Last reviewed 12 September 2016
Jef Smith explores the roles volunteers can play in care homes and the possible benefits to residents, staff and managers.
When we consider volunteers in residential care homes, the approach is generally positive. Nevertheless, using volunteers can feel risky, for both residents and regular staff, and even for the volunteers themselves. Some volunteers, particularly those at school or college schemes, may be reluctant workers and, occasionally, volunteers can seem to get in the way.
We need to face these negative arguments frankly, if we are to understand why in the care sector, as a whole, there remains a persistent reluctance to use voluntary workers. Their contribution is potentially substantial, but the gains are often long-term rather than immediate and there are undoubted downsides which should be candidly considered.
What, for a start, about the attitudes of regular staff? A recent report from the National Council for Voluntary Organisations (NCVO) refers to one source of possible tension by stating that “Volunteering should never be used as a replacement for paid staff.”
The fact is that volunteers frequently do undertake tasks which would otherwise fall to pay staff and that the presence of volunteer capacity inherently undermines the bargaining position of employees. The traditional case that volunteers should only be used to provide added value which would not otherwise be available is clearly leaky. A more pragmatic position is simply to accept as irreversible in the current employment market the fact that volunteers effectively subsidise the system with their free labours, but to recognise that there is value in volunteering for other, very good, reasons.
Here, the NCVO report is on strong ground. Volunteers, it argues, offer “an opportunity to nurture the workforce of the future”. Certainly, many people in caring roles were initially drawn to the profession by volunteering. With an ageing, employment profile and restrictions on immigration likely to damage recruitment over the coming years, employers cannot now afford to ignore any source of well-motivated staff. At least some of today’s volunteers could be tomorrow’s employees.
Matthew Hill, the report’s author, admits that he had expected some critical reactions to volunteers among staff and was surprised by the almost exclusively positive responses he encountered on a range of fronts. Sixty-eight per cent of the frontline staff and managers questioned — but how representative was this sample? — felt that the involvement of volunteers had a positive impact on their job satisfaction. Even more (71%) identified, reduced stress levels, and there were respectable percentages for improved staff retention (61%) and even feelings of job security (54%). Indeed, the only negative impacts for personnel which the research identified were the demands on staff time in having to work with volunteers and the lack of appropriate training for the additional responsibilities involved in managing voluntary workers. These are real and legitimate concerns.
Benefits to residents
To discuss at length, as the report does, the impact of volunteers on staff is by no means to underestimate the even more important consideration of their value for residents. The headline statistics here are that “89% of staff and 75% of the volunteers thought the involvement of volunteers had contributed major or moderate positive impacts in their care home overall”. Those are certainly impressive figures, though there is little information here about how residents themselves felt.
Heading the list of claimed benefits to residents were what the report describes as “fundamental socialisation”, which, put simply, unpacks to just providing companies. This process, for residents with moderate to severe dementia, might involve nothing more sophisticated than sitting and making basic communications, or even just hand-holding. This sort of social activity, for which care workers’ schedules rarely allow enough time, could progress to “more substantial long-term one-to-one befriending relationships and support”. These characteristically “involve trips outside of the home, relationships with relatives and a whole range of social and practical support with some developing into genuine and occasionally deep friendships”.
Rather oddly, the report makes a distinction between “befriending roles”, usually undertaken one-to-one, which constituted just over half of what was observed, and “activity-based roles”, which included arts and craft, reminiscence and pet therapy. This is just the sort of artificial differentiation which care staff are encouraged not to make. Helping a resident master a new skill, listening to and stimulating their memories, and even just being with them as they stroke the home’s cat can effectively form the basis for a relationship. They are emphatically not just “activities”, and it is disappointing to find the dichotomy resurrected in the volunteer context.
Similarly, it is perverse that the report seeks to separate the “social” and the “emotional” impacts of the volunteer contribution. Under the latter, it lists, helping people to settle into the home, injecting purpose and enjoyment to their lives, providing bereavement support, and generally helping to reduce stress and anxiety. Such emotional help can only meaningfully be given on the back of a successful relationship, that is a social contract. Indeed, the report finds that “The only negative impacts for residents were the emotional effects of volunteers withdrawing after a close bond had been formed”.
The third set of contributions to residents’ care came, Matthew Hill reports, in the form of benefits to their mental and physical wellbeing. In the psychological area, the gains came from the stimulation generated by participating in games, quizzes, newspaper reading or conversation, which supports the widely noted research finding that mental activity can significantly slow cognitive decline. Unsurprisingly, volunteers’ ability to accompany residents on walks or on activities involving other forms of physical activity proved beneficial, often to both mental and physical health.
After staff and residents, the third group benefitting from volunteering were, of course, the volunteers themselves. Half of those interviewed saw their volunteering as enhancing their employment prospects, or at least developing new skills. More humbly, visiting a care home and interacting with residents, was seen as promoting the visitor’s social and emotional wellbeing, limiting loneliness, or just having fun. Care homes may feel that such extra-mural outcomes are not really their concern, but in a wider context promoting a greater awareness of social problems and helping people to make a positive contribution to their community are in themselves appropriate social care goals.
Management of volunteers
The report has some rather more critical points to make about how volunteers are managed. Although most volunteers were satisfied with how a home had dealt with them, some homes failed to provide the “substantial ongoing co-ordination and support” which is vital to a successful project. Induction and training, and according to reward and recognition were selected out for particular criticism.
In relation to recruitment, whether this task is undertaken by the home directly or by a volunteer centre, the report suggests that the four key characteristics to look for are commitment both to engagement generally and to regular hours of input, an understanding of the care home environment, communication skills, and the ability to react appropriately to express emotion coupled with the capacity to manage their own emotions in complex situations. (This analysis incidentally provides a useful guide to the parallel task of staff recruitment.)
The matching of volunteers to residents is another skilled operation, and one which cannot, of course, be delegated to anyone outside the home. “The matching process,” says the report, “was largely based on broad personality traits rather than specific interests. This is an inexact science and the fact that some matches inevitably fail means that it is important to build in a review process and even more important not to allocate blame where relationships do not initially take off.
The particular claim of this research to the attention of the care home community is that it was an evaluation of a three-year project funded by the Department of Health involving engagement with actual homes in Central London, Lancashire, Shropshire and South Derbyshire. It drews on in-depth interviews with staff, volunteers, residents and relatives, based around 259 volunteers delivering nearly 10,000 hours of service. One disturbing element of the sample was that over three-quarters of the volunteers were female; this presumably reflects the national picture but, to be positive, suggest that there is a still largely untapped reservoir of men who could be involved. It is true that the majority of both residents and care staff are female, but that is not to say that both groups would not welcome a few more males around the place!
There are, of course, many more examples of successful use of volunteers than were studied in this project, but it remains sadly true that volunteering is generally underdeveloped in this setting, certainly compared with, say, hospices or even some acute hospitals. The report speculates, probably accurately, that this derives from the fact that the majority of homes are run as commercial organisations and are therefore not seen — or do not see themselves — as appropriate recipients of unpaid help. This is a pity; perhaps the way forward is to downplay the economic contribution of volunteers and to stress their value as a potentially lively link between homes, which by their very nature are always vulnerable to social isolation, and the wider community, where attitudes to residential care remain dangerously ambivalent.
One final argument for using volunteers is that nearly half of the staff interviewed felt that the volunteer project had had “a major positive impact” on their homes achieving a high Care Quality Commission rating. If you are a staff member trying to persuade your manager, that could just be a clinching point!