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NEW VOLUNTEER ORIENTATION — Transcript

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0:01Thank you for your interest in becoming
0:03a Four Seasons volunteer. We are always
0:06looking for dedicated individuals to
0:08join our amazing team.
0:12Our new volunteer orientation will cover
0:14a variety of required topics. We will
0:17begin with an introduction to hospice,
0:19four seasons, and our volunteer program.
0:22We will discuss subjects such as HIPPA
0:25and compliance. And then we will wrap up
0:27by reviewing various volunteer
0:29opportunities and the onboarding process
0:31for volunteers. If at any point during
0:34the orientation you have questions,
0:36please write them down and contact us so
0:39that we may answer your questions or
0:40address any concerns.
0:44To get things started, we'd like to show
0:46you a brief video clip from a film
0:48called Pioneers of Hospice. This will
0:51introduce you to a woman named Sicily
0:53Saunders who is considered to be the
0:55founder of the modern-day hospice
0:57movement.
0:59>> A young Polish Jew who had an inoperable
1:02cancer
1:04for the two months that he was dying. I
1:06visited him about 25 times and we talked
1:09all around himself, his problems, his
1:13needs and that's how we came to be
1:17thinking of a place that would be so
1:19much more suitable for him to make sense
1:22of the end of his life. Dying at the age
1:25of 40, feeling it made no impact on the
1:27world whatsoever and that would be
1:30nothing would make any difference when
1:31he died. people were not finding it easy
1:35to talk about feelings and doctors in
1:37particular were communicating very badly
1:39with their patients and I think this
1:41gave rise to a lot of suffering and
1:44Saunders was one of the people who
1:45recognized that fact having worked very
1:48closely with patients who she got very
1:52close to um began to realize that we
1:56really needed to change the way we
1:58thought about how people died and indeed
2:02about what happened to the them and
2:04their families.
2:06>> I took care of the dying before there
2:08was a Sicily Saunders and before there
2:10were hospices and people died badly. We
2:13never gave enough pain medication.
2:15Never.
2:17>> Well, I just knew there would be somehow
2:20I would do something about pain and
2:23need, but I needed to find out if I was
2:26the right person to do it. So I called
2:29up one of the early homes for dying
2:32patients and said, "Can I come and be a
2:34volunteer nurse? I am an RN." And I went
2:38there almost straight away for an
2:40evening or two a week. And they were
2:42that short of staff that I found myself
2:44being a ward sister for the evening and
2:47giving out the drugs. There I saw the
2:50regular giving of oral morphine for the
2:53first time and realized that here was
2:56the answer to the control of constant
2:58pain. The constant control that I'd
3:01never seen in hospital because people
3:03were having pain first. They were
3:05earning their morphine by having pain.
3:08And after I had been there for 3 years,
3:11I took the surgeon I was working for to
3:14visit there and out into one of the
3:16homes, a patient I used to sit with
3:19while his wife went out. And it was he
3:21who said, "Go and read medicine. It's
3:24the doctors who desert the dying. And
3:26there's so much more to be learned about
3:28pain, and you'll only be frustrated if
3:31you don't do it properly, and they won't
3:33listen to you."
3:36So with my father's money, bless him,
3:39and his encouragement,
3:41I became a medical student at the age of
3:4333.
3:46She embodied a belief in something. And
3:49she gave it system. To me, that's always
3:51crucial.
3:53You know, it's like you should go out
3:55and be good. Go and do that. Go and be
3:57good. Well, that's a little tough. What
4:00do you mean? What do you want us to do?
4:01Well, sister Lisa Saunders told you what
4:03she wanted you to do. She set up an
4:06institution and did it and it took her
4:09years to develop the idea to move it
4:11from nursing to medicine. She had to
4:13move herself from nursing to medicine.
4:15Right? So you see in that this evolution
4:18and then of course she's a very forceful
4:20person. I couldn't have done it as a
4:22nurse. I had to do it as a physician. I
4:25had to do the research. I started with
4:28research. I would like to end with
4:30encouraging research because we need to
4:32go on learning in your mind and in your
4:35heart. You've not got to forget the
4:37mind.
4:39I mean I wrote the first medical paper
4:41on suffering as unbelievable as that may
4:45sound as suffering in 1982. What there
4:48was no suffering before then? I mean you
4:50have to say well what happened to the
4:53world that suffering could be written in
4:551982. It wasn't written in 1962. These
4:58things I'm now talking about. So now in
5:00Sicily talks, people listen.
5:04I think a lot of the lessons that we've
5:06learned for caring pe with people who
5:07are dying is that we have to become
5:11tuned into their priorities which are
5:14very often nothing to do with death. You
5:16know, I know many patients who don't
5:18have any problem about dying, but
5:20they're very worried about what's going
5:21to happen to my wife and kids or what um
5:24will happen in my firm when I'm not
5:26there to carry on working, things of
5:28that kind. So, we almost have to start
5:31from where they're at. It's saying to
5:33people, you matter because you are you
5:36and you are the only one in the world
5:39and we will do all we can
5:43not only to help you die peacefully but
5:45to live until you die.
