Hello Volunteer,

We are excited you have chosen Unity Hospice as a place you would like to volunteer.  Volunteerism is the heart of hospice.  Prior to 1979, in the United States, there were no paid employees.  Everyone who served hospice patients were volunteers.  That is why we consider you the heart of all we do!  You have the ability to make a significant impact on our patients, their families and our team!  We consider you an equal part of our team!

We are grateful!

You will find your Volunteer Coordinator contact information, a checklist, some handy tools and your application on the next pages. If you need to stop at any point in time, select "Save" on the page you are on. You will then be able to pick up where you left off by clicking the original link sent to you. Once you have completed filling out the application, hit submit. The application will be forwarded to your Volunteer Coordinator.

Thank you again for choosing Unity Hospice as a place to share your time and your talents!

 

Sincerely,

Unity Hospice team

This checklist is a guide to help you with the steps you will need to take to volunteer at Unity Hospice.  These steps are required by state and federal regulations for volunteering with any hospice.

Your Volunteer Coordinator will set you up with appointments for drug testing/TB tests, fingerprinting (IL/IN only).  Your Volunteer Coordinator will also set you up with our Litmos training platform and Edocs (to document your visits).

Chicagoland office: 

Vera Junge - vjunge@unityhospice.com

Lariza Lopez - llopez@unityhospice.com 

 

Greater St Louis office: 

Joan Bevirt - jbevirt@unityhospice.com

 

Northwestern IL office: 

Kelli Graham - kgraham@unityhospice.com

 

Northwest IN office: 

Michelle Thoms - mthoms@unityhospice.com

 

Houston office:

Gemma Laberge: glaberge@unityhospice.com

 

 Wisconsin office:

Brenda McGarvey:   bmcgarvey@unityhospice.com

 

Use this tool to upload your driver's license/passport or state ID. This form is HIPAA secure.

Job/Title Positions:    Patient/Family Care Volunteer

 Reports To:                Director of Clinical Services (or PCC designee)

 Supervised By:          Volunteer Coordinator

 Job Description Summary

The patient/family care volunteer provides care and support services according to his/her experience and training and in compliance with agency policies.

 

Essential Job Functions/Responsibilities

1.  Serves as an integral member of the hospice Interdisciplinary Group amid various settings: home care; respite; in-patient, spiritual care, and/or bereavement.

2.  Participates in general orientation and completes annual orientation requirements.

3.  Serves the patient/family/caregiver in the home performing activities that the volunteer has been prepared for and has agreed to perform.  The volunteer may do homemaker chores, run errands, and provide respite care as well.

4.  Provides input into the Plan of Care and interdisciplinary meetings, as appropriate.

5.  Documents as educated and instructed maintaining confidentiality.
Meets all health requirements set by Unity Hospice.
Provides availability in volunteer support groups and/or keeping with the patient/family/caregiver needs.

6.  Participates in volunteer support groups and/or educational in-services.

7.  Maintains open communication and reports regularly to the volunteer coordinator.

8.  Assignment of other duties (as needed) directed by the volunteer coordinator.

9.  Abide by Corporate Compliance Program including Standards of Conduct and state and federal laws and regulations concerning confidentiality and patient privacy.
 

Position Qualifications

 1.  Mature, self-aware individual, supportive of the hospice concept, and willing to serve others in a volunteer capacity. 

2. Previous volunteer experience may be helpful. 

3.  Ability to work within an Interdisciplinary Group.

 

*At no time are hospice personnel (staff/volunteers) to transport patients.  This is for the safety of the patient and the volunteer.

I understand that any information about the patient/family to which I have access or which may be provided to me from the patient, the patient’s family, a community agency, or an interested person, whether contained in the patient/family record or received at case conference reviews, is privilege information and shall only be held in strict confidence in accordance with Unity Hospice policies and procedures. Patient/family information shall only be shared with appropriate Hospice personnel and agents or in accordance with the terms of a written release signed by the patient or the patient’s family.

Conflict of interest occurs when an employee participates in any activity within his/her role as a Hospice employee that will directly benefit him/her or someone with whom he/she has a close relationship. 
 
