Effective On-boarding Aids Hospice Staff Retention

Effective on-boarding practices, including training and orientation, can help stave off the impact of ongoing staffing shortages in the hospice space.

Hospices nationwide are fine-tuning recruitment and retention strategies as demand for their services are rising as they continue to lose current staff, often due to retirement or burnout.

More than 26% hospice leaders indicated in a Hospice News survey that staffing would be the greatest challenge hospice providers would face during 2020, compared to 18% who cited increased competition and another 18% who said new payment models were their biggest concern. Hospice News in collaboration with Dallas-based tech company Homecare Homebase surveyed more than 300 industry professionals, including owners, executive leaders, managers and staff about the movement they expect to see in the hospice space during 2020.


“I think the most alarming thing here is the projection of how many hospice specialists in particular are going to be needed to take care of these Medicare beneficiaries,” said Matt Abbott, senior product manager of hospice, in a recent webinar sponsored by health care technology company Axxess. “We know that nurses in particular are aging, we don’t have as many millennials coming into the nursing profession, and those that are work more in that inpatient hospital-based setting they want a little bit more structure.”

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.

Turnover rates for hospice providers reach as high as 18.7% for nurses and nearly 24% for hospice aides, Abbott indicated in the webinar. The average cost of nurse turnover falls between $37,700 to $58,400.


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 (NHPCO). However, many hospice staff members are also approaching retirement, with nearly half of the total nursing workforce expected to retire within the next decade.

Ensuring staff are engaged and on-board with a hospice’s organizational culture is key to reducing turnover, according to the webinar.

“If your employees are engaged, they’re more likely to stay. Those employees that you can get engaged in the process, get engaged in your culture and your mission and vision, and believing the things that your organization stands for, they are 87% more likely to stay with your organization, which is just going to lead to better outcomes for your patients as well,” Abbott said. “An employee’s orientation and their first 90 days to six months with your organization is going to be the difference between whether or not they stay beyond that six-month mark.”

Perhaps the most important step of engaging employees is hiring the right people in the first place. Matt recommends seeking candidates whose perspectives are already aligned with your hospice’s mission, vision and culture, as well as having the right technical skills.

Establishing expectations upfront is key. In addition to corporate policies and procedures, new hires should learn about basic regulatory compliance activities that may impact their work, as well as infection prevention and control, patient rights and safety and other key information.

But helping recent hires develop relationships with their new colleagues also aids retention, though introductory lunches, mentorship with established members of the team, and other opportunities to all staff to interact and get acquainted.

“Interpersonal relationships are what we all kind of crave as human beings, and so it’s really important to bring those new people along, introduce them to people in the office, so that everyone on board can get a chance to meet the new employee and greet them,” Abbott said. “It’s very intimidating to go in on your first day at a new job and not really know anybody except for the person who hired you. So helping them establish those relationships and making those introductions for them is hugely important as part of your on-boarding.”

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