++There are so many ways to make a difference, even when your time is tight. +
++Six out of ten US households donate to charity every year. Yet, under a quarter of Americans volunteered their time in 2021, according to a joint report from AmeriCorps and the US Census Bureau. +
++Donating is a great way to help your community, but volunteering can help you truly become a part of it. Its benefits extend beyond those who are helped: In a post-lockdown world — where 58 percent of adults report feeling lonely — volunteering could cement much-needed connections. Additionally, research shows volunteering actually boosts our overall physical and mental health and increases our sense of pride, motivation, and support. +
++“What brings me back here every single day is really the people,” said Juliana Soltys, a former volunteer and now the volunteer manager at Haley House, a Boston-based nonprofit that runs a soup kitchen, cooking classes, affordable housing units, and more for houseless individuals. “Every individual volunteer matters to us and we are just very grateful to have them in our space and getting to know them on a more personal level as well.” +
++But despite the very real need and the potential benefits for all involved, volunteering isn’t as popular as it used to be. Since 2000, the number of Americans volunteering fell, reports the Chronicle of Philanthropy. Between 2003 and 2005, more than 28 percent of Americans volunteered, according to the Do Good Institute. By the end of 2020, that number dwindled to less than 25 percent. 2020, of course, saw a decline in community participation due to the pandemic — but even now, in a post-pandemic world, nonprofits are struggling to find the necessary number of volunteers. +
++Volunteering can be a tough squeeze. For many, a lack of time or an inflexible schedule poses a hurdle. Then there’s the issue of finding an organization that aligns with your values. But the good news is volunteers are needed in so many different ways, from building homes to working from home. You don’t have to sacrifice other parts of your life to make an impact — you just need to be a bit creative to find the opportunities that fit your schedule, skills, and interests. +
++“I think too often we have misconceptions about volunteering,” Barbara Huelat, an author, hospice volunteer, and dementia caregiver, told Vox. “If you keep both your eyes and your heart open, you will see needs that need to be met, and it will bring you great joy to be able to jump in and do it.” +
++How do you find the right community? +
++Just like when you’re deciding where to send your money, selecting the organization or the causes you want to aid — animals in need, kids in under-served schools, people escaping domestic abuse — is the first step to getting involved. +
++When you donate money, you’re probably concerned about where that money goes, or if it’s doing the most good it possibly can. Those worries matter: The most effective charities produce 100 times as much benefit as the average organization, Future Perfect writers Dylan Matthews and Sigal Samuel previously reported. No one wants to feel like their money isn’t helping — or worse, wasted. +
++Online platforms like GiveWell and Charity Navigator can help you find top-rated organizations globally. If your priority is to make the most significant impact with your time, these websites could help guide you. (Disclosure: GiveWell is also an advertiser on Vox podcasts.) +
++Meanwhile, VolunteerMatch won’t necessarily help you identify the most effective organizations, but it does let you look for opportunities that fit your location, causes of interest, and skills (and it allows you to filter for remote options). +
++Sometimes other groups that you’re already a part of, like recreational sports teams or book clubs, can lead you to your volunteer community. Some of the largest sources of volunteers for Habitat for Humanity, a nonprofit organization that helps provide and build affordable homes, have been school groups and churches, said Boram Kim, the senior director of volunteer and institutional engagement at Habitat for Humanity International. +
++Let’s say you already know which organization you want to volunteer for, but feel hesitant because you’re not sure you have the skills needed to help. Reach out anyway, the experts Vox spoke to agreed. +
++For example, the task of building a home for Habitat for Humanity can seem daunting, especially if you’ve never even used a hammer. But there’s no reason to think you can’t help, Kim said. Prior to helping on a build, the organization ensures volunteers are trained and comfortable with the tasks they’ll be completing. +
++Similarly, new volunteers at Haley House receive a video orientation about what to expect before their first shift and at least one to two staff members work alongside the volunteers each shift to answer questions. When you’re volunteering, you’re never alone. +
++“Often people think they need special qualifications. They don’t,” said Randy Allison, a lifelong volunteer and founder of Alter X Company, an apparel company that donates 20 percent of its sales to a variety of causes. “Most often the greatest qualification is time and availability. Organizations need people to help fulfill their service-oriented mission often with limited financial and personnel resources to accomplish them.” +
++When it comes to volunteering, picking a cause you’re invested in is one step — the other is ensuring you’re comfortable with commitment. If you’re allergic to dogs, walking senior dogs at the shelter isn’t the best way to invest your time. Yes, there can be a lot of pressure to choose the most urgent issues, like gun violence or the opioid crisis. But ultimately, enjoying the work you’ll do is vital for maintaining the commitment to yourself and others +
++“I think one of the things you really have to do is be cognizant of what you want to do,” said Huelat. “You should really be finding what brings you joy, and what’s meaningful for you, and where your expertise is.” +
