Hospitals are not the only ones who rely on volunteers.

Nonprofits rely on them for aging programs. Faith communities rely on them for spiritual formation. Philanthropy relies on them for legitimacy. Even emerging “wellness” and “compassion training” industries rely on them for content and credibility.

But no one ever asks: Who sustains the sustainers?

For more than 20 years, I have watched hospital volunteers become the invisible infrastructure of modern care. We are not clinicians. We do not diagnose or prescribe. We sit. We listen. We accompany older adults through confusion, fear, and boredom.

There is no reimbursement code for that. Yet without it, the patient experience often crumbles.

The invisible workforce

Recently, my brother, a gifted hospital volunteer and social worker, joined a spiritual theater program operated by a faith-based organization. Their mission was to “cultivate compassion” through performance and service. The program recruited heavily from hospital volunteer groups.

Hospitals had already trained these volunteers to tolerate silence, to absorb anxiety, and to practice slow care. The theater program did not need to teach those skills. They simply harvested them.

After several sessions, my brother told me: “We provide the emotional labor the system depends on, but we don’t belong to the system.”

He wasn’t criticizing the program. He was describing the role volunteers play in every sector that uses them.

Hospitals use volunteers to bridge the emotional gap left by understaffed clinical teams. Nonprofits use volunteers to sustain their missions. Faith communities use volunteers to pursue spiritual formation. Aging societies use volunteers to fill the vacuum between independence and long-term care.

Across these settings, volunteers are treated as supplemental, inexhaustible, and low-cost resources. In reality, we are none of those things.

What volunteers provide is not charity. It is emotional labor, relational presence, and continuity, the kind of low-intensity, high-value caregiving that keeps older adults grounded but exists in none of our workforce models.

The shock absorbers

We see this clearly in aging societies like Taiwan, where integrated older-adult care is increasingly framed as “medicine + exercise + nutrition,” sometimes referred to as a “Yi-Dong-Yang” model. Physicians deliver the medicine. Trainers deliver the exercise. Dietitians deliver the nutrition. But it is the volunteers who deliver the relationship that binds them together.

If the gift has a name, it is this: We do the work no one else has time to do, but everyone agrees must be done.

Medicine has learned to measure caregiver burden and survivorship. Public health has learned to measure cost-effectiveness. But informal volunteer burden remains unmeasured and unnamed. Informal caregivers are labeled as family. Volunteers have no label at all.

We are the shock absorbers of the health care system.

We absorb sadness, uncertainty, and anger without billing, documentation, or supervision. We witness delirium, dementia, and despair in ways that rarely enter the chart. We practice relational medicine without authority, and without debriefing.

A call for sustainability

The irony is this: Everyone now talks about sustainability. Hospitals have sustainability plans. Nonprofits have sustainability plans. Faith communities have theirs too. But none of them include the volunteers who make their missions possible.

If sustainability is truly the future of health care, it must include the human resources, paid and unpaid, that sustain patients, families, and communities.

Volunteers do not need a paycheck. We need recognition that emotional labor is labor. We need debriefing instead of mystique. We need a sustainability plan that allows us to keep showing up without burning out.

Health care cannot afford to lose volunteers. In aging societies, no one can.

Gerald Kuo, a doctoral student in the Graduate Institute of Business Administration at Fu Jen Catholic University in Taiwan, specializes in health care management, long-term care systems, AI governance in clinical and social care settings, and elder care policy. He is affiliated with the Home Health Care Charity Association and maintains a professional presence on Facebook, where he shares updates on research and community work. Kuo helps operate a day-care center for older adults, working closely with families, nurses, and community physicians. His research and practical efforts focus on reducing administrative strain on clinicians, strengthening continuity and quality of elder care, and developing sustainable service models through data, technology, and cross-disciplinary collaboration. He is particularly interested in how emerging AI tools can support aging clinical workforces, enhance care delivery, and build greater trust between health systems and the public.