5:49Sicily and hospice care was the epitome
5:52of nursing mainly because it dealt first
5:56with symptoms and it dealt with what the
6:01patient said about their situation
6:05and it included the family.
6:08Those all were uh nursing principles
6:13rather than medical principles.
6:16But it was started by listening to
6:19patients. I was making tape recordings
6:21of people talking about their pain and
6:23its relief back in 1960.
6:27>> In 1963,
6:29uh Cesaly interviewed a woman with
6:32metastatic breast cancer.
6:35>> And I just asked her, tell me about your
6:37pain. And without any more prompting,
6:40she just said, well, doctor, it began in
6:42my back, but now it seems that all of me
6:44is wrong. She described other symptoms
6:47and then she said, "I could have cried
6:49for the pills and the injections, but I
6:51knew that I mustn't. Nobody seemed to
6:54understand how I felt. It seemed as if
6:56all the world was against me. My husband
6:59and son were marvelous, but they were
7:00going to have to stay off work and lose
7:02their money."
7:06Uh, Cesaly
7:09was first of all attentive enough and
7:12not then secondly shrewd enough and
7:16discerning enough that she heard not
7:19only troubling physical pain but
7:24emotional pain and social pain and
7:28spiritual pain
7:30and it included financial pain.
7:34She gave me the idea of a total pain
7:37which I started writing about in 1964.
7:40>> The person who uh in the late 50s a half
7:45a century ago uh worked out to a
7:48staggering degree what needed to be done
7:51was ces. And uh and there are now
7:56what is it 8,000 programs in over a 100
7:59countries around the world that have
8:02grown from the experience of St.
8:05Christopher's Hospice London period and
8:09the work of Ces.
8:12>> When viewing the clip, what words did
8:14you hear the speaker used to describe
8:16Sicily? They called her discerning,
8:19shrewd, forceful, attentive. They
8:22described her as a systems thinker.
8:25Sicily told you what she wanted you to
8:27do. She put it to a system. Sisley was a
8:30volunteer. She was a registered nurse
8:32and she became a doctor. But she offered
8:35her services first as a volunteer at St.
8:37Christopher's Hospice. When we hear
8:40those adjectives, we also think of our
8:41own Four Seasons matriarch Gene
8:43Hookstra. Almost 50 years ago, Gan and a
8:47group of volunteers gathered in her
8:48basement over grilled cheese sandwiches
8:50and tomato soup and decided that death
8:52and dying needed to be done better in
8:54their community. Now we are serving over
8:57a thousand hospice patients and
8:59paliative care patients every day
9:00throughout a 14ount service region. Gan
9:04was a pretty incredible lady and she has
9:06left a pretty incredible legacy and now
9:08you all get to be part of that legacy as
9:10well.
9:13Four Seasons is an independent nonprofit
9:16local health care provider in western
9:18North Carolina. We serve anyone living
9:21in our community with a serious
9:23life-changing illness, helping them to
9:25navigate their health care needs
9:27wherever they call home. We offer our
9:30services regardless of one's ability to
9:32pay. Let's break down what these terms
9:35mean. We are independent and we are not
9:38part of a larger health care system. We
9:40are a nonprofit, which means patients
9:43are our bottom line. And we are local,
9:45starting in Henderson County almost 50
9:48years ago as a hospice provider. We've
9:50grown throughout Western North Carolina.
9:53Our service lines have also grown to
9:55offer much more than hospice care.
10:00Our service region is divided up into
10:02three different service teams based on
10:04location in western North Carolina. Our
10:07south region covers Henderson, Pulk,
10:10Rutherford, and Transennsylvania
10:12counties. Our north region covers
10:15Bunkham, Haywood, Madison, and McDow
10:17counties. Our west region covers
10:20Cherokee, Clay, Graham, Jackson, Mon,
10:24and Swain counties.
10:28Let's talk about the services we
10:30provide. Four Seasons offers assistance
10:33with advanced care planning such as
10:35advanced directives and five wishes. We
10:38offer care navigation which provides
10:41trusted guidance during difficult times
10:43following the diagnosis of a serious
10:45illness. It can fill the gap by helping
10:48people navigate care options and choices
10:50by partnering with clients and families
10:52in their healthcare journey. We also
10:55offer home care services in some of our
10:57service area which began in 2016.
11:02We offer paliative care for those with
11:04chronic illness. We offer hospice care
11:07for those with terminal illnesses. Four
11:09seasons also offers pediatric paliative
11:12and hospice care through our Riverong
11:14program. Elizabeth House is our
11:17inpatient unit in Flat Rock. It was
11:19built in 1999 and expanded into a 19 bed
11:23facility in 2007.
11:26Elizabeth House is used to provide
11:28specialized care for hospice patients
11:29when needed.
11:32We have a research and development
11:34department that works on securing grants
11:36and participates in clinical trials.
