Ontario Volunteer Centre Network

The Contributions of Volunteers in Health Care Organizations

Case Studies

October 7, 2011

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Introduction Ontario’s health care system is massive, diverse and complex. Consider the following:

154 public hospital corporationsi;

440 children’s mental health agencies ii;

330 community mental health agenciesiii;

150 addiction agenciesiv;

98 hospicesv;

73 community health centresvi;

10 Aboriginal Health Access Centres vii; … and that list is not exhaustive. A wide array of other agencies and groups make an equally significant contribution to the health of Ontarians. Given that, it’s not surprising that 450,000 of the 5 million Ontario residents (9%) who volunteered in 2007 dedicated their time to the province’s health care system.viii What may be surprising is that volunteers in 21 hospitals alone provided more than one million hours of unpaid labour in a single year – 205 hours each, on averageix. Their roles, and those of their colleagues, are as diverse as the system itself: some work with patients directly, others serve in a leadership capacity, while others offer the type of specialized skills (resource development, for example) for which the organization would otherwise have to hire staff or pay for services. In doing so, they benefit the organization, the individuals they serve, their communities, and the health care system as a whole. The following case studies were collected by the Ontario Volunteer Centre Network (OVCN) to illustrate benefits delivered to health care in Ontario from the collaborative efforts of Volunteer Centres, community benefit organizations, and individual volunteers. Established in 1995, and formalized with approved terms of reference in 2003, the OVCN serves as the provincial network for all of Ontario’s 23 recognized Volunteer Centres, and as their collective voice. Through projects such as Change the World (the Ontario Youth Volunteer Challenge) and Building Stronger Foundations, the OVCN encourages and promotes volunteerism, provides tools and resources for volunteer managers, and strengthens the individual and collective ability of Volunteer Centres in Ontario. The OVCN and its members are indebted to the Ontario Trillium Foundation for funding this study.

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Case Studies This paper profiles four of the dedicated volunteers1 whose contributions enrich lives, support organizations, and ensure the sustainability of our health care system – now and in the future. It also focuses on the agencies with which they are involved and the role of Ontario’s Volunteer Centres in facilitating and supporting that relationship. From each of those perspectives, the benefits that accrue from their involvement are profound. Angela

Twenty years ago, having received help at a particularly difficult time in her life, Angela decided to give back by helping others. Summoning up her courage after attending a public presentation on palliative care, she made a call to Warmhearts Palliative Caregivers – a Sudbury-based agency that provides compassionate support for individuals and their families who are dealing with end-of-life issues. Angela found her calling at Warmhearts, and discovered that the work was satisfying, fulfilling and very rewarding. Two decades and 82 clients later, she still remembers her first: “There was a reason he was put in my life. I was getting as much from the visits as he was, probably more. I became his confidante, his family, and I helped him celebrate his life. He (and my other clients) helped me grow personally and spiritually.” She reflects on that growth: “The experience has completely changed my perspective about life and death. My life is enriched with unbelievable experiences, unforgettable memories and so many blessings that I will cherish forever.” Angela’s relationships with her clients are rich and deeply personal: “The volunteer’s main role is to provide comfort to the client and the family - to listen - but more importantly, to hear ‘what’s in their hearts’. Many times, when there is nothing else one can do, the volunteers do the only thing that matters: we offer comfort by just being present. No words are necessary.” Angela’s response to her clients’ needs is as varied as the individuals themselves, and often creative: “In one case, I was part of a team of volunteers. We all had different roles. One volunteer read to the client; she said that nobody could brush her hair like I could, so that became my job. It’s the little things that make a difference.” In another: “I line danced in the hospital. I don’t know what made me do it, but some nurses joined in and the client loved it.” Another time: “I wrote a song, it showed my client that she mattered in life.” And clearly they matter in hers: “This journey has taught me not to sweat the small stuff – and compared with dying, almost anything else is small stuff. I quickly learned to appreciate the little things we take for granted. Dying individuals teach you so much about living. Their stories are remarkable. It’s truly been a learning experience about courage, strength and hope. Our

1 The names of some of the volunteers have been changed to protect their privacy and that of their clients

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clients are the inspiration for me and my fellow volunteers to continue our work in hospice palliative care.” Just as Angela supports her clients and their families, Warmhearts ensures that they support their more than 170 volunteers by providing them with training and education, debriefing with each volunteer when he or she loses a client, teaching them to set boundaries and to cope with the emotions involved in working with people who are dying. On a regular basis, they celebrate the extraordinary contributions of volunteers like Angela with special recognition events. With just five staff and a mandate to cover Greater Sudbury, Sudbury East and Manitoulin Island, Warmhearts provides a hospice volunteer visiting program, advocacy, bereavement support, and hospice palliative care education. “Warmhearts depends largely on volunteers to deliver effective and professional service to the client,” says Madeleine Sauvé, Client Services Coordinator. “Volunteers also contribute to our success by fulfilling other roles ranging from public awareness, advocacy, education and revenue development to administration and governance – in short, every aspect of our agency’s mandate.” Warmhearts is supported, in turn, by its membership in Volunteer Sudbury/Bénévolat Sudbury, which assists the agency by promoting volunteerism, educating on best practices and referring the most appropriate volunteers to fulfill the organization’s mission. Volunteer Sudbury seeks volunteers from the community through a variety of methods: presentations to focus groups; kiosks at health, education and community fairs and events; postings on the website and requests through its contact list. The volunteer center keeps its members informed of training opportunities, new information in the field and strategies for volunteer appreciation, and co-hosts pertinent presentations and a networking group. According to Diane Charette-Lavoie, Manager of Volunteer Sudbury: “We help volunteers to understand the needs of organizations such as Warmhearts, so that they will be better prepared for their commitment to the community.” Together, all three – Angela, Warmhearts and Volunteer Sudbury – form a powerful chain, one that reflects Warmhearts’ slogan: “Holding hands, touching hearts, wherever they may be” and enables the organization to enhance the quality of life for people whose lives are ending, eases their transition from life to death, and supports their families in coming to terms with the most final of goodbyes. Without Warmhearts and volunteers like Angela, more people would die alone – at home, or in hospitals, hospices, retirement homes and nursing homes. More families would face the financial burden of hiring private care, and the health care system would experience even greater demands on its already stretched resources.

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Nicole

Nicole, like many of her colleagues at the Canadian Institute of Chartered Accountants (CICA), believes that the corporate community has a responsibility to support the work of Ontario’s health care system. Motivated by that belief, she joined with her colleagues to explore volunteer opportunities; Volunteer Toronto put them in touch with the Centre for Addiction and Mental Health (CAMH). Together, CICA staff have reinvigorated and helped to maintain CAMH’s Garden of Remembrance for the last three years. The garden, created in memory of a client who died many years ago, was intended to be a green space where current clients could seek respite. However, with few resources available at CAMH to maintain it, the garden had become unkempt and a less-than-uplifting sight for the many clients whose rooms overlook it. That is, until the CICA showed up. Twice yearly, 15 CICA staff arrive to plant and prune, water and weed, and ultimately, create a space that, according to Jim Davey, Coordinator of Corporate Volunteers for CAMH Volunteer Resources, “promotes recovery and wellness.” Working in partnership with the recreation therapist and the Centre’s clients, the efforts of CICA staff pay off in more than just pansies and petunias. “My colleagues have come to realize the value of volunteering – some of them have even sought out volunteer activities on their own – a first, for many of them,” says Nicole. “They’re proud of the work they do, and have developed a sense of community and an attachment to CAMH. We’ve bonded as a team.” The experience has helped to demythologize mental illness, raised the awareness of CICA staff about the issues surrounding mental health, and increased their understanding of the all-too-pervasive stigma experienced by those with psychiatric problems. It has also helped some of them to be more forthcoming about their own struggles with mental illness, or those of their families. The benefits are equally diverse for CAMH clients. According to Nicole: “Our presence in the garden is felt – it tells clients that someone knows that they are there, and that they deserve a nice place, too… We provide an important link with the community and the world outside the institution that would otherwise not be available.” Jim Davey elaborates: “CICA staff, like our other corporate volunteers, makes an effort to establish a rapport with clients. They encourage them and, through their engagement, instill confidence and self esteem. The main focus is on engaging the individual, not the illness – and it’s that connection that has a huge impact on our clients – they feel welcomed and accepted, part of the community.” Jim continues: “That relationship with the community helps to restore and maintain their health which, in turn, reduces risk of relapse,” – a substantial return for such a modest investment.

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Volunteer Toronto helped to leverage that investment. For the CICA, like other potential corporate volunteers, the involvement of Volunteer Toronto provides a third party endorsement of CAMH – a significant asset, given that mental health institutions often experience the same stigma as the people they serve. Deborah Gardner, Executive Director, Volunteer Toronto notes that, since establishing their connection through the garden project, her centre has also been involved with CAMH in a wide variety of other activities - most recently as a partner in the national emergency planning project initiated by Volunteer Canada. Volunteer Toronto shares CAMH’s commitment to cultural competency and has even become a corporate volunteer for CAMH in the interest of reducing stigma among its own staff. Mildred

After a lifetime as a nurse, Mildred wasn’t quite prepared to retire. Instead, at 72, she became a volunteer for the Alzheimer’s Society of Kitchener-Waterloo (K-W). Six years later, she describes her role: “I provide care for the caregiver – it allows them to get away for a few hours, instead of having to be ’on duty’ 24/7. I take people for walks – the exercise helps to keep them healthy.” The stimulation she provides – sharing photos, reading to her clients – helps maintain their cognitive abilities. Her only wish: that there were more of her. “If there were more volunteers (which would allow for more frequent visits and longer hours),” she says, “families would benefit even more.” She admits that there are challenges: “Sometimes, people (your clients) don’t recognize you. Families may be in crisis – not yet ready to place their loved one into long term care, but unable to cope.” And she imagines what would happen if volunteers were not available: “Families (many of whom can’t afford the $20 an hour it would cost) would have to pay for respite or rely on the limited resources available through the Community Care Access Centre. Clients would enter nursing homes much sooner.” And, perhaps most significantly from the perspective of the health care system, “calls to 911 and visits to the Emergency Department would increase.” Jill Mercier, Volunteer Companion Program Lead with the Alzheimer Society K-W recognizes Mildred’s value to her organization, and that of the other 100 + ‘core’ volunteers: “By contributing their time and talent, volunteers serve as extra hands whose skills augment those of our staff and allow us to spend more time on direct service. They provide input from, and knowledge of diverse communities, and help to increase public awareness of the Society. They often come to the position with skills and knowledge about Alzheimer’s disease and related dementia that they have acquired through their work experiences.” She describes Mildred’s role: “She’s been matched with several families over the years, and has become a friend and a strong advocate for the people she visits – both the person with dementia and their spouse, whom she ‘walks alongside’ as the disease progresses.”

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Like Mildred, Jill believes that her volunteers provide significant benefits. These benefits are illustrated in the ‘Rising Tide’ study, published by the Alzheimer Society of Canada, which found that volunteers help to increase physical activity, improve diet and enhance lifestyle, provide caregiver support, and assist families in navigating an often confusing health care system. None of that is a surprise to Jane Hennig, Executive Director of the Volunteer Action Centre of Kitchener Waterloo and Area. “In our role, we hear many stories of amazing volunteers like Mildred who contribute so much to our community. We also recognize the complexity of volunteer involvement and the related risk management strategies implemented for the well-being of the clients, the volunteers and the organizations.” What is clear from the Alzheimer’s Society story is that the need for highly skilled, dedicated, and long-term volunteers is paramount for service delivery. Jane emphasizes that: “It is vital for support resources like the Volunteer Action Centre to consult, collaborate, and provide guidance to community benefit organizations on the best practices in volunteer management that will ensure proper matching, training, supervision, and recognition of volunteers like Mildred. If we are to continue to retain these long-term volunteers, we must do a very good job in ensuring their experience is a positive one.” Jane notes that long-term volunteering is, however, not the strongest current trend in volunteering: “The Volunteer Action Centre also works with all of its member organizations to facilitate the motivations and interests of the evolving volunteer environment. Developing program directions that attract short-term, sporadic volunteers to meaningful and beneficial activities is essential to sustaining community organizations. We support organizations’ initiatives that foster creativity in program development and enhance short-term experiences for volunteers.” Both organizations are aware of the challenges inherent to the changing face of volunteering, but are optimistic about the positive effect that working in cooperation continues to have on their community. Jane is enthusiastic about the variety of collaborations between the Volunteer Action Centre and the Alzheimer’s Society. “As organizations like the Alzheimer’s Society meet growing demands for service through their volunteers, the Volunteer Action Centre works to find new connections that will expand the volunteer base for them. We have helped to bridge connections with local post-secondary education institutions to help inform and engage future generations and build their awareness of the value of volunteering. The Alzheimer’s Society has been an active participant in working with new audiences in order to develop volunteers who might move into vital long-term roles like Mildred’s.” Jill agrees, noting: “We appreciate the Volunteer Action Centre for being available and supportive as a bridging resource for us.”