I.  Policy

Unity Hospice shall expect all employees to maintain professional integrity in all aspects of Hospice duties.  Employees will avoid any activity that would cause a conflict of interest.  An employee shall disclose actual or potential conflict of interest to his/her supervisor.  The following standards shall be followed to avoid conflict of interest and ensure employees maintain professional integrity.

 A. Employees shall focus their efforts on Hospice mission and goals

B. Employees shall not use employee status for personal gain or to benefit anyone with whom they have a personal relationship.

C. Hospice paid employees shall not engage in outside employment that may interfere with their ability to perform their job with Hospice or that may potentially involve a conflict of interest.

D. Hospice employees shall not use Hospice facilities and or equipment to engage in other business or occupation.

E. Hospice staff and volunteers shall keep all confidential information confidential.
 

 

I have read the Conflict of Interest Policy and I am completing this form in accordance with the policy.

The following standard of conduct represents guidelines that volunteers must
follow in their work at Unity Hospice®. Should you have any questions related to your interaction or approach with a patient, you should discuss it directly with the Volunteer Coordinator or respective Program Supervisor prior to your taking action.

 Treat patients with dignity and respect. Do not place yourself above or below
patients. Respect each patient’s religious, political, and other beliefs and refrain
from imposing your own personal beliefs on others.

 Help every patient to the best of your ability. Do not avoid patients or give less than your best effort because they are sick, unattractive, dirty, hostile, or has done something you do not like.

 Respect the patient’s privacy. Learn only what you need to know, go only where you need to go.

 Maintain completely confidential relationships. Do not share information about patients with guests, family, or friends unless they specifically ask you to do so.

 Do not tell stories about patients to other agencies or organizations without
approval from the Volunteer Coordinator or Program Supervisor.

 Only do what you can do. If the patient requires services you are not trained to provide, refer them to the RN Case Manager. Do not try to go it alone. Do not attempt to provide medical advice or services to patients, but direct them to the RN Case Manager and alert the staff of their needs.

 Maintain a professional helping relationship. Do not use patients to satisfy the needs that should be satisfied by your friends, partners, and relatives. Maintain a strictly non-sexual relationship with patients.

 Do not enter into financial relations with patients. Accepting money or any other form of payment from a patient is strictly prohibited. Volunteers are not permitted to give direct financial assistance to patients. Any gifts or donations should be made through the Volunteer Coordinator or agency Administrator.

 Any situation or occurrence that puts the life or well-being of a patient, volunteer, or staff member in jeopardy must be immediately reported to the Volunteer Coordinator or agency Administrator or in emergency situations to the appropriate authority.

 Respect other staff members and volunteers. Each person has something to
contribute. Conflict resolutions should be dealt with through the Volunteer
Coordinator or agency Administrator.

 Protect your health and the health of the community. Always follow the standard precaution procedures for infection control. Continually maintain and upgrade the knowledge and skills you need to be most effective. Take responsibility for reporting or confronting unethical or risky behavior by staff, other volunteers, visitors, or participants.

 Do not mistreat or abuse patients, visitors, or other volunteers in any manner including loud, abusive, insolent, or rude behavior, and racial or ethnic slurs.

 No smoking within any patient’s home or nursing facility.

 No possession of an unauthorized weapon of any kind.

 The use, possession of, or being under the influence of alcohol, or any controlled substances is strictly prohibited.

 Dress in an appropriate manner. Always wear your name badge. Clothing should be clean and neat with no holes or slogans that may be considered in poor taste. Jewelry and make-up should not be overly done. Personal hygiene should always be practiced. Perfume/cologne should be kept to a minimum, as some people are allergic. Patients on certain medications may become nauseated from certain scents so it is preferable not to wear any when visiting patients.

 

PURPOSE:

 Unity Hospice realizes that many employees may participate in Social Media as a way to share their life experiences and thoughts with family, friends and colleagues.    An employee’s use of Social Media may involve certain risks and requires an employee to exercise certain responsibilities.  Thus, it is important for employees to remember than any conduct that adversely affects the employee’s job performance, the performance of colleagues or others, who work on behalf of or for Unity Hospice, such as suppliers, vendors, etc., may result in disciplinary action up to and including termination.  To assist employees in making responsible decisions about the use of Social Media, Unity Hospice has established the following guidelines for the appropriate use of Social Media.