11:38Some of these trials are pharmaceutical
11:40and some are not. These trials are open
11:43to the community and patients also have
11:45the option to participate or not. We
11:48provide grief services to those we serve
11:50and to the community at large. Per
11:53Medicare, we are required to follow the
11:55family and loved ones of hospice
11:57patients for 13 months after the death
12:00of that patient. Our grief services team
12:03is made up of music therapists, social
12:05workers, counselors, and chaplain. We
12:08also have a wonderful children and teens
12:11program called Compass.
12:16Have you ever worked for a company or
12:18organization that had a mission
12:19statement? Most do, but do you remember
12:22what it was? Often mission statements
12:25are long, wordy, and difficult to
12:27remember. Four Seasons original mission
12:30statement fell into that same vein. It
12:32was about a paragraph long. No one could
12:35remember it. And as a result, it lacked
12:37meaning for our staff and volunteers. A
12:40committee of staff and volunteers came
12:41together to develop what is our current
12:44mission statement. Co-creating the care
12:46experience.
12:48It is short, sweet, simple, and easy to
12:51remember.
12:53What we really love about this mission
12:55statement is that we can all speak to
12:57how we help co-create the care
12:59experience for our patients and
13:00families, regardless of our role at Four
13:03Seasons. Whether you're a clinician out
13:05in the field or an administrative staff
13:07person on our billing team or a
13:10volunteer at our home store, we can all
13:12find meaning in those simple words. Our
13:15vision at Four Seasons is innovate
13:17healthcare, influence humanity, impact
13:20life. That seems really big, right? At
13:23Four Seasons, we are innovators. We are
13:26aware of the great capacity we have to
13:28influence and we are passionate about
13:31the impact we can have every day on both
13:34a micro and macro level.
13:40Values are a big part of our culture at
13:42Four Seasons. We use them to appreciate
13:45one another and hold one another
13:47accountable. We use an acronym to help
13:49us remember each value. The acronym is
13:52Sebrider.
13:54C is for compassion. We care for all. B
13:58is for balance. We are intentional and
14:01present. R is for respect. We honor
14:05every person. I is for integrity. We are
14:09trustworthy.
14:11G is for gratitude. We are always
14:14appreciative.
14:17H is for humility. We are one of many
14:20who positively impact lives. T is for
14:23teamwork. We believe that together
14:26everyone achieves more. E is for
14:29excellence. We dream more than others
14:31think is practical and expect more than
14:33others think is possible. And R is for
14:36resilience. We thrive through challenge
14:39and change. We truly try to live our
14:42values every day in our work at Four
14:44Seasons.
14:48Let's take a look at our volunteer
14:49program at Four Seasons. The volunteer
14:52solutions department is headed by our
14:54team leader, the director of employee
14:56and volunteer solutions.
14:58There are volunteer coordinators
15:00specific to each region as well as to
15:02Elizabeth house volunteers and home
15:04store volunteers. We also have a
15:06volunteer coordinator who oversees many
15:08administrative aspects of our
15:10department. We all work together as a
15:12team with our volunteers to serve the
15:14patients, families, communities, and
15:16staff that we encounter each day.
15:21There are several measurements that we
15:23track as a program. Medicare assigned
15:26the 5% numerical standard for volunteer
15:28efforts in 1983.
15:31That means as a Medicare certified
15:33hospice, Medicare requires that a
15:35hospice must document and maintain a
15:37volunteer staff sufficient to provide
15:39administrative or direct patient care in
15:42the amount that at a minimum equals 5%
15:46of the total clinical staff hours. Not
15:49all volunteer hours count toward our 5%.
15:53How do we determine what does and
15:54doesn't count? There are two questions
15:57that we ask ourselves. Is this activity
16:00providing direct patient care or
16:01administrative support for direct
16:03patient care? The second is would we or
16:07are we paying a staff member to perform
16:09this activity?
16:12Things that do count toward the 5% are
16:14tech-in calls and bereavement phone
16:16calls, assembling mailings and
16:18administration packets, data entry,
16:21socialization and respit visits for
16:23patients, and 11th hour visits for
16:25patients. Things that do not count
16:28towards our 5% but are still very
16:30important to our mission and do count
16:32towards our overall cost savings include
16:35baking, sewing, gardening at Elizabeth
16:38House, serving at the home stores,
16:41facility activities, and continuing
16:43education.
16:45As you can see, we continue to meet the
16:47Medicare condition of participation, but
16:50as census grows, staff hours increase
16:52and our need for volunteers increases as
16:55well. So, thank you so much for being
16:57willing to help meet that need. We also
17:00track the percent of hospice patients
17:02directly served by a volunteer, our
17:05number of active volunteers each year,
17:07and the hours that these volunteers
17:09serve. This translates into our total
17:12cost savings for the agency each year.
17:15We were delighted in 2024 to hit a
17:18milestone cost savings of over $1
17:20million.
17:21As our census and organization continue
17:24to grow, so does our need for volunteer.
