Patient Companion Service

This is a draft proposal to establish a "companion service" at local hospitals, particularly in the emergency room, starting with Mission Hospital in Asheville.

Like a hospice volunteer — and unlike many companion services — a patient companion would be there solely to provide emotional support and reassurance: to keep people company, particularly if they’re there alone, in shock, etc. A companion would offer emotional support in three ways:

1. a calm, stable, caring presence
2. empathy (compassionate listening)
3. healing touch, if and when appropriate

Here is a good example.

This is our mission, and companions would operate under a very narrow scope of practice. They would not, for example, be what are commonly referred to as “sitters” or "safety companions" in the sense of providing constant supervision for patients at risk for adverse events such as falls, self-injury, or harm to others. Companions would not undertake or supervise any treatment, e.g., making sure patients get their meds on schedule. Unlike a personal care aide, their role would not involve making sure that patients eat, that they have everything they need, etc. They would not provide information, as a doula might do. This is not “spiritual support” either, the role of the chaplain, nor would a companion act as a therapist.

At Mission, along with their current volunteer positions and patient support services, this would be a distinct, separate offering, conceivably supervised by the Volunteer Services
 department but initiated by the Office of Patient Experience.

Requirements for the patient companion position would include Mission’s current volunteer requirements, training in infectious disease precautions, and a 16-hour Patient Companion Training conducted by The REAL Center. The prerequisite for this training would be The REAL Center’s four course curriculum. This amounts to another 64 hours, for 80 hours in all. (For comparison, most nurse assistant training programs are at least 150 hours, roughly half classroom and half clinical.) The format for REAL Center courses is eight weekly two-hour sessions. Consequently, the full patient companion training would take at least a year to complete.

The REAL Center has been in operation since 2006. Several hundred people have completed one to three levels of the program. Only a few dozen graduates have completed the entire curriculum. Drawing from this small pool of candidates, we would only be able to start on a small scale, e.g., with one volunteer at a time for only a few hours each week.

With any success, we should be able to build support, maybe even being able to pay companions. Then, with enough interest, the center could offer a condensed version of the curriculum specifically geared towards patient companionship. The initial goal would be to have coverage in the emergency room approaching 24/7. Then perhaps the program could be replicated elsewhere.

The REAL Center would be responsible for companion support and supervision. To assess performance, we would elicit feedback from patients as well as hospital staff. We have a number of contacts in the local health system who could offer their endorsement and be invited to serve on a steering committee/board of directors.

Questions as to how this would look include, "how exactly will patients opt in (or out) of this service? Will companions greet patients as they arrive, before they reach the reception desk, or will the receptionist introduce them?" Since this is not a familiar role, companions could offer to help fill out forms. Also, what if there’s only one companion on duty and he or she is helping a patient and another patient needs help?

To answer these and other questions, we will create a code of ethics and standards of practice. Even then, there would still be considerable legality and liability concerns: HIPAA, etc. These might vary somewhat depending on whether this would be administered by the hospital itself or by an independent "vendor." But in consulting with our contacts, our overall impression is that the hurdles involved in working with such a large bureaucracy would be insurmountable. Instead, we've been advised to offer this service independent of the institution. In other words, clients would enter the facility with this relationship already in place. This would necessitate the need to publicize the offering so that the public knows it's even available. If possible, working under the auspices of another well-known local service organization could help in this regard and many other respects.