This policy-orientated commentary aims to provide a perspective on the effects of policy changes designed to reduce the risk of infection as a result of COVID-19. The example of the abrupt cessation of volunteering activities is used to consider the policy and practice implications that need to be acknowledged in new public service research to deal with the on-going implications of the COVID-19 pandemic and for future preparedness.
The paper will provide a critical challenge to English pandemic health policy making, in particular, the national instruction “to stop non-essential contact with others” without a strategy on how to remedy the serious side effects of this instruction, in particular on older adults.
The abrupt cessation of volunteering activities of and for older people because of the COVID-19 pandemic is highly likely to have negative health and wellbeing effects on older adults with long-term and far-reaching policy implications.
The paper combines existing knowledge volunteering of and for older adults with early pandemic practice evidence to situate an emerging health and wellbeing crisis for older adults. It emphasises the importance of immediate further detailed research to provide evidence for policy and practice following the lifting of COVID-19 related restrictions and in preparation for future crises.
Grotz, J., Dyson, S. and Birt, L. (2020), "Pandemic policy making: the health and wellbeing effects of the cessation of volunteering on older adults during the COVID-19 pandemic", Quality in Ageing and Older Adults, Vol. 21 No. 4, pp. 261-269. https://doi.org/10.1108/QAOA-07-2020-0032Download as .RIS
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The health and wellbeing effects of volunteering by and for older adults have been reported in studies around the globe (Smith et al., 2016). These effects are described within two specific dimensions: the effects on the older volunteer and the effects associated with programmes delivered by volunteers for older adults and their carers. In the UK, nearly three-quarters of adults have volunteered at some time in their lives (McGarvey et al., 2019).
While the complexities of defining volunteering continue to be actively debated in terms of purpose and scope, here we will use the definition adopted by the UK Volunteering Forum in 1998 as quoted in Kearney (2001/2007):
It is the commitment of time and energy for the benefit of society and the community and can take many forms. It is undertaken freely and by choice, without concern for financial gain. (p. 6)
It is estimated that around five million older adults regularly volunteer (Citizens Survey, 2010; McGarvey et al., 2019), experiencing associated health and wellbeing benefits (Carr, 2018; Stuart, 2020). It is likely that a similar or larger number might benefit from volunteer programmes for older adults and their carers, albeit the numbers who benefit currently remain mostly speculative, extrapolated from available partial data, such as the number of volunteers and their beneficiaries in some hospitals, hospices, care homes and other volunteer involving public, voluntary sector and private organisations (Naylor, 2013).
In England, the onset of the COVID-19 pandemic led to a clear unequivocal policy direction delivered in television addresses and an undated letter to all households by the UK Prime Minister. On 16 March 2020, he called for dramatic reductions in social contact:
now is the time for everyone to stop non-essential contact with others
This was followed on 23 March 2020, by his televised request asking people to “stay at home” to “protect our National Health Service (NHS) and save lives”. This was followed by an undated letter to all households containing the unequivocal instruction “you must stay at home” [bold as in the original quote].
The key strategies used by the English Government to mitigate the threat from the virus was a three-week closure of all but essential services; restricting movement outside the home; social distancing; and reducing all but essential contact with people in health and social care settings. Importantly for older volunteers, anyone over the age of 70 was deemed vulnerable and advised to follow stringent social distancing, meaning staying at home and severely limiting contact with other people, and those clinically extremely vulnerable were advised to shield (Department Health and Social Care, 2020). This led to the immediate and almost total temporary cessation of all volunteering by older people outside the home and almost all, non-emergency response related, volunteering with direct contact for older people. While guidance changed over the early months, those aged 70 and over could only be involved in limited non-contact ways (NHS England, 2020) meaning benefits derived from personal social contact might be reduced. The four reasons for which people were at the time officially permitted to leave their home, “shopping, exercise, medical need and work”, did not include volunteering. Any remaining activities involving volunteers, for example, in the emergency response or food provision, explicitly excluded people who are considered clinically vulnerable, and people aged 70 and older.