17:29Four seasons provides many service lines
17:32to our community. Two of the largest are
17:34paliative care and hospice. Paliative
17:38care is a consult service that focuses
17:40on symptom management. Palative care is
17:43for patients who have a serious or
17:45chronic illness such as early stages of
17:48COPD, ALS, cancer or renal failure. This
17:53service can be provided along with
17:55curative treatment. The goal is to help
17:58patients live comfortably and have the
18:00best quality of life that they can.
18:02Palative care provides a limited scope
18:05of services. The team can include a
18:07physician, nurse practitioner, RN and
18:11social worker. Patients are seen in all
18:14settings including clinics, homes,
18:17facilities, and hospitals. While there
18:20is no guarantee of when any patient is
18:22going to die, palative care is often
18:24provided in the last 1 to three years of
18:26a person's life.
18:31Hospice care is end of life care for
18:33someone with a terminal diagnosis.
18:36Hospice is appropriate when a cure for a
18:38disease is no longer likely and all
18:41curative treatments are diminishing the
18:43patients quality of life. In order for
18:46an individual to qualify for hospice,
18:48two physicians are required to certify
18:50that a patient has 6 months or less to
18:53live given the typical progression of
18:55their disease. The goal is to provide
18:58end of life comfort care and manage
19:00symptoms and pain. Some discomfort may
19:03not be physical pain. It may be
19:05spiritual, it may be sadness, it may be
19:08anxiety. For that reason, hospice
19:10provides a larger scope of services
19:12including a physician, RN, social
19:16worker, chaplain, home health aid, music
19:19therapist, and volunteers.
19:24So to recap, hospice differs from other
19:27types of health care in several ways. At
19:30four seasons, hospice offers comfort
19:32care rather than curative care. It
19:35treats the person, not the disease. The
19:38emphasis is on quality rather than
19:40length of life. We consider the family,
19:43not just the patient, as the unit of
19:45care. We offer help and support on a
19:4824-hour, 7-day a week basis. We provide
19:51care regardless of ability to pay. We
19:54provide bereavement care and hospice
19:57care involves volunteers.
20:01The interdisciplinary team or IDT is a
20:04group of hospice professionals including
20:07volunteers who work together to meet the
20:09physical, social, spiritual, and
20:12economic needs of hospice patients and
20:14their families. It is a holistic
20:17approach to care.
20:19IDT meetings take place weekly in each
20:21region and these meetings are utilized
20:24to discuss patient admissions,
20:26discharges, deaths, and ongoing care and
20:29needs. Each team is required by Medicare
20:32to discuss a patient at least every 15
20:35days. Let's take a look at who makes up
20:38the IDT team.
20:42The interdisciplinary team is made up of
20:44physicians, nurses, social workers,
20:47chaplain, grief counselors, music
20:50therapist, home health aids, and
20:53volunteers. Each patient is required to
20:56have an assigned physician, nurse, and
20:59social worker. All other disciplines are
21:01optional for the patient and family and
21:04patients can opt out of ongoing social
21:06work visits.
21:10Let's talk finances for a moment. How is
21:13hospice paid for? What began as a
21:16grassroots movement to improve end of
21:18life care has in much of the country
21:20become a business. But for four seasons,
21:23co-creating the care experience remains
21:25our mission. In 1990, only 5% of
21:29hospices were for-profit operations.
21:32Today, that number has increased to
21:34almost 75%.
21:36While nonprofit and for-profit hospices
21:38are regulated by the same Medicare and
21:41Medicaid standards, there are some
21:43differences. For-profit hospices are
21:46prohibited from using charitable
21:47donations from the community for direct
21:50patient care. While nonprofit hospices
21:52may hold fundraisers, solicit donations
21:55from the community, and utilize those
21:58funds for patient care and other
21:59purposes. At Four Seasons, those
22:02donations go into our angel fund to
22:05provide care for patients in our
22:06community without a pay source. We do
22:09not turn away patients due to their
22:12inability to pay, and all patients are
22:14served with the same level of care.
22:18Nationally, the majority, about 85% of
22:22hospice patients, use Medicare as their
22:25primary insurance, which includes a
22:27hospice benefit. Medicare pays a perdm
22:31rate based on the average cost of care
22:33per patient day. The benefit includes
22:36two 90-day periods followed by unlimited
22:4060-day periods. All patients must be
22:43reertified at the beginning of each
22:45benefit period by a doctor to asssure
22:48that they still qualify for the hospice
22:50benefit. What does this benefit include?
22:54It includes doctor services, nursing
22:56care, medical equipment like wheelchairs
22:58or walkers, medical supplies like
23:01bandages and catheters, prescription
23:04medications related to the hospice
23:06diagnosis, hospice aid services,
23:10physical and occupational therapy when
23:12warranted, speech therapy and pathology
23:15services when warranted, social work
23:18services, dietary counseling, grief and
23:21loss counseling for patient and in the
23:23family, short-term inpatient care for
23:26pain and symptom management, and
23:28short-term respit care.
23:31In North Carolina, Medicaid works
23:33similarly to Medicare.
23:36Most private insurance policies also
23:38have a hospice benefit included, but
23:41actual coverage depends by policy.
23:45Other income sources include clinical
23:47research residuals, which is money made
23:50from research trials that goes back into
23:51patient care. grants and community
23:54support including special events and
23:56fundraisers, memorials, contributions,
24:00bequests, and income from our hospice
24:02home stores. We also receive endowments
24:06which are donations of money or property
24:08to a nonprofit for the ongoing support
24:11of that nonprofit organization.
24:14Unlike hospice, palative care, home
24:16care, and care navigation do not have a
24:20Medicare benefit, but some are covered
24:22by private insurance.
24:26These grants and community support are
24:29handled by the Four Seasons Foundation.
24:32The Four Seasons Foundation is a 501c3
24:36nonprofit organization and an essential
24:38partner of Four Seasons Care supporting
24:41our mission to co-create the care
24:43experience. The foundation heads all
24:46donations and giving opportunities, the
24:49three home stores, and annual
24:51fundraisers such as Resell Runway and
24:53Tree of Lights. Additional information
24:56on the foundation may be found at four
24:58seasons fdn.org.
25:01O RG
25:05the Medicare conditions of participation
25:08grant hospice patients certain rights.
25:11These include the right to receive
25:14effective pain management and symptom
25:16control from the hospice for conditions
25:19related to the terminal illness. To be
25:22involved in developing his or her
25:24hospice plan of care to refuse care or
25:28treatment.
25:30to choose his or her attending
25:32physician.
25:33To have a confidential clinical record,
25:37to be free from mistreatment, neglect,
25:39or verbal, mental, sexual, and physical
25:43abuse, including injuries of unknown
25:45source, and misappropriation of patient
25:48property.
25:50To receive information about the
25:52services covered under the hospice
25:54benefit.
25:56to receive information about the scope
25:58of services that the hospice will
26:00provide and specific limitations on
26:03these services.
26:06HIPPA is a very important part of our
26:08required volunteer training. In the
26:10docuign email that you receive following
26:13the completion of your training, you
26:15will see a HIPPA quiz that must be
26:17completed and returned.
26:20HIPPA stands for Health Insurance
26:22Portability and Accountability Act. This
26:26act was passed by Congress in 1996 to
26:30protect the health information of
26:31patients. The law applies to all health
26:34care providers, physicians offices,
26:37clinics, hospitals, nursing homes,
26:39pharmacies, hospices, and health
26:42insurance plans.
26:46Let's review some terms that will be
26:48useful to know and understand when
26:50discussing HIPPA.
26:52Health information. This is any
26:55information, oral or written, that is
26:58created by a health care professional
27:00related to the past, present, or future
27:03physical or mental health or condition
27:06of an individual.
27:08Information use is when information is
27:10shared within an organization.
27:13Information disclosure is when
27:16information is released outside of an
27:18organization.
27:19And protected health information or PHI
27:23is any information about health status
27:26that can be linked to a specific
27:28individual.
27:32Some examples of PHI include
27:35name, social security number, address,
27:39telephone number, medical record number,
27:43names of relatives, date of service or
27:46date of birth,
27:48bank or payment information, anything
27:50that can be connected to that individual
27:53and anything that can identify an
27:55individual.
28:00PHI can be located anywhere and
28:02sometimes in places you would not expect
28:04such as an email or stored in a printer.
28:08Please be mindful of your interactions
28:10with others in regards to PHI.
28:14Here is an example of a disclosure issue
28:16that you might encounter as a volunteer.
28:19A friend of a patient comes by the
28:21office or Elizabeth house and tells the
28:23front desk that she lives just around
28:25the corner and can help with anything
28:27that the patient needs. If we thank her
28:29and tell her that we will let the
28:31patient know, then we just disclose that
28:33the patient is indeed on service with us
28:35and this is a breach of information.
28:38What we should say is that we are unable
28:40to confirm whether that patient is on
28:42service with us. It is up to our
28:44patients and clients to determine when
28:46they would like to disclose their
28:48condition to friends
28:54to take care of PHI and remain
28:56compliant. Paperwork with any patient
28:59information on it should be shredded or
29:01returned to one of our offices to be
29:03shredded. All administrative volunteers
29:06who work with PHI have individual
29:08computer accounts with personal login
29:11and passwords that can be deactivated at
29:14any time. Never share your passwords.
29:18All visitors to our offices must be
29:20escorted while in the building and avoid
29:22areas with PHI. If you lose any
29:25documents containing patient information
29:28or accidentally disclose information,
29:31please report it immediately to your
29:33volunteer coordinator. Mistakes happened
29:35and our compliance officer can walk us
29:38through any necessary steps to rectify
29:40the situation.
29:45HIPPA law contains three rules that we
29:47will discuss. The privacy rule was
29:49designed to protect the privacy and
29:51confidentiality of an individual's
29:54protected health information or PHI.
