HI Volunteers

Best Practice to Implement Volunteer Program
Hawaii, April 2002

Project Description:

Our most important achievement was implementing our Long Term Care Ombudsman Volunteer Program.  Hawaii has 48 nursing facilities (actually 46 for the LTCOP since Guam has it's own Ombudsman and we don't go into Hospice Care) with 4,102 beds, 542 licensed adult residential care homes with 2,882 beds, 137 licensed expanded ARCHs with 722 beds and 3 licensed assisted living facilities with 354 beds. That totals 8,060 residents to visit "on a timely and regular basis," per OAA, for Iris Matsunobu (LTCO Specialist) and myself.  And spread over 6 islands, it really wasn't possible to do this.

We received $90,000 from our State Legislature to get the program off the ground. We got this money because we had a strong SUD who used her considerable political connections to push for this and lots of community support from the Aging Network, which we had been developing for 3 years.  We also had a sympathetic media and several letters to the editor advocating for our program, including letters from the two state senators in charge of Ways and Means at the time.

The job descriptions went through many revisions. Interviewing many applicants until we found just the right persons was also very time consuming. We hired Roberta Kucera, BSW, to be our full-time Volunteer Coordinator, and Mika Arikawa to be our clerical support person.  Both began on June 1, 2001 and both have proven to be excellent.  After orienting them to the Executive Office on Aging and the LTCOP, they reviewed the training manuals of approximately 10 states to get an idea of what are big topic areas and then went to work in drafting our own training manual specific to our own population.  Policies and Procedures were developed, forms created, a screening process implemented, etc.  The manual is now approximately 200 pages and will go through at least one more revision before we will make it available to other Ombudsman Programs. Through the support of Alice Hedt and the NCCNHR staff, we were also able to participate in three teleconferences for other Volunteer Coordinators to share experiences and capitalize on the expertise of other programs.

To become "certified" a volunteer participates in 20 hours of classroom training.  We meet for 4 hours Monday through Friday from 9 to 1 pm. Competency tests are given throughout the sessions but they are open book and open discussion. This helps motivate people to pay attention without re-living the stress of our high school/college days. We role-play, use humor, show videos, PowerPoint - anything to avoid a straight lecture style.

After the 20 hours, volunteers are required to participate in 2, 4 hour internship/orientations with Iris or myself.  We meet the volunteer at their assigned facility and introduce them to all the key players, point out public bathrooms, etc., discuss facility procedures in the event of a fire drill or some emergency and then model the appropriate OBRA mandated behavior in knocking on a resident's room, getting permission to enter their home, introducing the LTCOP, providing our brochure, "talking story" with the residents so they can build a relationship of trust and then discovering if their are any concerns which we may be able to help resolve.  The following week we repeat this but let the volunteer take the lead and this time we shadow them, pointing out any mistakes that we want to correct as quickly as possible. Proper documentation is also discussed and the need to document after each visit and not wait until the end of their visit.

At the end of the 28 hours of intensive training, a volunteer becomes "certified."  There is some flexibility in that if someone needs or requests a third or more internship/orientation before they solo, we are happy to provide that.  It's important that they feel comfortable in their role as an advocate and since it's a new role for many people, we don't want anyone feeling rushed.  This internship is important in that some volunteers may do very well in a classroom but lack the people skills to work in a nursing facility. This gives us another opportunity to either re-train or cut loose. We want to make sure the volunteer and facility are a good fit.  Some volunteers can handle a large facility while others may be very intimidated by such a prospect.  Volunteers are assigned facilities based on where they live.  Since we have no money to re-reimburse them for their gas or bus pass, we want to make "getting there" as easy as possible.

Certified volunteers commit for a year and visit residents every week for 4 hours, including documentation time.  Right now we only have volunteers visiting facilities during our normal business hours so they can reach us in the event of a problem.  If our program receives money for a pager or cell phone, we will allow volunteers to enter on the weekends but not in the evenings since most residents are sleeping at that time and we don't want our volunteers being confused for state surveyors.  Our focus is not on finding problems but fixing problems.

The last week of every month, all volunteers come back to our office in place of their weekly visit for continuous training and education, review of their documentation if appropriate for a group setting, guest speakers and always for support. We are not letting our volunteers do any investigations at this time.  Because the program is so new and their is a certain amount of suspicion or anxiety among facility staff, we would prefer that Iris or myself do all investigations since the staff know and trust us to be fair and professional.  In the future, after a volunteer has successfully completed a year as our "eyes and ears" we will consider developing a two-tier volunteer program with the more seasoned volunteers doing investigations but not at this time.

Our volunteers are incredibly dedicated.  They come to class prepared and demonstrate that they have read the manual thoroughly.  We don't have much to give them in the way of thank you gifts but they know they are making a difference in the daily lives of our residents and that itself is very gratifying.  We hope to have a volunteer in every nursing home on Oahu by the end of this year.  We will eventually train on the Neighbor Islands and then enter the care homes and assisted living facilities.  Our long-term goal is a volunteer in all 728 long term care settings.  It's a big goal but we're off to a good start and feel confident we will succeed.

Project Impact:

We get very few complaints, compared to other states.  We've never been sure if that reflects a wonderful job is being done by the facilities (in Hawaiiit's possible), our population is reluctant to complain (not part of the culture here) or our programs' visibility is so poor people don't know who we are or who to complain to.  With a volunteer in every facility, we will know for sure if there are problems and then we can fix them.

Contact Person: John G. McDermott             State: Hawaii

Phone Number (808)586-0100             Fax (808)586-0185

Email: jgmcderm@mail.health.state.hi.us