Despite the government’s call for and promotion of the wider beneficial effects of volunteer mobilisation in the UK in April 2020 with regard to the emergency response, this does not appear to have been well-coordinated nor aligned to public concerns to support older people by and through volunteering. Some observers such as the Association of Directors of Adult Social Services have been reported to point out specific government failings, describing it as “shameful” that the creation of the National NHS volunteer scheme had not been done in collaboration with councils and that it had “diverted 750,000 volunteers away from supporting local communities and left them with nothing to do for the first three weeks of the epidemic” (Booth, 2020).
Some initial data, for example, from sports volunteering (Savanta ComRes, 2020) and social networking feedback from individual volunteer involving organisations suggest that volunteering from home, for example, by phone and online or to produce personal protective equipment (Scrub Hub, 2020) continued but no detailed or comprehensive data about this is available at the moment (Lachance, 2020).
On the available evidence, it seems that COVID-19 not only affects mortality of older people but also that pandemic policy making in response to it is likely to affect the health and wellbeing of older adults disproportionally, which has the potential to deepen an emerging social care crisis and exacerbate existing inequalities for older people’s health and wellbeing in England.
Two questions are at the core of this article’s policy commentary.
Firstly, what are the unintended consequences of COVID-19 pandemic policy? In particular, can we expect the cessation of volunteer involvement of older people to lead to declining health and wellbeing exacerbated by the suddenness of the policy and general unpreparedness.
Secondly, are current plans for public service reform and public health interventions involving volunteering viable within current COVID-19 pandemic policy planning. This is particularly relevant as the NHS and others are planning to increasingly rely on volunteers in public service reform, and because public health interventions such as social prescribing rely on volunteer involvement (Volunteer Matters, 2019).
The paper will summarise knowledge about the health and wellbeing effects of volunteering on older people in two aspects, health and wellbeing effects on the older volunteer and the effects associated with volunteering programmes directed at older people. It will then review emerging evidence received by the Institute for Volunteering Research through professional networks, such as the “National Association of Voluntary Services Manager”, about how the effects of restrictions imposed because of COVID-19 affect older adults. We purposively selected diverse examples from a pool of accounts collected from social media and direct emails to illustrate emerging themes. Finally, the paper will critically consider this in the context of available policy and practice guidance, with a view to identify foci for developing appropriate guidance to support the volunteering related health and wellbeing, for when COVID-19 related restrictions will be eased.
Health and wellbeing effects of volunteering on older people
The older volunteer
The conversation about the role of volunteering in keeping older people physically fit and mentally active has been on-going since the early 1990s. In that time UK volunteer involving organisations have targeted older people in their recruitment (Davis-Smith and Gay, 2005). As a result, since the late 1990s, the rate of regular volunteers over the age of 65 increased and by 2019 had overtaken those of younger age groups, despite overall volunteering rates having remained steady (NCVO, 2020). In the late 1990’s the 50+ age groups were the least likely to volunteer (Davis-Smith, 1998) and in 2007, still, the proportion of formal volunteers was highest amongst people in the 35–44 and 55–64 age brackets and was lowest in the 65 or over age group (Low, 2007). This shifted to the over 65 s being proportionally the highest in 2019 (McGarvey et al., 2019) suggesting a current estimate of approximately five million over 65 s regularly volunteering.
Examples of the values underpinning the choice to volunteer, the purposes of the volunteers, are summarised by Rochester (2010) as altruism, solidarity, reciprocity, equity and social justice. Examples of the many forms volunteering take, its scope, are described in a typology of formal volunteering activities as “community activity; emergency response; community peacekeeping; social assistance; personal assistance; children and youth; human rights, advocacy and politics; economic justice; religious volunteering; education; health care; environment; data collection; promotion of knowledge; promotion of commerce; law and legal services; culture; and recreation” (Dingle, 2001). Some of these have remarkably high numbers of older volunteers. For example, in 2011, 52% of all volunteers at the National Trust were over 65, and 84% over 55 (Harfelt, 2014, p. 97).