29:57The word protected means that only those
30:00individuals who need to have access to
30:02the information may have access to it.
30:04This is called the minimum necessary
30:07standard. You only need the information
30:10necessary for you to perform your job. A
30:13nurse needs to know medications a
30:14patient is taking, but a member of our
30:16foundation staff does not. As a
30:19volunteer working with patients, there
30:21is certain information that you will
30:23need to know to better assist your
30:25patient and family. This does include
30:28name, address, phone number, and
30:31diagnosis of your patient. But this does
30:34not include medication lists, social
30:36security numbers, or medical account
30:38information.
30:41Some interesting facts about protected
30:43health information. PHI should never be
30:46disclosed by a volunteer, but it can be
30:48released by an agency in certain
30:50circumstances without patient
30:53permission. These instances include when
30:56required by law, such as reporting
30:59communicable diseases with a court
31:01order, or to a coroner, medical
31:04examiner, and funeral director.
31:08HIPPA law protects PHI for 50 years
31:11following a patient's death. If you see
31:14a violation of PHI, an occurrence report
31:17should be filled out and a supervisor
31:19should be notified. This applies to all
31:21volunteers and employees.
31:26The security rule safeguards all
31:29electronic PHI on computers, emails, and
31:32faxes. It requires that the building be
31:35secured, doors are locked, a badge is
31:39required for entry, and guests are
31:41escorted in the building and must avoid
31:44areas with PHI.
31:46All personnel and volunteers must be
31:48trained in HIPPA compliance. All
31:51computers must be secured with unique
31:53login, strong passwords, and a firewall
31:56and virus protection, and a security
31:59officer must be assigned within the
32:01organization.
32:06The third rule is the final rule, which
32:09establishes penalties for violation of
32:11the HIPPA privacy and security rules for
32:14volunteers. This can include fines up to
32:17$25,000,
32:19civil or criminal charges, and loss of
32:22volunteer status. These penalties are
32:25enforced when PHI is breached with
32:28willful and malicious intent. If and
32:32when HIPPA questions arise, you may
32:34direct questions to your volunteer
32:35coordinator.
32:39Let's look at some real life examples of
32:42HIPPA violations and penalties.
32:45The first is when a Walgreens pharmacist
32:47accessed the medical records of a female
32:50customer who had a child with her
32:51husband. She admitted to sharing this
32:54information with her husband and at
32:55least three other people.
32:58Walgreens gave her written warning
32:59instead of firing her. Courts held
33:02Walgreens accountable for the breach and
33:04fined Walgreens $1.44 million.
33:08Walgreens then immediately fired the
33:11pharmacist.
33:14The second example is with Affinity
33:16Health Plan. They sold some copers when
33:19they were renovating their offices. One
33:21of the copiers was bought by a branch of
33:24CBS News and they found PHI on the
33:26copier's hard drive. It contained
33:29information for over 344,000
33:32clients. Affinity was fined $1.2
33:36million.
33:40This responsibility can seem daunting,
33:43but just remember, be safe. Do not talk
33:46specifics about patients with your
33:48family and friends.
33:50Take care of any written information
33:53with PHI on it. Once you no longer need
33:56the information, do not simply throw it
33:58away or recycle it. Shred it, burn it,
34:01or bring it back to the office to be
34:03shredded. Do not talk about patients in
34:06public areas, even with other staff. Do
34:10not share your computer password. Do not
34:13leave your computer unattended. And
34:15never take photos of patients with your
34:17phone or other personal device. When it
34:20comes to social media, we love for
34:22volunteers to share how much they enjoy
34:24volunteering with Four Seasons, but
34:26never post photos with patients or
34:28disclose any patient information.
34:33Compliance is a process used to
34:35identify, correct, and prevent illegal
34:38and inappropriate conduct. It promotes
34:41honest, ethical behavior in the
34:43day-to-day operations of hospice.
34:46There are five major areas of risk for
34:48compliance that we deal with. The first
34:51is admissions, discharges, and
34:53revocations.
34:54Patients must meet requirements to
34:56qualify for hospice and maintain those
34:59qualifying measures. When a patient no
35:01longer meets these qualifications, they
35:04may be discharged from hospice service.
35:06And if a patient no longer wishes to
35:08remain on service, they may revoke
35:11services.
35:13With health care providers, we cannot
35:14solicit offices for patients. Our
35:18billing for services and supplies must
35:20be honest and we must offer all covered
35:22services to all patients despite the
35:25fact that some may incur higher costs to
35:27the organization.
35:29If a patients plan of care is for a
35:31nurse to visit twice a week, then a
35:34nurse must be seeing that patient twice
35:35a week. Our marketing practices must
35:38also hold to strict standards and remain
35:41in compliance. In North Carolina,
35:44hospices operate based on a certificate
35:46of need issued by county and hospices
35:49are only allowed to serve patients in
35:51that county and bordering counties.
