America’s “independent sector”—its civil society—is the best-funded and most robust in the world. It consistently develops new and effective approaches to some of the nation’s most serious social problems. Since 2001, the Manhattan Institute has sought to identify and recognize some of the most promising social entrepreneurs and the new non-profits they’ve founded, based on their own original ideas. The more than 50 winners of the Richard Cornuelle award, named for the writer who coined the term independent sector, have addressed challenges as diverse as teaching English to new immigrants, building facilities for charter schools, helping older Americans “age in place,” developing science and engineering curricula for high schools, and helping African-American college students continue through to graduation. Most are supported entirely by private philanthropy. In this column, I’ll profile this year’s winners of the Cornuelle award. This week, I profile Santa Fe’s Coming Home Connection, built on the idea that volunteers can play the key role in addressing one of our most stubborn social problems–helping the long-term ill and the dying avoid the bleak life of nursing homes.
As much as we praise and encourage voluntarism in America, there are some needs which, on the surface, which volunteers would not seem likely to address. But at a time when the number of chronically ill and elderly confined to their homes keeps rising, and the number of those willing to work as home health aides has failed to keep up, a small program in New Mexico is showing that community volunteers can help close the gap.
That there’s a need cannot be doubted. As in so many parts of the U.S., the over-65 population in Santa Fe is expected to grow by 64 percent by 2030. Yet the city has had, what a local hospital official calls, a “total lack of infrastructure” to care for these needs. One would never expect to see a feasible model for completely free, volunteer-provided in-home health care help to fill the vacuum.
But that’s exactly what Santa Fe’s Glenys Carl has built in what she calls the Coming Home Connection. Her organization recruits and trains volunteers to provide completely free in-home care—care that often is 24/7 and extends for months and years as well as for the short-term, filling a critical need for the elderly, the chronically ill, the uninsured, and low-income adults.
CHC volunteers provide gradually increasing amounts of care for dying patients, working closely to help families and those without families to stay in their homes through their last days. Surveys show that most people prefer to die at home—an option generally not funded by insurance plans. Long-term care coverage is a help but is not widely available and often is not sufficient.
Founded in 2007, CHC operates in a straightforward fashion. Gladys Carl recruits volunteers, many from a local nursing program run by a community college, as well as others with no medical training. Some 400 volunteers have been trained since 2007 and all are required to submit to a background check and attend a three-day training program. A registered nurse in the CHC office is in charge of patient intake (though Carl is involved with everything) to assess the patient’s needs and to make a care plan.
Many of those assisted just need temporary help after minor knee surgery. Other times, there are teams of CHC volunteers who provide full in-home care for weeks, months and even years. Approximately 80 active volunteers care for 30–100 patients every week, last year serving 147 families. Using online volunteer-scheduling software, CHC is able to tally annual total volunteer hours: for 2015, 20,000 hours of free care and 40,000 hours of care that was at least partially compensated.
One volunteer, Christina Simic, described how CHC cared for her friend, who was a middle-aged man dying of tongue and throat cancer. He had no insurance and no close family relations. Carl told the man, “we will be there for you,” which was a “precious and priceless” gesture for Simic. As the man declined, a team of 25 volunteers took turns with his care—care that was “compassionate and caring” and often overnight. The man “had never before felt loved” until this time and “felt safe for the first time in his life.”
Most of what CHC does is defined as long-term palliative care, end-of-life care and disability support. Volunteers help with meal preparation, getting in and out of bed, fall prevention, driving and shopping, changing dressings and just being a friend. One local volunteer specializes in modifying homes with grab bars at no charge. Donated medical equipment, such as wheelchairs and walkers, are also loaned free of charge.
CHC uses three categories to group patients by level of need; certain volunteers have specialized training to care for high-need patients but generally even those patients require something short of professional nursing care. As a practical matter, that means CHC can help someone with incontinence but not with a feeding tube. The mandatory three-day volunteer training focuses on practical instruction around care skills (lifting, transfers, wound care, first aid, following doctor’s orders, etc.), hospice care, ethical decision-making, grief counseling and volunteer self-care.
The experience of Coming Home Connection makes clear that such relatively basic assistance could help many stay in their homes --and stay out nursing homes. Its assistance is key, for both legal, as well as medical, reasons.
Those suffering from chronic, life-threatening illness may not, it's important to note, choose hospice care at home unless there is live-in family or a caregiver. Hospice care entails one or two visits a day (to check the patient’s health and pain levels and adjust medication) but does not assist with daily living. Carl herself, originally from Wales, remembers hospice homes (which originated in Wales and England) and has aspirations to build a small, home-like hospice house in Santa Fe, where patients could go for round-the-clock hospice care or respite care for families of the chronically and terminally ill. She has even caught the interest of a foundation in supporting her idea; but Santa Fe property values are very high, so she has not yet found the right property.
The organization operates on only $250,000 a year, none from government sources. Besides the Con Alma foundation and the St. Vincent’s Hospital Foundation, support is provided from the Kresge Foundation, the Santa Fe Community Foundation, the Rotary Club and several New Mexico family foundations. In 2009, as the program was getting started, CHC received a grant of $350,000 from the Robert Wood Johnson Foundation.
The CHC volunteers whom I met referred with disdain to our popular culture that “ignores or fears death.” In today’s modern, disconnected society, CHC offers the great gift of sharing in our illness and death by offering this loving, humane, often thankless work of charity.
This piece originally appeared on Forbes
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Howard Husock is the Vice President of Research and Publications at the Manhattan Institute.
This piece originally appeared in Forbes