The Biggest Barriers to Hospice Recruiting

As hospices sweat over recruitment and retention, many say that competition on wages and benefits is the leading barrier, as well as widespread misperceptions of their services.

Their employees, however, also cite burnout and the lack of flexibility of a career path as reasons they may leave the field.

A majority of hospices who responded to a survey by senior citizen advocacy group LeadingAge and consulting firm BerryDunn indicated that compensation, benefits and misperceptions were their biggest hiring challenges, according to a recent report. The survey was designed to identify best practices related to home health and hospice providers’ most pressing problems.

For several years running, staffing has been at the top of that list.

“Many of the most successful hospice organizations managed to accommodate for these [staffing] deficits without losing quality,” the report indicated. “Strategies revealed in the study include increasing the amount of social workers and re-allocating non-clinical responsibilities, such as scheduling, to other areas of the organization.”

The long-standing hospice and palliative care workforce shortage has worsened significantly during the pandemic, threatening not only profit margins but access to care for patients and families. A number of hospices have shut down or sold their businesses because they could not hire enough workers.

Providers have also had to compete for new hires with better capitalized organizations like health systems or travel nurse companies. Generally speaking, these have been able to offer nurses higher wages and more flexible as demand for their services increased during scheduling COVID.

Nearly every hospice came by LeadingAge and BerryDunn (98%) said that the workforce shortage has had a negative or “extremely negative” impact on their organization, according to the report. Close to 8-0% claims that at least 20% of their registered nurse positions are currently unfilled.

While most health care organizations have seen a rise in turnover during the pandemic, hospices seem to be having a rougher go, the survey found.

Most reported turnover rates of 16% to 20% during the past 12 months. But more home health agencies than hospice agencies had turnover rates of less than 10%, while more hospice agencies had turnover rates of 30% or higher.

Agencies to some extent have helped mitigate the risk of turnover by bolstering their cadre of social workers, who can take on more of the conversations and other support that in their absence would fall on nurses.

Shifting other nonclinical responsibilities for nurses to other employees also appeared to slow nurse turnover, with scheduling as one of the main tasks identified.

But the biggest determinant was compensation.

Even though hospices have been helping clinicians’ pay during the pandemic — with some also offering signing or retention bonuses — larger providers such as health systems have been able to offer more.

Hospice worker wage and salary increases ranged from 3% to 6% during the last two years. Admission liaisons, nurses, aides and IT staff saw the largest increase, according to the National Association of Home Care & Hospice (NAHC).

“Right now caregivers that have left the home care space, specifically private duty, have left for more wages,” Aveanna Healthcare Holdings (NASDAQ: AVAH) CEO Tony Strange recently said at the RBC Capital Markets Global Healthcare Conference. “We need to make sure that we continue to press [reimbursement] rates in order to pass those wages down to caregivers to entice them back into the home care space.”

LeadingAge and BerryDunn more than 1,000 home health and hospice sites to compile these data, which was collected over a 12-week period between September and December 2021. Organizations responded via online survey software, online polling, verbal interviews, and submitted paper survey responses .

The survey was field tested twice and refined using input from hospice agency leaders, according to LeadingAge.

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