 

DEFINITION:

 Social Media includes all means of communicating or posting information or content of any sort on the Internet, including to your own or someone else’s web log or blog, journal or diary, personal website, social networking or affinity web site, web bulletin board or chat room whether or not associated or affiliated with Unity Hospice, as well as any other form of electronic communication.

 

PERSONAL USE (NOT RELATED TO UNITY HOSPICE BUSINESS)

 Employees may not participate in Social Media while on work time, except as explicitly permitted below in the section entitled “Unity Hospice Business-Related Use.”  Any personal use of Unity Hospice computers or communication equipment such as workstations, phones, laptops, or network infrastructure, to participate in social media must be minimal, occasional, limited to non-work times, may not be at the expense of an employee’s job performance or interfere in any way with the business needs and operations of Unity Hospice, and may not impose costs on Unity Hospice.

 

An employee should not use her/his Unity Hospice email address to register on any Social Media website for personal use.  Any Social Media postings by an employee shall be consistent with Unity Hospice’s policies including, but not limited to Unity Hospice’s anti-harassment and non-discrimination policies as well as Unity Hospice’s policies regarding the non-disclosure of information Unity Hospice is required to keep confidential pursuant to state and federal laws.  Inappropriate postings that may include discriminatory remarks, harassment and threats of violence or similar inappropriate or unlawful conduct will not be tolerated and may subject an employee to disciplinary action up to and including termination.

 

If Unity Hospice is a subject of Social Media content an employee is creating, the employee must be clear and open about the fact that she/he is an employee and her/his views do not represent those of Unity Hospice.  (For example: “The views and comments stated herein are personal and do not necessarily reflect the views of my employer.”)  Unity Hospice reminds employees that work-related complaints are more likely to be resolved if the employee speaks directly with his/her co-workers or follows the procedures outlined in the Complaint/Grievance Policy.

 

If an employee decides to use Social Media to post complaints or criticisms, Unity Hospice asks that the employee avoid using statements, photographs, video or audio that could be reasonably viewed as malicious, obscene, threatening, intimidating, disparaging to Unity Hospice employees and clients or that might constitute harassment or bullying.  Examples of such conduct might include offensive posts meant to intentionally harm someone’s reputation or posts that could contribute to a hostile work environment on the basis of race, sex, disability, religion or any other status protected by law or Unity Hospice policy.

 

UNITY HOSPICE BUSINESS-RELATED USE

 An employee is not permitted to visit Social Media websites during work hours, unless specifically authorized to do so for business-related purposes, either: (1) by virtue of the employee’s job responsibilities; or, (2) with express authorization as specified below.  Those employees who do have authorization and post messages on Unity Hospice websites or Social Media accounts should understand that they are posting on behalf of Unity Hospice and must adhere to Unity Hospice’s professional standards, values, policies and applicable laws at all times.

 

1.  EMPLOYEES WHO HAVE JOB RESPONSIBILITIES THAT INCLUDE POSTING INFORMATION TO UNITY HOSPICE MAIANTAINED WEBSITES AND/OR SOCIAL MEDIA understand and agree that the content and followers of the blog or other website belong exclusively to Unity Hospice and that upon request the employee must provide Unity Hospice with any information necessary to logon to Unity Hospice maintained website or Social Media accounts.  No employee may create an official Unity Hospice account or change a password, as this is solely the responsibility of Unity Hospice’s IT Department, and specifically the Director of Technology, Systems Development. Further, employees must be mindful or the issue of copyright infringement when posting materials that may be owned by others.

 

2.     INDIVIDUALS WHO DO NOT HAVE JOB RESPONSIBILITIES THAT INCLUDE THE POSTING OF INFORMATION to Unity Hospice maintained websites and/or Social Media accounts in the name of Unity Hospice or in a manner that could reasonably be attributed to Unity Hospice must obtain express written authorization from the Administrator or CEO.

 

All employees authorized to post on Unity Hospice Social Media accounts should identify themselves and their affiliation with Unity Hospice.  Any account posted should be current and accurate.  If you do make an error, take responsibility for it and correct it quickly.  Do not post any information that is obscene, defamatory, libelous, threatening, harassing, or intimidating to another person or entity.  Examples of such conduct include offensive posts meant to intentionally harm someone’s reputation or posts that could contribute to a hostile work environment on the basis of sex, race, disability, religion or any other status protected by law or Unity Hospice policy.  Individuals may be held personally liable for such remarks.