35:56There is a reporting process for any
35:58compliance violations that you see at
36:00Four Seasons or within places that you
36:02visit patients. You can reach out to
36:05your volunteer coordinator, contact our
36:07team leader, or report anonymously
36:10through our third-party compliance
36:12hotline. The hotline information is
36:14shown here. This can be done by phone,
36:18email, or written correspondence.
36:21Please do not address compliance issues
36:24in facilities yourself by confronting
36:26facility staff.
36:31Documentation is an important topic for
36:33us as this is how we capture volunteer
36:35hours served. Those of you working
36:37directly with patients will have
36:39additional training and documentation
36:41for patient visits. This documentation
36:44training is for any agency support,
36:47continuing education, and other tasks
36:49that are not related to direct patient
36:52support. This is an example of a time
36:54and mileage log that should be submitted
36:57each month at the end of the month to
36:59your volunteer coordinator. To complete
37:01the form, you would include your name,
37:04the month, and year. Then simply write a
37:07brief description of the task you
37:09performed, your time, and your mileage.
37:12We do not reimburse for mileage, but we
37:15can track your mileage for tax purposes
37:18and upon request supply you with a tax
37:20letter at the end of each calendar year.
37:23These time and mileage logs may be
37:25submitted in person or via email or you
37:28may take a picture and text it to your
37:30volunteer coordinator. Please remember
37:32to never include any PHI on this time
37:35sheet. For example, if you attended a
37:38veteran pinning, please do not include
37:40the patients name, just that you
37:42attended the pinning.
37:46Four Seasons believes that we never stop
37:48learning. We offer ongoing learning
37:50through monthly newsletters in services,
37:54continuing education, and support
37:56meetings. These are offered in person
37:58and virtually and in various regions in
38:01our service area so that everyone has an
38:03opportunity to participate. We also host
38:06annual appreciation events for our
38:08volunteers with regional events in April
38:11and our annual awards event in the fall
38:14where volunteers are recognized for
38:16exhibiting our sebrighter values
38:18discussed earlier.
38:20We require annual education updates for
38:23all staff and volunteers for patient
38:26family support volunteers. We also
38:28conduct competency reviews at the end of
38:30one year and then every 3 years after
38:33that as required by joint commission. We
38:36want to keep you informed of what is
38:38going on within our organization and the
38:40volunteer department. We want you to
38:42stay involved and engaged. We encourage
38:45you to participate in as many of these
38:47educational and social events as
38:49possible. We do ask that volunteers RSVP
38:52for these events so that we can
38:54adequately prepare for space and also
38:56contact you in the case an event or
38:59meeting has to be cancelled or
39:00rescheduled.
39:04Now that we have the required training
39:06behind us, let's take a look at what
39:08volunteer opportunities we offer at Four
39:10Seasons. We have three main categories
39:13of volunteers. Agency support, patient
39:17and family support, and community.
39:21Our community volunteers provide
39:23services such as baking for special
39:25events and support groups, providing
39:28goodies for the hospitality card at
39:30Elizabeth House, and helping maintain
39:32our gardens at Elizabeth House. Our
39:35board members are community volunteers
39:37that are appointed by leadership for our
39:39organization board and foundation board.
39:42We also have community volunteers that
39:44sell comfort items, memory items for the
39:47families of patients, and other items
39:50such as blankets or quilts. Our memory
39:53items program has grown in recent years
39:55and offers a bear or pillow made from
39:58favorite clothing of a patient. We offer
40:00this to all families after the death of
40:02a patient and always get the most
40:04heartwarming thank yous from grieving
40:06families. It is truly a special gift.
40:12Agency support volunteers do just that.
40:14They support the agency through
40:16administrative support such as mailing,
40:19filing, and data entry. We have
40:21volunteers that participate in weekly
40:24scripted tuckin calls and condolence
40:26calls to patients and caregivers.
40:29We have volunteers that help out with
40:31basic maintenance around the offices and
40:33checkpoints. Our home store volunteers
40:35assist in all aspects of our home store
40:38operations. We also have volunteers that
40:40assist with special events throughout
40:42the year such as our tree of lights and
40:45resell runway fundraiser. Ambassador
40:48volunteers represent four seasons in the
40:50community at tableabling events and
40:52community health fairs.
40:55Ambassador
40:58volunteers can also assist the
40:59organization in other ways such as
41:02writing letters to the editor of local
41:04newspapers and assisting with faith
41:06community outreach.
41:08Ambassador volunteers are deeply versed
41:11in all four seasons service lines and
41:13are a great asset in the community. If
41:16you are interested in becoming an
41:18ambassador volunteer, we have additional
41:20training available.
41:23Our
41:25home store volunteers serve in one of
41:27our three home store locations and our
41:29warehouse assisting with sorting,
41:32cleaning, pricing, repair, display, and
41:35checkout. All Four Seasons volunteers
41:38receive a discount at our home stores
41:40when they present their Four Seasons
41:42volunteer ID upon checkout.