The research evidence clearly suggests positive effects of volunteering on mental health, physical health and longevity (Smith et al., 2016). For example, with regard to mental health volunteering might alleviate the negative effects of stress (Greenfield and Marks, 2004), offer a sense of belonging (Thoits and Hewitt, 2001) and of personal identity (Gottlieb and Gillespie, 2008). In particular, there is evidence suggesting that volunteering can alleviate symptoms of depression (Choi and Bohman, 2007; van Willigen, 2000). Therefore, volunteering and associated social contact may be especially beneficial during challenging personal episodes such as retirement or bereavement. Studies also suggest that volunteering improves physical health (Adams et al., 2011; Lum and Lightfoot, 2005; Shmotkin et al., 2003). Indeed, some evidence suggests that volunteering has beneficial effects regarding specific health conditions such as hypertension (Burr et al., 2011; Sneed and Cohen, 2013), albeit those effects can vary amongst age groups (Burr et al., 2016). With regard to longevity, the evidence is less conclusive but some studies suggest that the feelings of usefulness can develop through volunteering and may be a protective factor against disability and mortality and that volunteering can prolong life (Gruenewald et al., 2007; Kim et al., 2020; Okun et al., 2013). In particular, the evidence suggests that older people benefit from volunteering more than those of other age groups (Musick and Wilson, 2003; Kim and Pai, 2010). The COVID-19 pandemic policy of stopping social contact, which meant losing social connections that are a key feature of volunteering, might therefore be associated with reduced life expectancy (Holt-Lunstad et al., 2010).
The second question, the role of volunteer programmes in support of older adults is an on-going research and policy concern in England. For example, a three-year evaluation of volunteering in care homes, funded by the Department of Health, found “profound positive impacts for residents, backing up findings from the wider literature” (Hill, 2016, p. 4). Similarly, the supportive role of volunteers in non-residential social care is recognised, for example, through British Red Cross volunteers complementing statutory services, which provide support to people discharged from hospital (British Red Cross, 2018). Furthermore, while older people volunteering often supports other older people it is important to acknowledge that older people volunteering also supports intergenerational relationships with schemes such as Home Start and reading in schools.
The exact number of volunteers in social care is not known but based on the Citizenship Survey, a face-to-face household survey carried out by the Department for Communities and Local Government, the King’s Fund in 2013 has estimated the number at approximately three million volunteers in health and social care. It states, for example, that the Yorkshire and Humber Community Health Champions programme had trained 17,000 volunteers reaching around 100,000 members of the community and also references the approximately 70,000 volunteers in hospices around the UK (Naylor, 2013, p 5). The NHS has recently stated its plan to double that number over the coming years (NHS, 2019).
Volunteering is also reciprocal by its very nature with effects on both the volunteer and the beneficiaries. Cameron et al. (2020) reported that for older people volunteering gave them structure and purpose to the day and for the older person in receipt of the volunteer activity they benefited from having someone who could really take the time to talk and listen. Lilburn et al. (2018), exploring the experiences of six adults aged 68–90 who volunteer for home visiting, reported that while volunteers positioned the activity as ‘work and a responsibility’ there were also narratives of shifting these obligations into mutual connections that benefit both the volunteer and those they visit. These examples highlight that the ceasing of volunteering activities is likely to have had a detrimental impact on both groups.
How the restrictions imposed because of COVID-19 are affecting volunteering
Even before the UK Prime Minister’s announcement 23 March 2020 triggered the “lockdown”, organisations had started to reduce volunteer involvement which relied on social contact, especially after 16 March 2020, when the Prime Minister called for dramatic reductions in social contact. By the end of March 2020, this led to an almost complete temporary cessation of regular volunteering activities outside the home, for examples, in hospitals, heritage and charity retail. Through email correspondence with voluntary sector colleagues evidence grew of the impact on older people volunteering. All extracts are included with the person’s permission and anonymised to preserve confidentiality.
