Memorial Foundation to implement the project and fund a full-time Volunteer Coordinator position, which is currently being shared by Kay Hammer and Barabara Zerby. These staff members work with Wendy Tinnon, a hospice volunteer with a master's degree in education, to assist with the recruitment and support of teen volunteers.

Criteria for Involvement:

• Age 14-18 (younger teens can do office work)
• Parental consent
• Screening interview: Staff inquire about motivation for participation
• Completion of junior volunteer training
• Ability to commit adequate time
• TB test

Teen volunteers engage in a range of Possible Volunteer Services. Junior volunteers are expected to provide emotional and practical support to families facing loss of a loved one; acknowledge limitations; maintain confidentiality; submit oral reports to coordinators; participate in in-services; and maintain required records of patient and family contact [See Junior Volunteer Time Sheet.]

Recruitment and Training

St. Thomas Hospice staff members have recruited students in the high schools through contact with school counselors and promotional materials. Word of mouth has been the best source for generating interest. Teens participate in a 3-hour training session, which covers the following topics: An overview of hospice, Junior Volunteer roles and responsibilities, issues of confidentiality [See sample Confidentiality Agreement], communication with patients and families, and documentation skills. Staff has designed listening exercises and several self-reflection exercises. One exercise involves asking students to write down nine people or activities that are important to them and then to ask the teens to select and give them up one by one. The group then discusses this process of having to contemplate losing these key people and activities in their lives. Volunteer coordinators try to help junior volunteers prepare to encounter the unexpected during their home visits. Help is always a phone call away, and volunteer coordinators and the junior volunteer trainer aim to keep in close contact with junior volunteers who are visiting patients and families in their homes.

After training, volunteer coordinators combine group activities for teens with individual volunteer activities. Junior Volunteers are encouraged to bring a friend who has not been trained as a volunteer to periodic "Pizza and a Pal" parties to spread the word, build awareness of the program among their friends, and engage in a project for hospice patients and families. For example, the teens may spend an afternoon making dried soup packets, which they then deliver to hospice families who have indicated an interest in receiving them. These gatherings offer an opportunity to mingle in the service of creating a product for others. Volunteer coordinators run approximately four group events per year, which are interspersed with junior volunteers making individual visits to patients and families that are carefully matched by the volunteer coordinators and junior volunteer trainer.

Patient and Family Support:

Wendy Tinnon, the volunteer who works with the junior volunteer coordinators, talks to the hospice nurse and then interviews the family before matching a junior volunteer with the family. Some of the criteria in terms of whether a patient and family are appropriate for a teen volunteer are:

• Is the patient in touch with reality?
• Does the patient want a volunteer?
• Is the family aware of the reason the teen is coming in?
• Are there any safety issues? Is the patient's pain well controlled? Is the patient on oxygen?
• Will this be a safe environment for the teen?

Once a patient and family are deemed a good match for a junior volunteer, the volunteer coordinator talks to the teen so that the junior volunteer can anticipate what he or she will encounter and what the patient will look like. St. Thomas requires that the caregiver be at home during the junior volunteer's visit.

Junior volunteers visit patient and family alone and do "what needs doing." One junior volunteer helped a patient clean out drawers and while doing so, the patient reminisced about her life. Another hospice patient was literally trapped in her home because she could not negotiate the stairs. Teen volunteers built a ramp under the supervision of one of the adult volunteers who had worked for Habitat for Humanity. The patient was able to get outside before she died two weeks later. At the moment, a junior volunteer who speaks Italian has been matched with an Italian-speaking family where she is volunteering with the patient's husband. This junior volunteer is listening to the husband's stories of his youth during World War 2 in Europe. No one on the St. Thomas Hospice speaks Italian, so in this instance this junior volunteer is filling a need for companionship that no other staff member could accomplish. In this small program where staff members know each junior volunteer quite well and are in close communication with these teens, the coordinators feel that they can give the teens a great deal of leeway to meet with patients and family members and do what needs to be done. After each visit, junior volunteers make a phone call to Wendy Tinnon, the trainer, or to Barbara Zerby or Kay Hammer to report on their visit. If the coordinators do not hear from a student, they call the junior volunteer. While exact numbers of home visits vary, at any given time some junior volunteer is offering one-on-one contact to a patient or family.

Staff members know that their junior volunteers are busy and attempt to avoid focusing on actual amount of time volunteered, but rather on the quality of the time spent. Although one of the entry criteria is having adequate time, the volunteer coordinators do not make an explicit time commitment requirement and they don't judge students by how many hours they can give. Kay Hammer noted that Patrick didn't go that many hours to Miriam's house, yet he clearly made a difference in her life.

Keys to Success

This junior volunteer program is made up of a small group of motivated teens. The coordinators feel that they know every student well. Listening to Kay Hammer speak about the program, it has a small-town feel to it. This intimacy seems to allow the volunteer coordinators to trust the students to enter into hospice patients' and families' lives in personal ways. The matches between junior volunteers and patients are idiosyncratic and particular. Kay Hammer asks, "Who would be the best person? With adult volunteers, we think more about time availability, but with the kids it's about finding a good match. What junior volunteer hasn't been out to see a patient lately? Would that person be a good match with this patient? What is the need and who can fill it? Who can go out and mow a lawn?"

What's Ahead