++How to make volunteering fit with your skills and schedule +
++When you hear the word “volunteering,” what comes to mind? +
++Maybe you picture the packed cafeteria of your local soup kitchen, or an afterschool program where tutors help young kids with their math and reading homework, or a team of red-vested disaster relief volunteers handing out supplies and looking for survivors after a hurricane. +
++Your vision probably does not include the work behind the scenes that funds that cafeteria, organizes those student-tutor matches, or assigns the Red Cross volunteers. Yet, every organization needs people to complete those tasks, and many of these tasks can be completed from anywhere and at any time. These opportunities while not as flashy, are necessary for organizations trying to do the most good with the resources they have. +
++“Volunteers are the backbone of every nonprofit organization,” said Joshua Fields, co-founder and CEO of the Next Step Programs, a nonprofit that works with young adults who have intellectual disabilities to help them transition out of high school. “Without the support and dedication of volunteers from the community, it would be impossible to make as big of an impact as many organizations do.” +
+ ++For example, some Next Step Programs volunteers invest their time remotely, helping with fundraising or social media messaging. These posts help the organization attract donations and more volunteers, and still allow someone to connect and interact with the team remotely. “These types of tasks can be completed from the comfort of folks’ homes, and often time at one’s own schedule,” said Fields. +
++Similarly at Haley House, volunteers can help plan events, the organization’s annual concert fundraiser, and help with social media posts from anywhere in the world. Soltys says it’s just a matter of reaching out and finding the right place in the organization for the individual. +
++Other virtual volunteer opportunities include sending Christmas cards to deployed troops, becoming pen pals with someone who is incarcerated, or operating a mental health hotline. +
++The key when you’re new to volunteering is starting small. “I think a lot of people feel that they have to commit a ton of hours to an organization when they choose to volunteer,” said Fields. “What I have learned is that every person has different tools, strengths, and skills to share. Organizations often welcome volunteers in many different capacities, and will usually work with your schedules.” +
++Look at your calendar and figure out what day or days you have small chunks of time to spare. Maybe you’ll find a 30-minute window to make fundraising calls as you wait in the pickup line at your children’s school, or maybe you’ll discover that the library needs volunteers to read to the children who gather there. “Only commit to what you can safely fulfill,” Allison said. “Think about how you can best use and reorganize your time to give yourself more opportunities to serve.” +
++And if you can’t commit to any one organization or charity, maybe try helping someone more directly. These types of informal opportunities to help members of your community can easily be found in neighborhood social media pages, or through mutual aid hubs. Mutual aid involves community members coming together to address an issue as a collective, rather than individually. It can be as simple as sharing meals, teaching each other new skills, or pooling your resources to help members of the community purchase necessary medical treatments. +
++“An elderly woman in the neighborhood no longer drives, and I take her to get groceries, and not only does it help her get the groceries, but I spend time with her and she’s not lonely and she gets out,” said Huelat. “I think that’s probably the biggest need when we just see people that need assistance. It doesn’t have to be a formal organization.” +
++Jimmy and Rosalynn Carter have drawn attention to the benefits of hospice care. But it’s not serving everyone well. +
++Rosalynn Carter, whose unflagging advocacy for mental health reform and on behalf of human rights, democracy, and health programs redefined the role of a president’s wife, died on November 19 at age 96. +
++Half a year earlier, her family had shared publicly that Rosalynn had been diagnosed with dementia. She began receiving hospice care — i.e., end-of-life comfort care for patients and caregivers — at home in Plains, Georgia, two days before her death and died there peacefully. +
++Her husband, former President Jimmy Carter, also opted to receive hospice care nine months ago after multiple medical problems landed him in and out of the hospital. Although his family thought he was in his last days when he made the choice, he has surpassed expectations. “Rosalynn was my equal partner in everything I ever accomplished,” he said in a statement on the day of her death. +
++It’s not clear why the couple were in hospice care for such different durations. But in that difference are echoes of a nationwide phenomenon: The way hospice is paid for — and the way eligibility is determined — makes it a good fit for people with terminal illnesses with predictable end-of-life courses, like cancer. But for Americans with dementia, hospice care often becomes available much later in the illness than it’s needed — or is offered and then withdrawn repeatedly over the course of a long decline in health status. +
++To be clear, there’s no evidence this was Rosalynn Carter’s experience. But as both Carters’ end-of-life choices have drawn attention to hospice care and the value it can bring, it’s worth looking at who it works for, and who it doesn’t. The truth is that the US’s current hospice model doesn’t serve people with dementia as well as it could. Here’s why, and what could make it better. +
++Hospice care focuses on symptom relief and support for dying patients and their families +
++Many Americans hear “hospice” and think it’s equivalent to giving up. +