We have made the decision to stand down our 700 hospital volunteers for this month following the lock down advice from the PM and we won’t be looking at them or any new volunteers coming back into the system until the risks are much lower […] So for now we are collating a list of our own volunteers who are willing to take on alternative roles at home (telephone support, welfare checks, advice lines etc) away from any public facing areas and a list of new applicants who are interested in volunteering longer term.
It is unclear how many volunteer managers, staff who are employed to recruit, deploy and retain volunteers for voluntary and public sector organisations, were put on furlough at that time. However, it seems very likely that it became difficult for volunteer managers to continue to provide support for volunteers who struggled with the sudden loss of all social contact, including that which they had through volunteering:
One of the biggest challenges during lock down has been how we support our volunteers who are struggling with isolation and lack of purpose […] We are emailing, phoning and producing regular newsletters but it's still been really tough on some of them […] Quite worryingly so in some cases.
Examples of adapted activities
While face-to-face volunteering activities largely ceased during March 2020 the commitment of many volunteer organisations meant that several have tried to adapt their support activities to continue to meet the needs of older people:
During lockdown the needs of those living with dementia have become more pressing. As a singing group we're busy remodelling 23 music/singing groups: telephone befriending (and sometimes singing!) services, but more specifically an interactive newsletter where people can share their thoughts on singing and music in words, pictures and poems. There's been wonderful uptake and creativity- clearly it's helping those isolated at home to feel connected, valued and not forgotten.
(Coordinator of music groups)
National organisations such as Age UK have also increased telephone befriending schemes. Some observers noted that while a telephone call is welcome it is unlikely to provide the same social stimulation as attending a luncheon group or Men’s Shed project or a memory café:
We arranged a programme of support with twice weekly phone calls and offers to do shopping, collect medicines etc but we couldn't provide the one thing everyone craved, that is company and respite time. Hopefully we are going to be able to start some activities in the near future but all our clients are vulnerable and many of our volunteers are over seventy, which is not a good combination in a pandemic.
(Coordinator of dementia support group)
Furthermore, virtual volunteering offered through digital means is unlikely to be accessible to all volunteers or receivers of the support due to the inequalities related to age in access to Information Technology (IT). As we move forward from the acute crisis, there seems an urgent need to identify and report those groups who were most marginalised by the drive to digitalise the majority of social support.
In summary, in the UK older adults are the largest group of regular volunteers to be affected by the COVID-19 pandemic policies that caused a cessation of their volunteering activities. This is not an experience unique to the UK as data from other parts of the world, such as Australia, also suggest that women and older adults were most likely to have stopped volunteering as a result of the pandemic (Biddle and Grey, 2020). The cessation of most volunteering activities in the UK from 16 March 2020 means that around five million older people might currently not be experiencing the health and wellbeing benefits they derived from volunteering and that potentially further millions of older people and their carers who had been supported by volunteers are currently not receiving that support. However, there is a need for further research to explore whether older people were able to, and wished to, undertake more remote forms of volunteering.
What do we know about how this might play out when restrictions ease
As restrictions continue, including local lockdowns due to fluctuating infection rates the longer-term implications for older people volunteering remain unclear. Alan Hopley, Chief Executive of Voluntary Norfolk, publicly stated:
[…] Going forward, the role of the volunteer is not only integral to the recovery of the current crisis but is also instrumental in providing early help and support for communities longer term.
However, conversations with volunteer involving organisations suggest three immediate areas of on-going concern: fear of liability, sustainable safeguarding and anxiety about returning to volunteering and the organisation of volunteering. Establishing ways to return volunteers over 70 requires volunteer involving organisations to identify ways to manage sustainable supervision and safeguarding for them. Any return will most likely be volunteering in unfamiliar roles and required to adhere to new restrictions and practices all of which need to be trained and maintained at all times. As a result, the role of the volunteer service managers and volunteer coordinators may become more operational than before the COVID-19 pandemic. This will also require effective and efficient collaboration with their human resources, occupational health and health and safety teams to create policy and to design risk assessment tools to initiate recovery plans post lockdown.
