• Volunteer Annual Review

    True or False - Please choose the most appropriate answer:
  • Date
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  • 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.
  • 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.
  • 3. As a volunteer, it is okay to share a patient’s Protected Patient Information (PPI) with other volunteers.
  • 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.
  • 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.
  • 6. Hospice patients typically experience many physical changes as their disease progresses, including decreased appetite, increased sleep, and congested breathing.
  • 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.
  • 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.
  • 9. Active listening involves fully concentrating on what is being said and responding without judgment or advice.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.

  • 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.
  • 2. The ongoing volunteer training's available through Bonner Community Hospice are helpful.
  • 3. The requirements for documenting volunteer visits and mileage are reasonable
  • 4. I am satisfied with my level of involvement as a volunteer.
  • 5. The Volunteer Coordinator has been available when needed to problem solve or answer my questions.

  • 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

    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
  • 2. Contacts patient/family within 48 hours of assignment
  • 3. Provides volunteer services as requested,such as respite, companionship, bedside vigil, life review, errands, light housekeeping, meal preparation, reading or sitting in silence
  • 4. Meets visit/time commitments, providing consistent, reliable contact with client, based on client needs and program guidelines
  • 5. Creates a comfortable and non-judgmental environment through listening and supporting
  • 6. Notifies patient/family and volunteer coordinator of changes in visit schedule
  • 7. Maintains appropriate professional and personal boundaries with patients and families
  • 8. Follows HIPAA guidelines and maintains patient confidentiality by protection of paperwork
  • 9. Takes an active part in client care planning by attending IDG and/or maintaining consistent contact with the volunteer coordinator
  • 10. Observes and reports any needs or concerns to Volunteer Coordinator, Social Worker or Nurse (including possible neglect/abuse or suicide risk).
  • 11. Follows hospice program policies and procedures
  • 12. Notifies hospice of changes in availability (vacation/illness, etc.)
  • 13. Maintains current auto insurance
  • 14. Maintains current driver license
  • 15. Submits visit/telephone call documentation within 72 hours after visit
  • 16. Documentation of volunteer time is legible, clear and complete
  • 17. Attends volunteer support meetings regularly
  • 18. Attends volunteer training's regularly
  • 19. Recognizes and reports signs of complicated grief or suicide risk

  • Volunteer trainings you have attended since last annual review:

  • Name of training: Date:   Pick a Date   

  • Name of training: Date:   Pick a Date   

  • Name of training: Date:   Pick a Date   

  • Date
     - -
  • Date
     - -

  • Period from:   Pick a Date   to   Pick a Date   

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  • Should be Empty: