I have been a Hospice volunteer for about a year and a half. I volunteered for Hospice because as I get closer to the time I could be in one myself, I wanted to familiarize myself a little more with the organization and the dying process itself. Also, Cryonics organizations have found in general, hospices are more cooperative with cryopreservation teams than hospitals and nursing homes. Up to this point, I had only been in one hospice, it was on Florida’s west coast. A small building with perhaps room for ten or fifteen patients.

Once I had decided to volunteer, I looked in the phone book, there were 4 or 5 hospices listed. The one that caught my eye was the one that had "innovative health care" in the name. I took their training course and soon was a qualified volunteer. Along the way I also learned that there are non-profit Hospices and for profit Hospices. The first thing that had me questioning whether I had made the right decision was when my Supervisor asked me if I wanted to work in the field, visiting patients or work in the office. I had always associated hospice with one-on-one contact with patients, and if I worked in the office I would never see a patient.

Being that I have such sharp insight, it wasn’t long before I made the connection that if I worked in the office and since this was a for profit Hospice I would be providing a commercial company with free labor. So I worked in the field. I had a total of about 18 patients. I also noticed that they didn’t have a building to house their patients who were bedridden. When one of these patients needs such care they are put in a nursing home.

I wondered if this is why they have the word "innovative" in their name. I visited a number of hospice patients in nursing homes, We were told that they got better care than if they were just a regular nursing home patient. I never saw any difference.

Because of the nature of the business, patient turnover is quite high. I visited with them, or sat with them so that their caregiver could get out of the house, or took them for a ride so they could get out of the house. Every one of the patients I had that was cared for at home was happy with their care.

Like the rest of Florida, new developments are springing up everywhere. In one of the newer ones, an ingenious developer built a building with around ten small offices, the idea was to get one company from each field of specialization to put a satellite office there. There were Opticians, Hearing Aid Specialists, Financial Planners, Medical prosthesis dealers, Tax Preparation, Insurance Broker, Exercise equipment, and of course my Hospice took an office.

One day my Supervisor asked me if I would like to volunteer to staff the office to "educate" visitors about Hospice. We were given forms for anyone that wanted further information to fill out. We were then to FAX it to the main office. Once again my keen intuition kicked in, this sounded like an unpaid salesman’s job! I went back home and did a little research, and discovered that the fellow who started this Hospice, sold it in 2004 for 335 million dollars.

The buyer was a nation wide sewer cleaning company! So here was a sewer cleaning company, who, if they asked for volunteers to go and develop leads for them , would be laughed out of town. But they bought a company that has volunteers getting leads for them! Not only that, the sewer cleaning company’s (they have since changed the name of the hospice parent company) President had a salary in 2004 of $917,000, plus stock options!

I resigned from my volunteer position, but I still have doubts about whether my "keen intuition" was right! I Called a non-profit hospice, that has their own facility, their next training session is in August. I plan on going.

My suggestion would be to pick out the largest, most well known and respected non-profit hospice in the area, visit them, asking to see their executive director, or someone like that, and say, "I've got a really burning question for you, and that is, are you guys really competing with the for-profits, or playing in entirely different marketplaces?" You could say that your reason is based on your experience with for-profit operations, and your concerned you were simply being used as a 'volunteer salesman'. If that's the way it works, they'll probably level with you, or, they might say, "Those guys are permitted to take no more than 4% of the gross as profit, and then only if private fees account for 75% of that, etc., etc.,etc." and you'd have a better idea of how they're regulated, whether they're tapping different markets, and so forth.

Ben Best has asked what advice I would give someone contemplating hospice. Well, the quick answer would be to make sure the hospice had their own facility. In this way when a patient could no longer walk or take care of themselves, and their caregiver was unable or unwilling to perform the additional tasks, the patient would not be put in with the general population of a nursing home. I saw this happen with two men, and they were VERY unhappy.

But I have also seen exceptions to this rule. One was a frail 90 year old woman who was cared for by a younger sister, she received full Hospice care in the sister’s home until she died. Another was a frail man in his 90’s. His closest relative lived out of state. He was bedridden and lived in a private home. There was another (non-hospice) patient in the house. One woman took care of these two patients. These people received excellent care.. I wondered why this man didn’t wind up in a nursing home like some of the others. Perhaps there was sufficient financial resources available? I never asked about money matters, and no one ever told me.

So, I guess I’d change my answer to "if the hospice doesn’t have their own facility, make sure the primary caregiver is willing and physically able to take care of a bedridden patient OR there are resources available to hire the necessary help OR place them privately. Otherwise, if that hospice doesn’t have their own facility, when you become bedridden, you’re going to a nursing home!

Ben also asked what training I was given. It consisted of about a half dozen 2 hour sessions. They showed us how to fill out our "volunteer note." Every time we finished a visit with a patient, we had to fill in the spaces: Patient’s name, number, time spent with patient, any changes since last time, traveling time, mileage, location of service, etc.

We learned what palliative care is: The study and management of patients with active, progressive, far advanced disease for whom the prognosis is limited and the focus of care is quality of life

We learned what NOT to do:

NEVER

Accept money

Administer medications

Give legal or medical advice

Enter into a business transaction

Try to convert them to your religion

Give them your personal phone #

Disclose personal information

Other subjects covered were:

Role of the volunteer

Psychosocial needs and family dynamics

Ethics and family directives

Spiritual care

Grief and loss

Compliance training.

Before I close this, I’d like to go back to the two men whose wives put them in a nursing homes very much against their will. One fellow, in his 80’s pleaded with me to get him a lawyer. I explained I couldn’t. I saw him three times in the nursing home, each time he was progressively worse. The last day was around 1PM, he was unconscious, receiving oxygen, and breathing heavily. Around 4PM I received word that had died at 2PM.

The next morning his wife called me, (the office gave her my number!) she said she was there yesterday, that he had the "death rattle," but she couldn’t stay as she had "other things to do." She showed no sign of grief.