42 C.F.R. § 418.78

Conditions of participation—Volunteers

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The hospice must use volunteers to the extent specified in paragraph (e) of this section. These volunteers must be used in defined roles and under the supervision of a designated hospice employee.

(a) Standard: Training. The hospice must maintain, document, and provide volunteer orientation and training that is consistent with hospice industry standards.

(b) Standard: Role. Volunteers must be used in day-to-day administrative and/or direct patient care roles.

(c) Standard: Recruiting and retaining. The hospice must document and demonstrate viable and ongoing efforts to recruit and retain volunteers.

(d) Standard: Cost saving. The hospice must document the cost savings achieved through the use of volunteers. Documentation must include the following:

(1) The identification of each position that is occupied by a volunteer.

(2) The work time spent by volunteers occupying those positions.

(3) Estimates of the dollar costs that the hospice would have incurred if paid employees occupied the positions identified in paragraph (d)(1) of this section for the amount of time specified in paragraph (d)(2) of this section.

(e) Standard: Level of activity. Volunteers must provide day-to-day administrative and/or direct patient care services in an amount that, at a minimum, equals 5 percent of the total patient care hours of all paid hospice employees and contract staff. The hospice must maintain records on the use of volunteers for patient care and administrative services, including the type of services and time worked.

Notes of Decisions
Cited in 1 case (1 in the last 5 years), 2026–2026 · leading case: United States of Am. & State of Tennessee, ex rel. BRANDY BRYANT & CAROL BLACKWOOD v. COMFORT CARE HOSPICE, L.L.C., et al. (M.D. Ala. 2026).
United States of Am. & State of Tennessee, ex rel. BRANDY BRYANT & CAROL BLACKWOOD v. COMFORT CARE HOSPICE, L.L.C., et al. (M.D. Ala. 2026). “” 42 C.F.R. § 418.78 (d), (e). She alleges that Comfort Care Hospice, L.”
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