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Margaret

In her twenty-nine years as a volunteer with Brockville General Hospital (BGH) Margaret has served in many roles. From circulating among the wards with the auxiliary snack wagon, to delivering flowers, to feeding patients in the complex continuing care ward, Margaret’s nurturing tendencies and sunny disposition have been put to good use. More than twenty times a month for the past 13 years, she’s fed people who are unable to feed themselves. And it’s not just about dinner. For someone whose life is defined by the hospital walls and the unrelenting sameness of its schedule, the quality time and social interaction Margaret offers is as important as the meal itself. Although they may have trouble communicating, her patients let her know how much they appreciate her contribution to their lives: “One of my patients has a wonderful smile – her eyes brighten when I come in.” Despite that, and despite having received the highest honour available to a health care volunteer (the Hospital Auxiliaries Association of Ontario Provincial Life Membership award) Margaret is convinced that she gets back as much as she gives: “I enjoy the work – especially talking to people.” And she understands the fragility of the human body: “I often think that it (immobility) could happen to me.” What she doesn’t say is how important it would be for her to have another ‘Margaret’ available if it did. Christine Deault knows all too well the value of Margaret’s contribution. As Coordinator of Volunteer Services at BGH, she’s proud of the Volunteer Association’s 121 years of continuous service. She notes that, in 2010/11, BGH volunteers provided 26,563 hours of service – in addition to those contributed by Palliative Care volunteers and members of the hospital foundation. She describes the work they do: “Volunteers provide service to patients on two nursing floors – they deliver ice water, take away breakfast trays, replenish supplies and chat with patients.” In Day Surgery: “Volunteers wheel patients to their car on discharge, help the person who’s meeting them, liaise with families in the waiting room.” Since January, they’ve also provided support in the Emergency Room: “… providing blankets, ice packs, coffee or juice.” They don’t, she emphasizes, replace professional staff. Instead, they allow nurses more time for patient care by assisting with non-nursing tasks, which might otherwise be left undone (such as hair care) or done quickly (feeding, for example) without the added value that people like Margaret are able to provide. In general, they help patients be more comfortable, and make an inherently challenging experience less difficult. Christine also notes the importance of volunteers as the hospital’s ambassadors in the community: “They help us to stay engaged,” and they participate in consultations about the design of Brockville’s health system.

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Frank Rockett supports the work of the BGH Volunteer Association. As the Executive Director of the Volunteer Bureau of Leeds-Grenville, Frank provides the type of training and information about best practices on which Christine relies. The Bureau’s volunteer-matching web portal also links people looking for volunteer opportunities with agencies that need their service. Frank sees his job as “promoting volunteerism” – a role that he fulfills through participation in special events and community fairs, and by focusing the media’s (and, consequently, the public’s) attention on the worth and value of volunteers. He is committed to “keeping volunteerism in the minds of politicians,” and works hard to do exactly that. His only regret is that, with a very limited budget and a very large region to serve, he is unable to do more.

Why It Matters The cost of Ontario’s health care system is growing at what most consider an unsustainable pace. Consider the following:

The 2011 provincial budget allocated $47 billion to health care.x

Between 1989 and 2009 the per capita cost of health services more than doubled - from $1,500 to $3,500 for every Ontarian.xi

Health care currently accounts for 42% of the Ontario government’s total program spending, and could rise to 50% in the near futurexii, causing at least one analyst to refer to health care as the “Pac Man” of provincial budgets.xiii

The percentage of people over 65 in the population will rise from 13.7% in 2007 to 21.9% by 2030. xiv Each of those 3.7 million seniors can be expected to place increased demands on the province’s already overburdened health care system – costing three times more, on average, than their younger counterparts.xv

Given those startling figures, it’s not surprising that all of us – taxpayers, politicians, policy analysts and health care providers themselves – are looking for ways to relieve the pressure on the system while, at the same time, ensuring that it continues to provide the high quality care that Ontarians need and expect. Volunteers, and the agencies that support them, contribute significantly to that effort.