++In fact, hospice care is a type of medical care that centers a patient’s goals — and provides support to their caregivers — when they’re nearing the end of life. And as Jimmy Carter has so transparently shown us, the shift in care can be surprisingly nourishing. +
++In the US, the hospice approach and the mechanism to pay for it are two different things, explained Carolyn Clevenger, a professor and nurse practitioner who leads a dementia care clinic at Emory Healthcare in Atlanta. “There’s the hospice philosophy,” she said, and “there’s the hospice benefit.” This is what makes hospice care so different from other treatment approaches in the US: It not only prioritizes comfort over cure, but it also switches the patient over to a totally different insurance plan, often called the hospice benefit. (Medicare, Medicaid, and most private insurance plans have a hospice benefit.) As a result, all the care, supplies, and equipment a hospice organization provides its patients is generally fully paid for by the benefit. +
++The approach focuses on providing symptom relief rather than curative treatment. It generally includes a complete package of services to care for both the physical and emotional symptoms that come with nearing the end of life, and it provides support for both the patient and the family. A person in hospice care could get specialized medical equipment, such as a hospital bed, some home care, and in-home nurse visits. They and their families also benefit from social worker services, grief counseling, and spiritual services. +
++Hospice care reduces what insurers pay for care at the end of life. People in hospice typically don’t receive much pricey in-hospital care, so even though their insurer pays for a lot of other services, they ultimately save money. A study published earlier this year by NORC showed that for Medicare beneficiaries who got hospice care in their last year of life, Medicare spending was $3.5 billion less — more than 3 percent lower — than it was among those who didn’t. +
++But those cost savings don’t come at the expense of the patient’s well-being. In the same study, patients and families in hospice reported better quality of life and pain control, less physical and emotional distress, and less prolonged grief. +
++Lots of patients with longer life expectancies would benefit from hospice care, but can’t get it paid for +
++The hospice benefit makes important services available for seriously ill patients and their families. But to qualify for it, a person needs to have a life expectancy of less than six months. Where does that leave people who need the same services, but don’t have as grave a prognosis? +
++For people whose serious illness causes them a lot of symptoms and their caregivers a lot of strain, the broader field of palliative care — of which hospice is sort of a subset — can be extremely helpful, even when the life expectancy is relatively long. But in the US, the difference is that while palliative care can prescribe these services, it cannot generally pay for them the way the same services are paid for when they’re provided under hospice care. +
++In the US, there’s a stark difference between what regular insurance plans pay for and what hospice pays for. So unless they qualify for hospice, it’s hard for many Americans to get the full benefit of a comfort-oriented approach without breaking the bank. That’s complicated by the fact that doctors, patients, and caregivers often have a difficult time approaching conversations about the end of life. +
++The result of linking hospice access to a six-month prognosis leads to both overuse and underuse of the benefit, said Clevenger. Overuse comes into play when providers fudge a prognosis to get badly needed services that hospice provides for a patient who might not be terminally ill. Underuse happens among terminally ill people whose end-of-life planning has been delayed. +
++By the time they qualify for hospice, people with dementia look very different from people with other terminal illnesses +
++The six-month-or-less life expectancy that the hospice benefit hinges on looks different depending on what disease a person has. Broadly, it involves a combination of medical findings, declining function, and the absence of (or a patient’s refusal of) curative treatment. +
++What makes things particularly challenging for people with dementia is that it often progresses at a slower pace than other life-threatening conditions. By the time they get to the point where they qualify for hospice, they are much sicker than with other conditions, and their family is under much more strain than the families of others. +
++That means “that person and that family’s experience is going to look very, very different from almost every other person who elects the benefit,” said Rory Farrand, vice president of palliative and advanced medicine at the National Hospice and Palliative Care Organization (NHPCO). +
++It’s a little easier to understand if you compare dementia with a condition like cancer. When a person with cancer runs out of curative options (like chemotherapy or radiation), health care providers can usually predict how many months they have to live within a reasonable margin of error. In many cases, people with the condition are still relatively functional at the time a provider tells them they have less than half a year to live. +
++It’s different for dementia, said Farrand. Dementia symptoms usually progress slowly, and there is no definitive treatment that cures it. According to the federal government’s criteria, to have a life expectancy of six months or less, people with dementia “basically have to be at a very, very, very, very advanced aspect of the illness — meaning that you are bedbound, you’re incontinent of bowel and bladder, a person has very few meaningful words,” said Farrand. +
