As hospices stare down widespread staff shortages across all disciplines, many are looking to the millennial generation to fill those gaps, adapting recruitment and retention strategies to potential employees who came of age in a very different cultural environment than their baby boomer or Generation X colleagues.
Hospices are already struggling to fill their ranks.The United States has 13.35 hospice and palliative care specialists for every 100,000 adults 65 and older, according to an April 2018 study. The research estimated that by 2040 the patient population will need 10,640 to 24,000 specialists; supply is expected to range between 8,100 and 19,000.
Hospice and palliative care providers also experience shortages in non-physician disciplines, including chaplains, nurses, and social workers. As far back as 2008, the U.S. Centers for Medicare & Medicaid Service (CMS) began allowing hospice providers to use contracted nursing staff because not enough nurses were available to fill permanent positions.
“There are many hospices across the country that are having very serious challenges recruiting and retaining physicians, nurses, and other staff,” said Stacie Levine, M.D., section chief of Geriatrics and Palliative Medicine at the University of Chicago Medical Center. “We have the baby boomers reaching their twilight years, and I am not sure what we are going to be able to do with what we have in front of us.”
The aging baby boomer population is both a challenge and an opportunity for hospice. Hospice utilization is rising; a record 50% of Medicare decedents received hospice care during 2018, according to the National Hospice and Palliative Care Organization. However, many hospice staff members are also approaching retirement, with nearly half of the total nursing workforce expected to retire within the next decade.
Hospices face unique recruitment challenges, particularly because medical, nursing, and social work students receive very little exposure to hospice or palliative care during their training. A 2018 study concluded that most students in clinical disciplines do not feel prepared to provide family care at the end of life.
“A big challenge that we face every day is that people do not understand this kind of work,” Bethany Cox Snider, MD, vice president and chief medical officer for Hosparus Health, told Hospice News. “They don’t yet fully grasp the awesome, rewarding nature of this work because they have never touched it.”
Snider speaks from experience. A millennial herself, she first became aware of hospice and palliative medicine during her residency in a hospital intensive care unit. She found herself increasingly frustrated with the lack of opportunities to have in-depth discussions about patient needs, goals and values, and how the health care team can optimize the patient’s quality of life. Ultimately an attending physician on the unit asked her if she had ever considered hospice care, a question that Snider says changed her life.
To counter widespread lack of awareness, Hosparus does regular outreach to clinicians and members of the local communities they serve to educate health care providers and the public about what hospice is and what it involves.
Hosparus staff provide education about hospice at local health systems and educational institutions, reaching out to nurses, physicians, medical students, residents, social workers and the other disciplines that comprise a hospice team.
‘There is tremendous value in the millennial generation, and employers are going to have to start being creative and innovative in how they recruit the next generation of employees,” Snider said. “We were trained differently, and organizations need to step back and be willing to tailor their programs to the needs of their different employees. Because the reality is we need them. We need to get them into our industry or else there will not be enough staff to take care of people.”
Millennial values in the workplace are often different than members of other demographics. They value technological proficiency, instant access to information, autonomy as well as variety in their work, and pathways to career advancement.
Millennials’ experience of always having immediate access to information via the internet often promotes a sense of independence and an expectation of accomplishing tasks effectively on the first try.
“They have always had an instant answer to every question and are more likely to look up an answer on their own than turn to coworkers,” said Darcy DeLoach, vice president of learning and development for Seasons Hospice and Palliative Care. “Having information and resources readily available to them can help them feel supported by the organization.”
Seasons provides employees with mobile-enabled, short-burst content, including videos to address common questions and scenarios staff may encounter in the field.
Variety and autonomy abound in hospice. A hospice clinician tends to work independently much of the time. They may do patient care every day, but each patient is different, as are the settings in which clinicians serve those patients. Patients receive hospice care in their homes, skilled nursing facilities, hospitals and a range of other environments.
“Variety is extremely fulfilling and you get that in hospice. We never do the same things from day to day, and that is a huge source of job satisfaction among my employees,” Snider said. ‘When it comes to recruiting millennial staff, getting the message out, emphasizing the mission, talking about the variety and flexibility, and addressing work-life balance is extremely important. I think hospice organizations also need to be very deliberate in creating pathways that lead to advancement.”
Millennials are very mission driven and want to make sure an employer’s values align with their own, which bodes well for mission-driven enterprises like hospice and palliative care, particularly with smaller organizations or nonprofits that may struggle to pay competitively compared to health systems or larger companies.
“This is a generation that needs a values-driven reason to go down a particular path,” DeLoach said. “For them work is about more than earning a paycheck, which works well in a hospice, which is a very special and unique type of work.”