The time (61 hours per volunteer, according to Giving and Volunteering in Ontario) and expertise that Ontario’s 450,000xvi health care volunteers contribute to the province’s health care system has considerable monetary value. Even at the modest hourly rate ($16.50) used in Volunteer Canada's “Volunteer Management Audit, 2001,”xvii the total contribution of all health care volunteers in Ontario can be estimated at $452 million per year. The size of that contribution rises dramatically (to $555 million per year), if the more recent hourly rate ($20.25) set by a major US organization in 2009 is appliedxviii.

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Whichever figure is used, it’s clear that volunteers contribute enormously to the sustainability of Ontario’s health care system from a financial perspective. For a system in which funding is increasingly tight, that’s a contribution that must not be undervalued.

Estimating the monetary value of volunteer time and expertise is only the beginning. Assessing the contribution of volunteers in the health care system must also consider the types of non-monetary advantages demonstrated in just these four case studies:

As demonstrated in Angela’s story, volunteers can help to reduce the number of emergency department visits and hospitalizations by helping people who have chronic illnesses or those who require palliative care to remain longer in their homes.

Margaret shows us that, volunteers can help to deliver essential services such as feeding in acute care environments, which helps to relieve the pressure on professional staff and enhances the quality of life for the patient.

Mildred’s experience makes it clear that, volunteers can help to reduce early admission to long-term care facilities by helping seniors to maintain brain health, and remain as independent as possible for as long as possible.

Nicole and her colleagues demonstrate the power of volunteers to help reduce the stigma and isolation associated with mental illness by helping people to connect with the community, and focusing on the individual, not the illness.

Angela, Margaret, Mildred, Nicole and the almost half a million other health care volunteers like them are providing an invaluable service – one that we cannot do without. The Ontario government has demonstrated a strong commitment to controlling health care costs while also maintaining and enhancing the care that Ontarians receive. In light of that commitment, the corps of volunteers that contribute so generously to that system must be recognized and strongly supported.

As Jane Hennig has observed, volunteer involvement is a complex process. Matching volunteers with organizations and roles, providing them with the tools and resources they need to be successful, recognizing their contributions, and ensuring risk management and due diligence require the skillful management of volunteer resources.

The organizations that support Ontario’s volunteers, and the Volunteer Centres that, in turn, support those organizations each play a pivotal role in ensuring the sustainability of Ontario’s health care system. It is critical then that we, as a province, support them.

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Appendix: Project Methodology In January 2011, the OVCN received funds from the Ontario Trillium Foundation to develop a Case Study document focused on the contributions of volunteers and Volunteer Centres in Ontario’s health care sector. An external consulting firm was engaged through a competitive selection process, and the project was completed under the direction of a steering committee comprised of OVCN member representatives. The Volunteer Action Centre in Kitchener-Waterloo acted as the lead for the project.

To obtain case examples that could be included in the research, a questionnaire for health care organizations and a package of explanatory material were developed by the consultants in consultation with the project steering committee. Those documents were forwarded to all members of the OVCN on April 8th with a request that they forward the materials to up to five health care organizations to which they provide services. Health care organizations were asked to:

describe the involvement of volunteers in their organizations;

comment on the benefits accrued from the contribution of volunteers;

provide a detailed description of one volunteer’s role and contributions; and

identify the ways in which the services provided by Volunteer Centres have supported the organization’s engagement, retention, and management of its volunteer corps.

Completed submissions were requested by May 6th; fourteen organizations responded. Their submissions described a broad range of volunteer roles and contributions in a variety of health care settings – ranging from hospitals and community health centres to palliative care and chronic illness support programs. It was noted that the number of cases submitted was somewhat less than anticipated because volunteers may be reluctant to ‘tell their stories’ –many may not understand what’s unique or ‘special’ about the work they do, and may feel uncomfortable being singled out for their contribution. Four submissions were selected to be featured in the case study document, using criteria developed in consultation with the project steering committee. It should be noted that, although all four of the case examples described in the study involve female volunteers, thirty five percent of the individual volunteers described in detailed case examples were male. For each of the examples selected, telephone interviews were utilized to build an in-depth picture from the points of view of the volunteer, the health care organization, and the Volunteer Centre. Findings from the interviews were documented as ‘stories’ which were intended to convey the highly individualized nature of volunteer involvement and to highlight the many benefits of those contributions to patients and clients, health care organizations, the community, and the volunteers themselves. Each ‘story’ was reviewed by those whose experience it described prior to being finalized for inclusion in the Case Study document. The consultants wish to extend special thanks to the volunteers and the staff of health care organizations and Volunteer Centres for contributing their stories to this document.

