Volunteer Annual Review

Volunteer Annual Review

True or False - Please choose the most appropriate answer:
Name

First NameLast Name
Date

MonthDayYear
Date
1. Hospice care utilizes a holistic approach to promote quality of life and comfort, rather than a cure, by addressing the physical, psychological, social and spiritual needs of the terminally ill person and their support system.

TrueFalse
2. Throughout history, medicine was unable to prevent or cure illness or prolong life. As medical care advanced in the 20th century, death began to be viewed as a medical event rather than a family, community, or religious event.

TrueFalse
3. As a volunteer, it is okay to share a patient’s Protected Patient Information (PPI) with other volunteers.

TrueFalse
4. If a hospice patient is actively dying while you are in the home, and no family members are available, you should always call 9-1-1.

TrueFalse
5. For patients in hospice care, it is important to honor and respect their choices, even if they are choosing to not take medication for moderate or severe pain.

TrueFalse
6. Hospice patients typically experience many physical changes as their disease progresses, including decreased appetite, increased sleep, and congested breathing.

TrueFalse
7. After a patient dies, a hospice agency does not have to make bereavement support available to family and friends of the patient unless they have the resources to do so.

TrueFalse
8. The hospice patient must receive verbal and written notice of his or her rights and responsibilities in a manner they understand at the time they are admitted to hospice.

TrueFalse
9. Active listening involves fully concentrating on what is being said and responding without judgment or advice.

TrueFalse
10. Hospice is unable to provide care to patients who are transferred from their home to a skilled nursing facility as this is considered a duplication of services under the Medicare hospice benefit.

TrueFalse
11. If a hospice patient is experiencing spiritual distress, it is okay to share your religious beliefs with them, even if they haven’t asked, in order to ease their fears and bring them comfort.

TrueFalse
12. One of the best ways to protect yourself and others from commonly spread bacteria and viruses is by washing your hands before and after you visit a hospice patient.

TrueFalse
13. As a volunteer, you are expected to intervene in the family’s patterns of dealing with one another, the goal being to create a lasting and positive change in the family system.

TrueFalse
14. The ethical principle of autonomy refers to the right of patients with decision-making capacity to make their own decisions regarding the care they receive.

TrueFalse
15. Families of patients with Alzheimer’s Disease are grieving not only the anticipated death of their loved one but all the changes that are occurring along the way.

TrueFalse
Volunteer Annual Review

Please choose the option that best describes your volunteer experience:
1. I feel like I am an important part of the Bonner Community Hospice team.

DefinitelySomewhatMinimallyNot at all
2. The ongoing volunteer training's available through Bonner Community Hospice are helpful.

DefinitelySomewhatMinimallyNot at all
3. The requirements for documenting volunteer visits and mileage are reasonable

DefinitelySomewhatMinimallyNot at all
4. I am satisfied with my level of involvement as a volunteer.

DefinitelySomewhatMinimallyNot at all
5. The Volunteer Coordinator has been available when needed to problem solve or answer my questions.

DefinitelySomewhatMinimallyNot at all
Please answer the following questions, being careful to not include any protected health information of patients you have worked with in hospice:
1. What has been the most positive part of your volunteer experience this past year?
2. What has been the most negative part of your volunteer experience this past year?
3. What are your goals as a hospice volunteer for this coming year?
4. In what aspects of your work as a volunteer do you need more experience or training?
5. What changes could Bonner Community Hospice make to improve their volunteer program?
Volunteer Annual Review

Please evaluate yourself as a volunteer in the following areas
Evaluation Criteria:

M = Met

NM = Not Met

NA = Not Applicable
1. Willingly accepts volunteer assignments when available

MetNot MetNot Applicable
2. Contacts patient/family within 48 hours of assignment

MetNot MetNot Applicable
3. Provides volunteer services as requested,such as respite, companionship, bedside vigil, life review, errands, light housekeeping, meal preparation, reading or sitting in silence

MetNot MetNot Applicable
4. Meets visit/time commitments, providing consistent, reliable contact with client, based on client needs and program guidelines

MetNot MetNot Applicable
5. Creates a comfortable and non-judgmental environment through listening and supporting

MetNot MetNot Applicable
6. Notifies patient/family and volunteer coordinator of changes in visit schedule

MetNot MetNot Applicable
7. Maintains appropriate professional and personal boundaries with patients and families

MetNot MetNot Applicable
8. Follows HIPAA guidelines and maintains patient confidentiality by protection of paperwork

MetNot MetNot Applicable
9. Takes an active part in client care planning by attending IDG and/or maintaining consistent contact with the volunteer coordinator

MetNot MetNot Applicable
10. Observes and reports any needs or concerns to Volunteer Coordinator, Social Worker or Nurse (including possible neglect/abuse or suicide risk).

MetNot MetNot Applicable
11. Follows hospice program policies and procedures

MetNot MetNot Applicable
12. Notifies hospice of changes in availability (vacation/illness, etc.)

MetNot MetNot Applicable
13. Maintains current auto insurance

MetNot MetNot Applicable
14. Maintains current driver license

MetNot MetNot Applicable
15. Submits visit/telephone call documentation within 72 hours after visit

MetNot MetNot Applicable
16. Documentation of volunteer time is legible, clear and complete

MetNot MetNot Applicable
17. Attends volunteer support meetings regularly

MetNot MetNot Applicable
18. Attends volunteer training's regularly

MetNot MetNot Applicable
19. Recognizes and reports signs of complicated grief or suicide risk

MetNot MetNot Applicable
Volunteer trainings you have attended since last annual review:
Name of training: Date: Date
Name of training: Date: Date
Name of training: Date: Date
Volunteer Comments:
Volunteer Coordinator Comments:
Volunteer Coordinator Signature

Clear
Date

MonthDayYear
Date
Volunteer Signature

Clear
Date

MonthDayYear
Date
Period from: Date to Date
Should be Empty:

Volunteer Annual Review

Volunteer Annual Review

Please answer the following questions, being careful to not include any protected health information of patients you have worked with in hospice:

Volunteer Annual Review