++By that point, a person with dementia has likely been unable to function independently for a long time. Their caregivers — usually, their family — will have been bearing the strain of helping them dress, bathe, eat, and care for themselves for years. Additionally, the person has lost so much of their ability to make decisions that they can’t participate in their care. +
++The services hospice provides are often really helpful to people with dementia and their families. In the last month of their lives, people with dementia in hospice care receive what their loved ones feel is better care, and experience less sadness or anxiety, compared with those not enrolled in hospice. +
++So while the care patients and families receive once they’re in hospice is helpful, it comes much later than it would need to if it were to really alleviate the immense caregiving burden that often comes with dementia. +
++Here’s what would better serve people with dementia and their families +
++Congress created Medicare’s hospice benefit in 1982. Since then, medical science has gotten better at preventing or treating a variety of diseases that commonly cause death in older adults, including cancer, heart disease, and lung disease. That means people are living longer — which means more of them are getting old enough to get dementia. If current population trends persist, more than 9 million Americans will have dementia by 2030, and 12 million by 2040. +
++Those people and their caregivers are going to need a lot of support, said Larry Atkins, chief policy officer at the National Partnership for Healthcare and Hospice Innovation. Unless people are insured by Medicaid, or have paid for long-term care insurance, they don’t have coverage for long-term care, he said. +
++Because it offers such supportive, wraparound care that provides for both the patient and the family, “hospice is the ideal care model,” said Atkins. But its requirement that eligibility hinge on a six-month prognosis means it’s unavailable to many of the people who would most benefit from it — including people with dementia. +
++Instead of relying on prognosis, said Atkins, hospice eligibility should depend on how sick a person is, how much help they need with daily activities, and how vulnerable they are to disease or death. +
++One way the US could make hospice’s benefits more available to people with dementia is by providing them under an expanded and more generously covered version of palliative care services — what Ben Marcantonio, NHPCO’s CEO, calls “community-based palliative care.” In this scenario, people would be able to access all of the good things hospice provides at whatever point their disease becomes burdensome to themselves and their families. +
++The Community-Based Palliative Care Act, a bipartisan bill introduced earlier this year, aims to make more of the services typical of hospice available to people who are still receiving curative treatment. +
++It’s worth noting that the US has tried this model, and it works: Several years ago, a handful of sites in the US trialed the Medicare Care Choices model, which allowed people to get hospice services while also receiving curative treatment, and it worked great — there was still plenty of cost savings, and high family and patient satisfaction. +
++Meanwhile, families can do some things to maximize the likelihood that the existing hospice benefit better serves them in the event of life-threatening illness, said Farrand. “Don’t be afraid of having conversations with your loved ones about what their wishes, goals, and values are as it pertains to their illness,” or how they’d want to live their lives if they were diagnosed with a serious illness. +
++And if they’re in the midst of a serious illness, they should ask for a palliative care consult, said Marcantonio. People sometimes misunderstand palliative care as “giving up,” said Farrand, but both palliative care and hospice involve “aggressively ensuring that your quality of life is what you want it to be — that you can live the best you can, even while living with a serious illness,” she said. +
++“If anything, it’s the absolute opposite of the idea of giving up.” +
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++If you want to do good this Giving Tuesday, it’s probably a good idea to donate regularly. +
++November 28 is Giving Tuesday, the day for donations and a national conversation about how to give back and do good. Especially in a turbulent year when many of us want to give back, but also want to be cautious with our budgets, here’s one important question: If you want to donate to charity, should you go out and pick an organization today? Or should you wait, save your money, and leave it to charity in your will (or at least donate it down the road)? +
++There’s a case for either of these approaches. To some extent, the answer depends on what you think the highest priorities for donation are — and whether you think you’ll be a more informed donor later in your life. +
++On the whole, though, close observers of the nonprofit world tend to think that donating your money now is likely to achieve more good in the world than saving it up to donate after you die. That’s because donations now can, in some senses, make the donor better at doing good, and because history suggests that many of the best giving opportunities out there aren’t going to be around in 10 years — let alone in 50. +
++It might be best to give when there’s “low-hanging fruit” +
++There’s some reason to think that your money will go further if you give it now than if you give it later. +
++The case here is a little complicated. In a field like global health, we know about lots of interventions that are valuable. As more money pours into supporting an important intervention, it will probably spread widely — especially wherever the conditions are ripe for it. +
