Staffing a Barrier to Palliative Care Growth

While the number of hospices and other organizations providing palliative care continues to expand nationwide, staffing shortages represent a barrier that threatens to slow this growth.

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.

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“The workforce pipeline is a crisis for both hospice and palliative care. It is very clear to us that there will never be enough of a specialist trained workforce to even begin to meet the exploding need for palliative care and hospice services,” Diane Meier, M.D., executive director of the Center to Advance Palliative Care (CAPC) said in a recent Hospice News webinar. “We have got to step into the bridge and try to compensate for the failure of medical and nursing ]schools to teach future generations of clinicians how to communicate about what matters most to patients how to manage common distressing symptoms, simply not part of our training.”

More than 26% of hospice providers in a recent Hospice News poll indicated 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.

Widespread reform in medical and nursing education may be necessary to fully address this issue. Some organizations are taking matters into their own hands and developing fellowships, on-the-job training programs as well as collaborations with local colleges and universities.

“Education is lacking so much that there’s not even an acknowledgement of the inevitability that people will die, and so if we have no understanding that that is an absolute, we can’t accept it,” said Timothy Ihrig, M.D., chief medical officer for Crossroads Hospice and Palliative Care. “We can’t break free from a linear, algorithmic formulaic approach of [health care organizations] doing things to someone, and so the whole paradigm of how we think about care how we think about life needs to change. It is the narrative of not trying to avoid death, but living life, that I think is fundamentally missing from all medical curricula and sets us up for such a great disparity now and in the future.”

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