Community-Visiting

Community visiting palliative care volunteers offer a valuable adjunct to the support given by community nursing and the palliative care team. They provide a number of important roles including assisting a person receiving palliative care, assisting and providing respite for the carer, and reducing social isolation after bereavement, and in children’s services to assist parents and siblings.

Solitude, isolation are painful things and beyond human endurance

Jules Verne

Supporting people to live, and even to die, at home requires a good level of autonomy and emotional skills on behalf of the volunteer.

A robust sense of boundaries is also important. It is possible that the community visiting volunteer spends more time with the family than do the palliative care team. There is the potential for inappropriate relationships to inadvertently develop. This can often place the volunteer ‘on the spot’ as family members grapple with changing roles, strong emotions, and the burden of caring for a loved one.

Being discrete and maintaining privacy are particularly important for community visiting volunteers who are given access to the most intimate settings of people’s lives and homes. This is challenging in small communities such as rural towns where privacy can be quickly lost. Where the population is small and highly concentrated then not everyone wants ‘Jack from up the road’ coming into their house and knowing all their personal details.

The challenge of managing community visiting volunteers typically includes: identifying and managing risk; keeping track of their whereabouts and planned visits to clients; keeping in contact with them as they may not be in proximity to visit the manager in their office; obtaining documented details of their activities (reports); and networking them, such as by having them attend the monthly meeting.

Being attentive to the safety of volunteers traveling and visiting in the community is important. Remember that many other disciplines regularly visit people in their homes including community nursing, child and maternal health, mental health, disability support, housing, aged care in the home and child protection are just some of the disciplines that regularly visit people in their own homes. In addition Meals-on-Wheels, home maintenance services, Patient Transport and many of the cultural-specific support groups also have volunteers attending people at home.

These services may provide useful points of reference for developing policies on community visiting, especially if your service is new, doesn’t yet have appropriate policies in this area or is in need of reviewing their existing policies.

Some relevant points to consider in managing community visiting volunteers are:

  1. Preparing for a home visit – Receiving referrals for home visits, site assessments and identifying safety issues, risk assessment, determining level of risk, managing risk;
  2. During a home visit – on arrival, during, after, critical situations, when to leave and when to not visit, what and how to dress and present;
  3. Supporting volunteers – briefing and debriefing, instructions about equipment and dress, possible boundary and performance issues, reporting and recording home visits and contact; and
  4. Appropriate training – in safe home visiting including how determining when it is safe to visit, how to make it safer and what to do if the visit gets tricky, practical safety tips and strategies for home visiting, working with difficult clients.

The task of managing and supporting community visiting volunteers is complicated by them operating away from a central base. This sense of being ‘away from’ the health service may result in an unintended sense of isolation for the volunteer.

A significant part of the role of the manager will be keeping in contact with volunteers who may easily feel disconnected, or who may stray from the boundaries set for them.  The time taken to support, brief, debrief, and follow-up should not be underestimated by a service intending to create a home visiting volunteer program.

Some key points about a home visiting program

  • Identify features of the person’s social situation, their home setting, and reason for referral to the volunteer service.
  • Identify clear timeframes, site of care and care-tasks to be performed. This can be done at the time of referral and then again as visits commence.
  • Punctuality by the volunteer is important as the person may have scheduled appointments with which the volunteer can assist.
  • Where there are children involved ensure that the volunteer understands the scope of their involvement with the children (such as supporting the children with their chores or homework, assisting the parent to collect them from school) and that these are within the health service’s policy requirements.
  • Match the volunteer to the person as much as possible.
  • Make sure the volunteer is briefed, and then debriefed particularly after their first visit. Also contact the person after the initial visit to check the suitability of the volunteer match.

You will find helpful information in Chapter 4 of our Palliative Care Volunteer Services: Guidance for managers (2016).

Your volunteers will find information on community and home visiting in Chapter 11 of Palliare: A Handbook for Palliative Care Volunteers in NSW (2018).

The National Palliative Care Program Guidelines for a Palliative Approach in Residential Aged Care(2006) are still a useful resource for material for visiting in a context away from acute care. Find them at www.pcvlibrary.asn.au under Aged Care resources.