++For example, an innovation that improves traffic safety will probably first spread in the rich countries that can afford it, so that after a few years, the places lacking it will be ones where it’s complicated to deploy. A new surgery that prevents a health problem will probably first be offered in places with good medical care, to patients whose conditions don’t have added complications. Once those patients have been treated, handling the remaining cases will be more expensive. That means that money given now will go further than money given later, once we’ve already solved the problems that can be solved cheaply. +
++So for any given organization — whether it’s treating fistulas from childbirth or deworming kids — we might expect donations to be most needed fairly early on, when there are a lot of problems that can be solved easily, and to go further than they will later, when most of the problems that remain are ones that are harder to solve. Donors will have found the “low-hanging fruit” in a cause. +
++How seriously to take this argument depends on which cause you think is the most promising. In 2018, I asked Julia Wise, who was the president of Giving What We Can at the Centre for Effective Altruism at the time, for advice. “If you want to work on global health and development,” Wise told me, “the best opportunities are now.” There are already lots of organizations providing health services, and the problems they’re working on are mostly improving, so money now will probably go further than it will in five years. +
++“For causes that we know less about, where our understanding is more in its beginnings,” Wise thinks there’s a case for waiting. In a few years, we might discover a new giving opportunity that’s better than any of the existing ones. On the other hand, “in these areas where the evidence is thin, the right thing to do is fund research. If we’re all waiting for somebody else to fund things so we could find out what works, then we could be waiting for a long time.” +
++Giving now can allow charities to develop better programs — creating better options sooner +
++Giving What We Can encourages people to give every year — though some participants give to a donor-advised fund, an account that you control and from which you can choose a charity to give to later. +
++Wise pointed out that one of the most important effects your donation has is encouraging a charity that is running programs you believe in, helping them expand those programs and invest more energy there. If you’re strategic about donating to charities that are running trials of promising new programs and learning through their research how to best get results, then your donations can actually change which giving opportunities are available in the future. +
++“We’ve been really encouraged to see evidence-based charity growing as people are supporting it with their donations,” Wise said. “We see that as improving the charitable landscape and making it so charities have an incentive to continue conducting and participating in research about their work, so everyone can know the best places to donate.” +
++This incentive effect works much better with living, active, engaged donors. Charities will respond to donations this year by thinking about what work they need to do to still be a good target for donations next year. “If we delay,” Wise said, “we’re not participating in improving the state of knowledge.” +
++Giving now might help you commit to a generous life +
++“My husband and I have decided to donate now rather than waiting until later,” Wise told me. “Part of that is thinking that works best with our motivation. It makes it a steady part of our life rather than part of the indefinite future.” Telling yourself you’ll donate someday in the distant future isn’t the same as donating every day. +
+ ++People who’ve taken Giving What We Can’s pledge often describe the same motivation. “Giving now cultivates your own virtue, and ensures that you’ll continue to live up to your own ideals,” Haseeb Qureshi wrote in an essay about this question. “You are not a perfect creature. Even if you intend to do something hard now … you always have to factor in the possibility that you’ll change your mind or regress.” The best way to be someone who will want to give away money in your will, then, is to give money now. +
++Wise also thought habits were important, so much so that she recommended people donate a little bit of money even if they’re early in life and building their limited savings. “It can be good to donate on a regular basis so you’re still making decisions about where to give and keeping it a part of your life,” she told me. +
++Giving later might help you be a more informed donor +
++But there are good reasons to consider delaying your donation. Some charities are vastly more effective than others. Some highly effective charities are so flooded with money that they don’t use additional donations to expand their programs — meaning that your money won’t achieve much. +
++That variance in effectiveness is a reason why you might want to give later instead of giving today. If you don’t know much about the opportunities out there, it’s not a good idea to pick a charity haphazardly without a clear understanding of what it will do with your money and why it’s competent to do it. A few thousand dollars to charity can save a life. It should be treated as seriously as any other decision that could save a life. +
++If you want to commit to giving now, but you don’t feel equipped yet to make an informed choice about where to give, one option is a donor-advised fund. You make the donation now (and take the tax deduction now) but can choose any qualified charity to donate the money to later. Donor-advised funds are one way to set aside the money for charity while giving yourself more time to learn. +
++But this is probably a reason to wait five years, not 40. You’d have to do a lot of ongoing research to keep your will up to date with the giving opportunity you’ve found the most promising — and once you’re doing all of that work and have identified the best giving opportunity out there, it’s probably worth just giving to it. +
++Update, November 2023: This story was originally published in 2020 and has been updated for 2023. +
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