Ongoing workforce shortages in the hospice space are expected to worsen, with Florida taking the biggest hit due to the size of its population older than 65.
The number of hospice and palliative care physicians and members of other disciplines will drop precipitously during the next two decades, largely due to retirements and staff leaving the field due to burnout, recent research has found. Among U.S. physicians, 40% are 56 or older and incoming palliative care and hospice specialists will not be enough to replenish the ranks. By 2045, only one physician will be available for every 808 patients, according to the same study.
Florida may see the worst of the workforce shortage, which will affect workers from every discipline in the hospice field. Currently, the state has a grade of “C” in the Center to Advance Palliative Care’s state-by-state rankings of access to palliative care. While certainly not a “failing grade,” the rising senior population will create sizable new demand for hospice and palliative care.
This could seriously impact patients’ access to care.
“I would contend that Florida is the state with the highest population density of people needing palliative care with the lowest grade,” Arif Kamal, Duke University professor and chief medical officer at Acclivity Health in Jacksonville, Fla., said. “If there’s a severe clinician shortage, which will only worsen before it gets better, it requires health systems to focus on efficiency of practice, meaning that palliative care clinicians could only see the patients with the highest needs, the highest risk of bad outcomes.”
More than 20% of the state’s population was 65 or older as of July 2018, according to the U.S. Census Bureau. This number is expected to exceed 32% by 2030, a 34% increase from 2012.
Hospice utilization is also high in the state. Nearly 60% of Florida’s Medicare decedents received hospice care in 2017, the third highest in the nation behind Utah and Arizona, according to the National Hospice & Palliative Care Organization.
Legislative efforts to address the shortage are underway, both houses of Congress are currently mulling over versions of the Palliative Care and Hospice Education and Training Act, which would allocate funds to support expanded hospice and palliative care medical and nursing education.
The recently formed bipartisan Comprehensive Care Caucus in the Senate will champion the legislation in addition to developing new initiatives, but passage of the bills is uncertain as is their impact if enacted.
“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.”