Hospice Volunteers

Hospice Volunteer Data:
The Case for Consistent Data Collection & Reporting

Cordt T. Kassner, PhD
CEO, Hospice Analytics

Volunteering is a core component of the Hospice Philosophy of Care. In fact, hospice is the only Medicare benefit with a volunteer requirement. As a hospice volunteer and a numbers guy, I wondered how much information about volunteers is publicly reported? In summary, not much. There are bits and pieces of volunteer information reported in different ways in different places. To advocate on behalf of all Hospice Volunteer Coordinators and Volunteers, it would be extremely helpful to consistently collect and report hospice volunteer information. Below is a table of information that would be helpful for every hospice to collect and report[1]. I’ve reviewed several data sources and penciled in my estimates.

Using these ratios, that means each volunteer would provide ~40 hours / year and each patient receiving volunteer services (~40% of patients) would receive ~30 hours of care.

As noted above, these are estimates because this hospice volunteer information isn’t consistently collected or reported. However, I reviewed several data sources and wanted to summarize them for you:

• NHPCO Press Release: In 2019 NHPCO estimated 420,000 trained hospice volunteers provided more than 19 million hours of service. https://www.nhpco.org/celebrating-volunteer-week/
• NHPCO Facts & Figures: https://www.nhpco.org/research/
  • 2019 F&F: Discussed volunteer services but shared no data points.
  • 2018 F&F: There was no 2018 F&F edition.
  • 2017 F&F: Discussed volunteer services and included how volunteer time was distributed (43% direct patient care; 30% clinical support; 27% non-clinical). This information combined 2015 and 2016 volunteer data as reported in the NHPCO National Data Set survey. Of note, ~12% of hospices participated in the 2014 NDS survey (the most recent NDS response rate I could find).
  • 2016 F&F: Included the same information reported in the 2017 F&F.
  • 2015 F&F: Was the last F&F edition that included a little more detail:
    • NHPCO estimated in 2014 that 430,000 hospice volunteers provided 19 million hours of service, per the National Data Set survey. (So, this is about the same as reported in the 2019 press release.)
    • In 2014, they reported 61% direct patient care, 20% clinical support, and 19% non-clinical support. (Note this is a bit higher direct patient care than reported in 2016-2017.)
    • In 2014, 5.2% of all clinical staff hours were provided by volunteers. The typical hospice volunteer averaged 46 hours of service over 20 visits per year.
  • 2014 F&F:
  • NHPCO estimated in 2013 that 355,000 hospice volunteers provided 16 million hours of service, per the National Data Set survey. (Note this was significantly lower than numbers reported in 2015.)
  • In 2013, they reported 61% direct patient care, 20% clinical support, and 19% non-clinical support.
  • In 2013, 4.5% of all clinical staff hours were provided by volunteers. The typical hospice volunteer averaged 46 hours of service over 20 visits per year.
• CMS Provider of Service File: This file includes information on all Medicare-certified organizations, including staffing numbers using Full-Time Equivalents (FTEs). Information reported here appears much higher than expected (e.g., NHPCO estimated ~22,000 volunteer FTEs).
• Nationally hospices reported ~150,000 paid employee and ~54,000 volunteer FTEs.
• Of the ~54,000 volunteer FTEs, ~51,000 of them were designated volunteers (versus being a volunteer physician, volunteer nurse, etc.).
• Louisiana hospices reported ~2,800 paid employee and ~700 volunteer FTEs.
• Of the ~700 volunteer FTEs, ~650 of them were designated volunteers (versus being a volunteer physician, volunteer nurse, etc.).
• Mississippi hospices reported ~2,000 paid employee and ~600 volunteer FTEs.
• Of the ~600 volunteer FTEs, ~450 of them were designated volunteers (versus being a volunteer physician, volunteer nurse, etc.).
• CMS Cost Reports: Freestanding Hospice Cost Reports include a few fields of information on volunteer hours of service (B-1 III worksheet). I checked with a couple hospices to compare Cost Report information versus actual reported hours. The hospices I checked with were reasonable. I found Cost Report volunteer hours were similar to the percentage of Medicare reimbursement – i.e., if the hospice reported 90% Medicare reimbursement, then the volunteer hours reported were ~90% of actual. However, this was not the case across all hospices. The 2018 Freestanding Hospice Cost Report[3] included over 400 million hours – compared to NHPCO’s more reasonable 19 million hours.

• Missouri Hospice Survey: Please contact the Missouri Hospice & Palliative Care Association for information on their annual survey of hospice providers.

• Discussion with a few hospices: I also spoke with a few hospices, reviewed their annual reports, and compared this information with their Provider of Service and Cost Report detail.

Summary: Volunteers are an important aspect of comprehensive hospice care. However, hospices do not consistent collect or report volunteer information that can be aggregated to state or national levels. Different volunteer details are collected in different ways, making coherent reporting challenging. A basic set of volunteer metrics would be helpful to better describe and improve hospice volunteer services.