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Endnotes i Ontario Hospital Association www.oha.com/ABOUTUS/WELCOME/Pages/Default.aspx . ii Navigating the Journey to Wellness: The Comprehensive Mental Health and Addictions Action Plan for Ontarians (2010). Final Report of the Select Committee on Mental Health and Addictions. Available at: www.ontla.on.ca/committee-proceedings/committee-reports/files_pdf/Select%20Report%20ENG.pdf . iii Navigating the Journey to Wellness: The Comprehensive Mental Health and Addictions Action Plan for Ontarians (2010). Final Report of the Select Committee on Mental Health and Addictions. Available at: www.ontla.on.ca/committee-proceedings/committee-reports/files_pdf/Select%20Report%20ENG.pdf . iv Navigating the Journey to Wellness: The Comprehensive Mental Health and Addictions Action Plan for Ontarians (2010). Final Report of the Select Committee on Mental Health and Addictions. Available at: www.ontla.on.ca/committee-proceedings/committee-reports/files_pdf/Select%20Report%20ENG.pdf . v Hospice Association of Ontario. Available at: www.hospice.on.ca/faq.php#where. vi Association of Ontario Health Centres. Available at: www.ontariochc.ca/index.php?ci_id=2341&la_id=1 vii Association of Ontario Health Centres. Available at:www.ontariochc.ca/index.php?ci_id=2341&la_id=1 viii Lindsey Vodarek, David Lasby and Brynn Clarke. Giving and Volunteering in Ontario: Findings from the Canada Survey of Giving, Volunteering and Participating (2007) pp. 18-21. Imagine Canada. Available at: www.givingandvolunteering.ca/files/giving/en/reports/ontario_report_en_2007_21122010.pdf ix D. Kew, L. McGrattan and M. L. Tinmouth. Volunteer Resources: Healthcare Benchmarking 2009/10 Results. Professional Administrators of Volunteer Resources – Ontario (p. 5-7) x 2011 Ontario Budget: Chapter II: Ontario's Economic Outlook and Fiscal Plan- Section H: Details of Ontario’s Finances. Available at: www.fin.gov.on.ca/en/budget/ontariobudgets/2011/ch2h.html xi Ideas and Opportunities for Bending the Health Care Cost Curve: Advice for the Government of Ontario (2010). Ontario Association of Community Health Centres, Ontario Federation of Community Mental Health and Addiction Programs, and Ontario Hospital Association. Available at: www.oha.com/News/MediaCentre/Documents/Bending%20the%20Health%20Care%20Cost%20Curve%20(Final%20Report%20-%20April%2013%202010).pdf xii Ontario's Long-Term Report on the Economy, Chapter 3: Long-Term Sustainability of Ontario Public Services (2010). Ontario Ministry of Finance. Available at: www.fin.gov.on.ca/en/economy/ltr/2010/ch3.html#ch3_2 xiii Don Drummond, Charting a Path to Sustainable Health Care in Ontario: Special Report (May 27, 2010). TD Bank Financial Group. Available at: www.td.com/economics/special/db0510_health_care.pdf

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xiv Ontario's Long-Term Report on the Economy, Chapter 3: Long-Term Sustainability of Ontario Public Services (2010). Ontario Ministry of Finance. Available at: www.fin.gov.on.ca/en/economy/ltr/2010/ch3.html#ch3_2 xv Ontario's Long-Term Report on the Economy, Chapter 3: Long-Term Sustainability of Ontario Public Services (2010). Ontario Ministry of Finance (2010). Available at: www.fin.gov.on.ca/en/economy/ltr/2010/ltr2010.pdf xvi Vodarek, Lindsey, David Lasby and Brynn Clarke. Giving and Volunteering in Ontario: Findings from the Canada Survey of Giving, Volunteering and Participation (2007), pp. 18-21. Imagine Canada. Available at: www.givingandvolunteering.ca/files/giving/en/reports/ontario_report_en_2007_21122010.pdf xvii Volunteer Management Audit: The Canadian Code for Volunteer Involvement (2001), Volunteer Canada. Available at: http://www.volunteerguelphwellington.on.ca/useredits/File/ManagementAuditEng.pdf xviii The Value of Volunteer Time (2010) The Independent Sector. Available at: http://independentsector.org/volunteer_time