Hospices on both sides of the Atlantic ended October under financial pressure. In the UK, Hospice UK said the Autumn Budget 2026 did nothing to address the funding crisis facing hospices, warned that services are being cut and repeated its call for an immediate £112.5 million a year. Its director of external affairs, Charlie King, said hospices cannot keep relying on charitable donations to plug the gaps.

In the US, Hospice News set out how policymakers are thinking about payment reform. The GAO has recommended paying for routine home care per visit rather than per day, which it estimates would have cut 2024 Medicare hospice spending of $27.5 billion by $7.6 billion. MedPAC is weighing outlier and add-on payments for high-acuity care, and CMS has asked for input on a hospice-specific wage index.

Volunteers are not a fix for funding gaps, and they should never replace paid clinical roles. But when every budget line is being examined, a hospice that can clearly show what its volunteers contribute is in a stronger position with boards, commissioners, surveyors and donors. November is National Hospice and Palliative Care Month in the US, which makes this a good moment to take stock.

Know what you must record (US hospices)

For Medicare-certified hospices, volunteer evidence is a requirement, not a nice-to-have. The Conditions of Participation at 42 CFR 418.78 require hospices to:

• Provide and document orientation and training for volunteers

• Use volunteers in defined roles, in day-to-day administrative support, direct patient care or both, under the supervision of a designated hospice employee

• Document active, ongoing efforts to recruit and retain volunteers

• Document cost savings, including the positions volunteers fill, the hours they work and what those hours would cost if done by paid staff

• Keep volunteer hours at a minimum of 5% of the total patient care hours of all paid employees and contract staff, with records to prove it

Surveyors will ask for this, so the records need to be accurate and quick to pull together. If your volunteer coordinator is reconciling paper timesheets at the end of each quarter, that is a risk worth fixing now, especially if payment reform brings closer scrutiny of how hospices use their resources.

Build a cost-savings figure you can defend

UK hospices have no 5% rule, but the cost-savings method in the US regulation is a sensible model for anyone. For each volunteer role, record:

• Total hours given in the period

• The equivalent paid role, if there is one, and its hourly cost including on-costs

• Whether the activity would otherwise be done by staff, or simply would not happen

Be honest about that last point. Much of what hospice volunteers do, such as sitting with a patient, supporting bereaved families or running a ward tea trolley, is something staff would rarely have time for. That is a strength. Report it as added value rather than money saved. Boards and commissioners trust figures more when they can see how you got there.

Show the difference, not just the hours

Hours and savings answer the question ’how much?’. Funders and families also want to know ’so what?’. Add a small number of outcome measures that fit your services:

• Patients and families reached by volunteer-led services such as befriending, compassionate neighbours or bereavement support

• Short, sensitive feedback from patients and families

• Contribution to income, for example volunteer hours in hospice shops and at fundraising events

• Staff time released, measured by asking clinical teams what volunteers take off their plate

Retail and fundraising volunteers belong in this picture. For many UK hospices they keep a large share of charitable income flowing, and that is part of the story when you explain to commissioners what the local community already puts in.

Look after volunteers while you make the case

Financial pressure can quietly push organisations to ask volunteers to do more, more often. That is how burnout and drop-off begin. Keep an eye on:

• Role creep, where volunteers drift into tasks that should be paid or that need clinical training

• Supervision and emotional support, especially for volunteers working with dying patients and grieving families

• Recognition, so long-serving volunteers feel valued through difficult changes

If you are reshaping services, talk to volunteers early. They often hear rumours before anyone tells them anything, and honest communication keeps trust intact.

Make reporting a habit, not a scramble

The hospices best placed for the next funding conversation will be the ones that can produce a clear picture of volunteer activity in minutes, not days. That means recording hours, roles and training in one place as they happen, and agreeing a short set of measures you report to your board every quarter.

Whether you are preparing for a Medicare survey or a meeting with your integrated care board, the evidence you need is the same: who your volunteers are, what they do and what difference it makes. If your current records make that hard to show, it may be time to change how you capture it. Volunteero helps organisations log volunteer hours, track training and build impact dashboards, and we’re happy to show you how that could work for a hospice.