Informed decisions will have to be made to balance a number of factors, such as the benefits of the volunteering role to the organisation, the effects on beneficiaries such as older people and their carers but also the benefit or danger to the volunteers themselves. In short, this is extremely complex. The initial, anecdotal, responses from practitioners suggest that COVID-19 policy making in this context requires detailed experiential knowledge of volunteers and those who organise volunteering to be combined with the substantial evidence gathered from pre-pandemic volunteering research.
The evidence overwhelmingly points to potentially negative health and wellbeing effects from the sudden cessation of volunteering both of and for older adults. The national English COVID-19 pandemic policy does not appear to have included any remedial actions, for example, resources for volunteer managers to help them support volunteers that had been stood down. The same applies regarding the lack of resources for and consideration of volunteer involving organisations delivering programmes for older adults and their carers. This is linked to what appears to be, the not unusual, lack of preparedness, with pandemic policy planning either not being available or not being used to consider societal impact beyond the immediate medical emergency response (see also Aguirre et al., 2016).
The anxieties now expressed by volunteers and volunteer involving organisations around a return to volunteering in changed circumstances are exacerbated by the absence of consistent and clear policies and associated practice guidance, which suggests that a return to volunteering as normal may be some time in coming. Therefore, it is likely that the negative health and wellbeing impacts on older adults will be on-going. Finally, it is currently unclear how the learning about the reduction in social connectedness on older people’s health and wellbeing from the COVID-19 pandemic policy response will be systematically gathered or how it may be used in the future pandemic policy, especially regarding preparedness.
To answer the two questions at the core of this policy-orientated commentary we considered materials concerned with the immediate and on-going consequences of pandemic policy making using the example of volunteering. Firstly, a picture emerges that suggests insufficient pandemic preparation, with regard to the requirement to stop non-essential contact with others, resulting in negative impacts on older adults’ health and wellbeing with these impacts likely to be on-going. Secondly, in COVID-19 pandemic policy planning, there appears to be a lack of the systematic use of experiential knowledge of volunteers and practitioners about how the return of and for volunteering for older and clinically vulnerable people might be achieved safely and consistently. Further, there appears little consideration of what the long-term effects may be for the NHS and other health and social care sectors, especially with regard to the role of volunteers in public service reform.
This commentary, therefore, agrees whole-heartedly with the President of the UK’s Academy of Medical Sciences, that pandemic policy making needs science because the emerging evidence about the effects of COVID-19 pandemic policy making indicates very poor use of existing with knowledge calamitous results.
Given the nature of the crisis, there is now a particularly strong argument for involving volunteers and those working to involve volunteers in moving forward. Volunteers have experiential knowledge to bring to making practice relevant to any COVID-19 pandemic remedial and preparedness policy, with nearly three-quarters of adults in the UK having volunteered at some time in their lives. Considering the example of volunteering enables us to learn important lessons for policy and practice, to better support the health and wellbeing of older adults and pandemic planning.
We, therefore, suggest that further to Academy President Lechler’s (2020) request that pandemic policy making needs social science and systematic approaches to democratic participation in research, there is a need for much improved remedial practice and preparedness regarding the health and wellbeing effects related to volunteering during and after the COVID-19 pandemic.
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The authors thank the volunteers and those who involve volunteers whose experience and insights have helped shape our thinking on this important topic.Conflicts of interest: The authors have no conflicts of interest to declare.Funding: Jurgen Grotz and Linda Birt’s involvement was supported by the National Institute for Health Research (NIHR) Applied Research Collaboration East of England (ARC EoE) programme.Disclaimer: The views expressed are those of the authors, and not necessarily those of the NIHR, NHS or Department of Health and Social Care.Data availability statement: The materials that support the findings of this study are publicly available. We have included citations in the reference section.
About the authors
Jurgen Grotz is based at the Institute for Volunteering Research, University of East Anglia, Norwich, UK
Sally Dyson is based at Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
Linda Birt is based at the School of Health Sciences, University of East Anglia, Norwich, UK