Employees are prohibited from using or disclosing any personal identifiable information about any individual who has received services from Unity Hospice.  If a comment contains information that identifies an individual who has received services from Unity Hospice and is sent by anyone other than that individual, the posting author should edit the identifying information out of the post promptly.  All HIPAA and Corporate Compliance Policies must be adhered to.

 

CONFIDENTIAL INFORMATION COMPONENT

 Employees are prohibited from sharing information that is confidential and proprietary about the company.  This includes information about policies, internal reports, internal communications, information about finances, census figures, number of employees, company marketing strategies, or any other information that has not been publically released by the company.

 

These are given as examples only and do not cover the range of what Unity Hospice considers as confidential and proprietary.

 

EMPLOYMENT REFERENCES

 Requests for employment references or recommendations on Social Media websites from former employees of Unity Hospice should be treated like any other employment reference and are subject to Unity Hospice’s reference policy.  An example of this would be a former employee asking a current employee to provide a reference on LinkedIn.  Any posting to that website automatically includes an individual’s business affiliations.  Therefore, employment references (whether on line or not) should not be provided by Unity Hospice personnel, other than through the Administrator.  Additionally, the former employee must first submit a reference release to the Administrator.

 

EMPLOYMENT REPRESENTATIONS

 Following the end of you employment relationship with Unity Hospice, you shall take prompt affirmative steps to ensure that no Social Media website represents you to be a current employee of Unity Hospice.

 

GENERAL IMPLEMENTATION OF POLICY

 This Social Media Policy is not to be applied or interpreted in a manner that interferes with any rights employees have under the National Labor Relations Act.  Employees who violate this policy are subject to discipline, up to and including dismissal or legal action.  Unity Hospice prohibits taking negative action against any employee for reporting a possible deviation from this policy or for cooperating in an investigation.  Any employee who retaliates against another employee for reporting a possible deviation from this policy or for cooperating in an investigation will re subject to disciplinary action, up to and including termination.

Employees are CONDITIONALLY hired until results from federally mandated criminal background checks are received by the Agency.  All employees who come into contact with patients are required to complete the following:

 

1. I consent to a criminal background check by UNITY HOSPICE which may include Illinois, Missouri or Indiana as well as any other states in which I have worked, resided or attended training.  This background check may or may not include fingerprinting depending upon my job -responsibilities. I understand that it is mandated by law that the criminal background check be conducted.  I understand that I have the right to be notified of and to appeal any findings revealed in the background check. 

2. I understand that if my fingerprints are taken they will be submitted to the following search engines or data bases:  State Police, National Sex Offender Registry as well as state registry, Department of Corrections Inmate Search Engine, Department of Corrections Wanted Fugitive Search Engine, Health and Human Services Office of Inspector General.

3. In addition a Department of Children and Family Services Form 718 will be submitted for a Central Register/Child Abuse and Neglect Tracking System (CANTS) search. 

4. Results of the above searches will be reported directly to the Department of Human Services for inclusion in the web based portal as a FEE_APP result.

5. I understand I must disclose in the space provided any criminal background, including any conviction of or plea of guilty to a misdemeanor or felony charge.

6. I understand I must disclose in the space provided any suspended imposition of sentence, any suspended execution of sentence or any period of probation or parole.

7. I understand I must disclose in the space below if I am on the employee disqualification list maintained by the Department of Social Services in the State of Missouri or on the Department of Children and Family Services list for Indiana or Illinois.

Please tell us where you are willling to travel to.  you can tell us via location, city, nursing home, miles you are willing to travel, etc..

I grant to Unity Hospice, its representatives and employees, the right to photograph, video and use the story and/or history of :

Which can be used in diverse educational settings, on the Unity Hospice website and social and print media outlets, as well as for internal use.

I have read and understand the above:

This is to certify that:

  

I agree to bring the Skin Test Result Card after 72 hours of the test with the reaction to it marked.
 

