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Medicare Regulations for Hospice Volunteers

Hospices participating in Medicare must comply with numerous regulations. One condition of participation is that 5 percent of all patient care hours at a Medicare-certified hospice be provided by trained volunteers. In addition to the "5 percent rule," the hospice must utilize volunteers for care and services in accordance with standards set by the secretary of the Department of Health and Human Services. These standards are designed to ensure a continuing level of effort to use hospice volunteers.

  1. Training and Supervision

    • Hospices must ensure that volunteers are trained and supervised. All of the hospice's efforts in this regard should be fully documented and meet the standards found throughout the hospice industry. Medicare does not set specific qualifications for hospice employees responsible for training and supervising volunteers in order to give hospices the flexibility to make staffing decisions as needed.

    Role of Volunteers

    • Medicare regulations require hospices to use volunteers in day-to-day administrative or direct patient care roles; however, these regulations do not define any specific roles for volunteers. So long as a volunteer meets the qualifications generally stated in the Medicare regulations, as well as, meeting any other applicable state and local requirements---such as obtaining certification or a license---a volunteer can perform any role required for the hospice's use.

    Recruiting and Retaining

    • Hospices are required to engage in ongoing efforts to recruit and retain volunteers. These efforts must be documented and be demonstrably viable in order to maintain a volunteer-based essence in the hospice care. In addition to using volunteers in day-to-day roles, hospices may also meet this requirement by using volunteers for special events and non-routine services.

    Cost Savings

    • Medicare requires that hospices maintain records on the cost savings achieved through use of volunteers. These records are designed to show the hours for which volunteers were used that the hospice otherwise would have been required to pay its employees. The Medicare regulations on this point require recording specific information as to the identification of each role performed by a volunteer, the time spent by volunteers in those roles and an estimate of the dollar costs saved by the hospice.

    Level of Activity

    • As noted previously, hospice volunteers must provide, at a minimum, administrative or patient care services that equals 5 percent of the total patient care hours of all paid hospice employees. Although there have been some suggestions in recent years to dispense with this requirement, surveys conducted by various federal and state agencies during hospice reviews have found that this requirement is invariably met. This is primarily the result of flexibility in the Medicare regulations that permits a variety of roles to count toward the 5 percent requirement. In addition to including hours worked by volunteers in traditional roles such as companions, homemakers and administrative staff, hours worked by volunteers serving as medical directors, nurses, counselors and spiritual advisers can also be included to meet the 5 percent requirement.

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