With 23 hours of training required — and knowing they will be dealing with families facing the death of a loved one — becoming a hospice volunteer is not something the 20 men and women involved with Visiting Nurse & Hospice of Fairfield County take lightly.

For Peggy Ottman of Wilton, it is some of the most fulfilling work she has ever done. And she has done some pretty substantial volunteer work — first as an EMT and then in a hospital infusion center where people receive chemotherapy treatment.

"I found when I was an EMT I'm a very good hand-holder. My strength is being the peaceful presence," she said in an interview at the agency's office last week.

Working at the infusion center led her to the hospice program. "I am really fulfilled by this," she said. "It's a very quiet way to volunteer."

The agency recently graduated seven new hospice volunteers. Their training included information on the diseases they would most likely be dealing with, Alzheimer's and dementia being the most common. They also went through OSHA training on a number of issues including infection control.

"They learn about confidentiality laws, about death and dying," said Chris Urpin, the agency's volunteer coordinator. "They learn effective communication and how to listen, how to do a life review with a patient. Basically reminisce," she added.

While most hospice volunteers are women, there are a few men in the program, and Ms. Urpin said more are needed. "We have requests for more men" from families, she said.

Potential volunteers go through a variety of screenings, Ms. Urpin said, and the primary attribute the agency looks for is compassion.

Volunteers provide companionship for the patient and respite for caregivers, who are often family members.

With a volunteer in the house for an hour or two a week, it gives caregivers a break to either take some time for themselves or run errands to keep their household going.

When a patient is not alert, a hospice volunteer can simply be a "peaceful presence," Ms. Urpin said.

That is the case with Ms. Ottman's current assignment. Ms. Ottman, who received her training in 2008, is currently working with an older woman living in a nursing home and suffering from dementia.

"We don't talk much," she said. "We listen to music together."

Hospice work is special, she said. "Generally it's the end of someone's life. It's sad to me that some people are alone."

This is Ms. Ottman's fourth assignment. Her previous case was much different. It was a home assignment and she was with a man suffering from cancer for a year.

"We got very close," she said. "I got to know his family." He died this summer.

"It was very sad when he died," but of her experience, she said, "I wouldn't trade it for anything. He gave as much to me as I may have given to him."

Of visiting her patient in a nursing home, she said, "It's a little different but it's still meaningful. It's not about me, just them."

The volunteers visit their clients for one hour a week. They do no hands-on work, but they may be asked to run errands for a family or drive a family member.

Volunteers assigned a patient attend a monthly meeting at the agency, where they can talk about issues or concerns and enjoy the camaraderie of their colleagues.

When a patient is admitted to Visiting Nurse & Hospice of Fairfield County, a nurse or social worker reviews the services offered, and providing a volunteer is one of them. Within five days of admission, Ms. Urpin calls the family to follow up.

Growing trend

The need for volunteers like Ms. Ottman will probably only increase in the years ahead.

Visiting Nurse & Hospice of Fairfield County experienced a 100% increase in hospice and palliative care patients in the last year.

"Today we have 42 patients in the hospice program and 35 on palliative care," said Sharon Bradley, the agency's president and CEO.

"This time last year we had 35 altogether."

Much of that growth is attributable to the closure last year of Visiting Nurse & Hospice Care of Southwestern Connecticut, which was based in Stamford.

Hospitals and physicians in the area either know Ms. Bradley or Christine Pfeffer, director of the hospice program, as nurses or they know someone the agency staff has cared for, she said.

"The program has also grown due to our outreach, our support groups for the newly bereaved," she added. "As people get to know us," she said, they might be inclined to mention the program to someone they know suffering a chronic or life-limiting illness.

The agency can provide clients a full range of services through all stages of an illness. Should a person experience a crisis — often a hospital admission — it is usually a difficult time to make decisions about future care.

"That's the point of time you least need a change of caregivers," Ms. Bradley said.

Should a person's "goals of care" change, the agency can adjust with them.

"There are many things that can be done at home," she said. "Our staff can work very actively with a person's physician.

"Most people when they talk about a natural death, they would like that at home," she said.

A century ago when the agency was founded, most people died at home. "Today there are very technologically intensive treatments," she said, and sometimes people do not wish to subject themselves to that.

The agency offers hospice services at home, in a skilled nursing facility, in assisted living facilities, and at Stamford and Norwalk hospitals.

While the agency offers hospice care to all ages, as the population ages hospice services will grow, Ms. Bradley said, "particularly for people with very serious dementia."

The Affordable Care Act, she said, offers more financial support for people to have end-of-life conversations with their doctors.

"Medicare now covers end-of-life planning with a physician," she said. "That's an important element in getting the conversation going."

In the future, the act will provide more funding for community-based care in all forms, she said, including hospice, home care, visits to the doctor, and community education programs.

Information: visitingnurse.net or 203-834-6341.