41:47We also have agency support volunteers
41:49that assist with facility activities at
41:51nursing homes such as bingo and music
41:54and volunteers that visit home care and
41:56paliative care patients. The we honor
41:59veterans program is a national program
42:01with MOA the military officers
42:04association of America that matches
42:06patients who are veterans with
42:08volunteers who are veterans. We also
42:10have volunteers attend pinning
42:12ceremonies for our veteran patients.
42:18Patient family support volunteers
42:20provide direct support to our patients
42:22and caregivers in the home facilities or
42:24wherever the patient calls home.
42:27Volunteers provide respit visits
42:29typically lasting 2 to three hours.
42:32During these visits, volunteers sit with
42:34a patient so that the caregiver can
42:36attend a meeting, run errands, or go to
42:39a personal appointment. Volunteers also
42:42offer social visits to patients where
42:44they can read to them, play a game with
42:46them, or just socialize. We offer
42:49errands and transportation to ambulatory
42:51patients who need a ride to an
42:53appointment or groceries picked up. This
42:55does require a specific level of auto
42:58insurance coverage for the volunteer. We
43:01have a number of complimentary
43:02alternative medicine or CAM therapies
43:05offered by volunteers including
43:07haircuts, pet therapy and facilities,
43:11massage therapy, reike and more. 11th
43:15hour volunteers are additionally trained
43:17volunteers that sit at the bedside of
43:19actively dying patients in facilities
43:22when the family or patient has expressed
43:24a desire for the patient to not die
43:26alone. We also have volunteers who are
43:29members of local threshold choir that
43:32sing for patients when requested.
43:35Four seasons volunteers also serve in
43:37numerous ways at our 19 bed inatient
43:40facility in Flat Rock called Elizabeth
43:42House. They provide support to our staff
43:45by assisting with daily activities and
43:48sitting with patients. Other volunteers
43:50serve as greeters, helping escort
43:52visitors to patient rooms. We have a
43:55hospitality team that provides
43:57refreshments to patients, visitors, and
43:59staff on special occasions, and camp
44:01therapy volunteers who provide
44:03additional support at Elizabeth House.
44:08Let's review the application process,
44:10which you have already begun. An
44:12application is required for all
44:14volunteers, which includes two
44:15references that we will reach out to.
44:18Agency support and patient family
44:20support volunteers complete new
44:22volunteer orientation which is what you
44:25are doing now. Patient family support
44:27volunteers will additionally complete
44:30PFS training and some volunteer
44:32positions such as 11th hour require
44:35additional training. We conduct a
44:38criminal background check on all
44:40volunteers and an interview where you
44:42will meet one-on-one with your direct
44:44volunteer coordinator to discuss
44:46specific volunteer opportunities,
44:49schedules, and complete any additional
44:52paperwork. You will need to provide a
44:54copy of your driver's license and the
44:56declarations page of your auto insurance
44:59policy. If you practice a camp therapy
45:02as part of your volunteering, you will
45:04need a copy of that professional license
45:06or certification to give to us.
45:10And for all of those serving directly
45:12with patients or in a facility,
45:14including Elizabeth House, you will need
45:16a current TB test.
45:21Just for clarification, here is what we
45:24are looking for on the auto insurance
45:26declarations page. In order for
45:28volunteers to be able to provide errands
45:30or transportation, a 100,000 300,000
45:35coverage is required. Regardless of your
45:38volunteer position, we are required to
45:40have a declarations page on file for all
45:42staff and volunteers.
45:46For the tuberculosis or TB requirement,
45:50again, this is only for those volunteers
45:52working directly with patients or in a
45:55facility, including Elizabeth House. If
45:58you have had a TB test in the last 12
46:00months and can provide a copy, that will
46:03fill the requirement. If you have not
46:05had a TB test in the last 12 months, you
46:08will need to have a one-time two-step TB
46:11test, which is essentially two tests
46:14within one month. We have vouchers for
46:16several local health departments. For
46:19anyone who cannot do a TB test due to a
46:22false positive reaction, a chest X-ray
46:25will be needed to keep on file.
46:29If you plan to volunteer in an agency
46:32support capacity, your training is now
46:34complete. Please notify your volunteer
46:37coordinator that you have completed
46:38orientation and are ready for your
46:40docuign forms which will include a HIPPO
46:43quiz, orientation test, background
46:46check, release, compliance statement,
46:48receipt of volunteer policies. This was
46:51an attachment to your email containing
46:53the link to this orientation, training
46:56verification, and some other forms
46:58depending on your chosen role. If you
47:00will be working directly with patients,
47:02please notify the volunteer coordinator
47:05that you have completed orientation and
47:07are ready for the patient family support
47:09training links. You will receive your
47:11docuign papers once you complete PFS
47:14training.
47:18Thank you for watching Four Seasons new
47:20volunteer orientation. We're excited to
47:23have you as part of our volunteer team.
47:26Please reach out with any questions as
47:28we are here to support you in your
47:30volunteer role and journey with Four
47:32Seasons.

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