A passionate advocate for expanding the role of volunteers in long-term care settings, Dr. Paul Falkowski is the founder of VolunCheerLeader LLC, a non-profit that trains volunteers to nurture personal relationships with people living in nursing homes. His organization also researches the efficacy of volunteers to impact quality of care and life. Initially trained as a musician, he became interested in gerontology by happenstance, when he visited a nursing home to play some music. The residents’ enthusiastic response led him to earn a master’s and doctorate in the field, and eventually to focus on how volunteers could make a significant and meaningful difference for individuals. We spoke recently about his work and why relationship building is so essential to improving quality of life for people living in nursing homes. Our conversation has been edited for length and clarity.
DC: Studies show that nursing home residents are meaningfully engaged less than 10 minutes per day on average. Music can help. You’re a gerontologist. Why the focus on volunteers in nursing homes?
PF: So many people feel, who am I now, living in this nursing home? A volunteer can give them some sense of connectedness. You don’t have to be a musician or have any special skills; just be there, be present for them. I still play my horn and love to play for the residents, but I wanted to shift policy and produce research and really bring volunteers back to the forefront.
DC: Most nursing homes have volunteers. But what you are trying to do, and what you are advocating for in your book, Creating the VolunCheer Workforce, is a new category of volunteer, a super volunteer, as you call it. What do you mean?
PF: I think that there are probably a lot of good volunteer programs out there. But my experience has been that the volunteers really aren’t prepared for the experience. So, people come in but don’t stay, and the volunteer program gets the reputation of being unreliable. We need to be intentional about the volunteer workforce. I like to use “workforce” instead of program because I see it as a significant piece of care that is being provided.
Volunteers should be led by a paid, professional manager of volunteers who understands how to recruit, how to develop training, what needs to be done for retention, and then how to evaluate the program, evaluate the volunteers and be able to report to their leadership exactly what the impact is. For example, Mrs. Smith has been getting regular visits and is more engaged now, she is out in activities as opposed to isolating in her room and not wanting to leave. The volunteer support is an intentional part of care.
DC: How does a super volunteer contribute to person-centered care, bringing life back? As the saying goes, “it’s not about adding years to life, but life to years.”
PF: What I’m working on is increasing community engagement so that people from the outside are coming in, but they are not just coming in for an event. They are coming in to stay. They are coming in to be a part of that environment. Even in the best of situations, a CNA is not going to have time to sit with a resident for an hour and chit chat. People have to be bathed, fed, dressed, plus medical care
DC: In your book you talked about assisting someone who needs help eating. On average, with an aide helping, it takes 18 minutes for someone to complete their meal, but when assisted by a family member, a friend or a volunteer, they spend 90 minutes – talking, socializing during a meal. It’s a different experience.
PF: What you are bringing up is the business of volunteers taking something that is routine and making it non-routine. This is an important concept. God bless the CNAs. I can’t even imagine the pressures they are under. A CNA has 25 or 30 people every morning to get dressed. They should try to be polite and caring about the person. But they don’t really have the time for person-centered care. Whereas if a volunteer comes into the room, the volunteer is not on the clock. They can talk about the person’s favorite colors, what they want to wear, and what’s going on. It becomes sociable. The same with the meals. Otherwise it can feel like boot camp. You’re up at 6:00, bath at 7:00, breakfast, lunch, activities at 2:00 and then we’re back for dinner and then you go to bed.
DC: The business of caring for older adults is two-thirds relationship building and one-third medical treatment. That should be our goal. The idea of relationship building should be everyone’s goal. It’s a bigger piece than just running through the ADLs and chores and such. Let’s refashion care around relationship building. And volunteers can be a big part of that.
PF: If there is any upshot to the pandemic, we have a real clear picture now that social and psychological care is far more important than medical care. How many people died last year because of loneliness? How many suicides? The whole business of relationship building, that should be right at the top of our list for providing care.
DC: Green Houses and small, 7 to 12 person communities are ideal, but it’s not going to happen because we have 28,000 nursing homes and 30,000 assisted living communities in the U.S. The Green House Project has been around 15 years and they are approaching 300 homes.
PF: It’s a tough transition to go from a hierarchical management system to the Green House model or the Eden Alternative®. We will really have to re-think how you operate. And you will have naysayers in your organization dragging their feet. Getting there can be difficult.
DC: But we could bring in music today and bring smiles right now. Calm people down. Anxiety is high and depression is high. We know that music facilitates connection, social interaction. That’s something that’s tangible, do-able, doesn’t cost much of anything, and has immediate benefits.
PF: Yes. Music is one part. Another part is the individual, one-on-one connections, “authentic partnerships.” Music is a catalyst toward creating these deeper relationships. The way that I experienced it was visiting a woman who was a retired concert pianist. She said it had been so long since she’d heard Debussy’s symphony La Mer. So I went to the library, got a copy, and brought it back to the nursing home, and we sat and listened. It was fantastic, her reaction. Later that month, I started getting letters from her family and relatives all over the country. She had written to everybody that this guy brought in this music and how much it meant to her. It just helped cement that relationship even more. I would suggest that the arts in a lot of ways can do that. Music, for sure.
You train someone to do this. This isn’t a walk-in. There are all kinds of volunteers. You have musicians. You have people coming in to do birthday parties, or call bingo, arts and crafts. But this would be a volunteer trained to get to know people and know their history, the things they like to do. And then creating individualized activities for them and getting into their life, creating relationships based on getting to know each other. That’s a different mindset.
DC: How much time does it take to train a super volunteer?
PF: My current training program is 16 hours. In addition to things like HIPAA (privacy) and resident rights, we want them to learn what is person centered care, what does that mean. Then we want to train them to understand the aging process. What are the things that we believe about older adults that may or may not be true. Are they senile? Are they asexual? Are they out of touch? Countering negative stereotypes. I want to get working on ideas, communication techniques. If someone is experiencing aphasia, how do I handle that? Basic communication techniques, not to shout in people’s ears. How do we create these activities? How do we learn about someone? It’s a different mindset. The 16 hours include role play, trips to the nursing home during the training.
DC: As you said in your book, the benefit is that the nursing home gets a committed, reliable, trained person who’s in it for the long haul.
PF: I think of Bill, my Marine, who is still volunteering after 20 years, amazing. You have to screen for a certain type of person. When I first started this level of screening and training, I wasn’t sure people were really going to do this. But they do.
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