I agree to contact Unity’s Clinical Director within 48 hours if there is a reaction to the TB Skin Test.
 

NOTE:  You are not required to have the Hep B vaccination

but we are required to offer it to all staff and volunteers

BLOODBORNE PATHOGENS

      

I have been informed of the symptoms and modes of transmission of blood-borne pathogens including hepatitis B virus (HBV).  I know about the facility’s infection control program and understand the procedure to follow if an exposure incident occurs.

 

I understand that the hepatitis B vaccine is available, at no cost, to employees whose jobs involve the risk of directly contracting blood or other potentially infectious material. I understand that vaccinations shall be given according to recommendations for standard medical practice in the community.

 

Please choose one of the two listed below (Decline OR Consent)

 FOR HEPATITIS B VACCINE DECLINATION

I understand that due to my occupational exposure to blood or other potentially infectious materials I may be at risk of acquiring hepatitis B virus 9HBV0 infection.  I have been given the opportunity to be vaccinated with hepatitis B vaccine, at no charge to myself.  However, I decline hepatitis B vaccination at this time.  I understand that by declining this vaccine, I continue to be at risk of acquiring hepatitis B, a serious disease.  If in the future I continue to have occupational exposure to blood or other potentially infectious materials and I want to be vaccinated with hepatitis B vaccine, I can receive the vaccination series at no charge to me.

OR

HEPATITIS B VACCINE CONSENT

                                     

            I consent to administration of the hepatitis B vaccine.  I have been informed of the method of administration, the risk, complications, and expected benefits of the vaccine. 

 

Family history: Check the conditions that apply to any member of your immediate relatives:

Check any that apply to you (disease of):

Other serious illnesses which might affect your ability to perform the essential functions of the position offered. Please explain. If this does not apply to you please write N/A.

State details of prior injuries or operations which might affect your ability to perform the essential functions of the position offered. If this does not apply to you please write N/A.

What, if any, accommodations do you feel would be needed in order for you to perform the essential functions of this position? If this does not apply to you please write N/A.

I, the undersigned, certify the above answers are true:

I have been given a copy of Unity Hospice Zero Tolerance Drug and Alcohol Policy along with the accompanying Unity Hospice Drug and Alcohol Testing Process.  I have been given training on the meaning of the policy and the understanding of the consequences associated with positive test results being returned to Unity Hospice after testing.  I have had an opportunity to have my questions answered to my satisfaction.

 

·   I know that a copy of the Zero Tolerance Drug and Alcohol Policy is posted in each Unity Hospice office and I am able to ask any additional questions as they arise.

 

·    I give my consent to be tested for drugs or alcohol at any time I am asked to submit to the test.

 

·    I understand that signing this consent and then refusing to submit to testing will result in my immediate dismissal.

 

·    I also understand that refusal to sign this consent will result in my immediate dismissal.

 

 Copy link for drug test policy:  https://form.jotform.com/231775296470060

I intend to be fully vaccinated against Covid-19 by CDC Standards.

I have read the "Covid-19 Vaccine Information Statement" .  I have had an opportunity to ask questions, which were answered to my satisfaction.  I understand that Covid-19 vaccinations are under emergency use authorization and are still being studied for effects.  I understand the currently known benefits and risks of the Covid-19 vaccination.

Please upload copy of COVID-19 Vaccine Card

I decline the Covid-19 vaccine.  By doing so, I acknowledge that I am aware of the following facts:

 

*  COVID-19 is thought to spread mainly through close contact from person to person, including between people who are physically near each other  (within about 6 feet).         

*  People who are infected but do not show symptoms can also spread the   virus to others.

* There is evidence that under certain conditions, people with COVID-19 seem to have infected others who were more than 6 feet away. These transmissions occurred within enclosed spaces that had inadequate ventilation.

*  I acknowledge that COVID-19 vaccination is recommended by the Centers for Disease Controland Prevention (CDC) for all health care employees to prevent infection from and transmission of COVID-19 and its complications, including death, to patients/residents/clients, my coworkers, my family and my community.

Knowing the facts set forth above, I choose to decline vaccination at this time. I may change my mind and accept vaccination later if vaccine is available. I have read and fully understand the information on this declination form.

I decline the offer of vaccination for the following reason (please initial all that apply):