Even as COVID-19 puts new staffing pressures on hospice and palliative care providers, organizations continue to wrestle with ongoing staffing shortages. While organizations respond to the pandemic, the business of hospice continues — including the need to control routine issues such as staff turnover.
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.
“It is extremely costly to replace any clinician, but especially in nursing. Costs can range anywhere from 1-1/2 to 2-1/2 times salary, so huge financial issues related to losing staff.or having a high rate,” said Catherine Dehlin, director of hospice and palliative services for WellSky. “Operationally, it affects scheduling. It affects an organization’s ability to accept admissions or capacity. It can often lead to poor outcomes, because we are stretching our staff thin and reducing visits or frequency.”
More than 26% of hospice providers in a recent Hospice News poll indicated that staffing would be the greatest challenge they would face during 2020, compared to 18% who cited increased competition and another 18% who said new payment models were their biggest concern. More than 300 providers responded to the survey, conducted in collaboration with Homecare Homebase.
Numerous factors can impact turnover rates, including persistent problems such as staff burnout and routine staff retirement. Other leading causes are poor relations between employees and their managers, an unsustainable work-life balance, a lack of professional development opportunities and concerns about compensation.
“Compensation is a huge deal. It’s a very competitive industry out there, and all too often people are just guessing what the market rates are for these positions. In this industry, with the demand and growth we are seeing in hospice, a current compensation range might be very different to what it really is six months from now or a year from now,” Eric Scharber, principal at Exact Recruiting, told Hospice News. “It’s fluid, and I think organizations don’t stay on top of that enough as far as really understanding what a compensation package should look like.”
Turnover impacts hospice businesses even in the best of times but becomes even more complicated during a pandemic when hospices are already strained to their limits and encountering new and increased expenses. Supply costs have surged since the outbreak sparked, as have costs associated with telehealth programs and paid leave for exposed staff, among a barrage of other expenses.
Employees themselves are faced with other dilemmas that could impact their work, such as the need to care for children during school closures or fears of contracting the virus or spreading it to vulnerable family members.
“Fear has really impacted this more than anything. We really encourage organizations to have a COVID team so that we can reduce the amount of exposure among the staff members,” Dehlin said. “There’s an inherent push and pull with operations and management and field staff as to who is going to be exposed and who’s not, and who has children at home and who doesn’t. All of those factors intertwine and really create ethical dilemmas and conflicts within an organization. That definitely contributes to the turnover.”
Staff may also leave if they feel like their leaders are insufficiently concerned about their safety and the ways in which the pandemic is impacting their lives, financially, emotionally and otherwise, Schrader said.
“You’ve got the organizations that are realizing that the way through this as an organization is by focusing on your people, doing everything you possibly can to take care of your staff. You do what you can to not furlough staff or reduce staff. You do what you can to keep your people whole,” Scharber said. “There’s a faction that’s really focused on making this about their people. Those organizations are going to thrive. Staff will stay because they feel like they were taken care of in the hardest of times, and the organization is going to develop a reputation for that culture.”
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