Designing Career Paths Aids Hospice, Palliative Care Staff Shortages

The hospice and palliative care workforce has been shrinking in recent years due to staff retirement, burnout and limited opportunities for specialty training. Designing a career path with opportunities for advancement can boost recruitment, improve retention and reduce turnover.

“Currently, the specialty workforce is just too small to meet demand,” said Brynn Bowman, chief strategy officer, Center to Advance Palliative Care (CAPC). “The relationship between the supply and demand of palliative and end-of-life care teams is overwhelmingly short-staffed. We hear tons of reports of clinicians working ‘round the clock. We need and want to provide more training avenues so that people enter these specialties because there’s a workforce shortage.”

Hospice leaders identified staffing shortages as their top concern moving into 2020 on a Hospice News survey in collaboration with Dallas-based tech company Homecare Homebase. More than 26% of 300 respondents anticipated staffing as their greatest challenge, outweighing concerns over increased competition in the hospice space and new payment models.


Shortages are expected to worsen during the next 25 years, with research indicating that supply of a hospice and palliative care specialized workforce will be exceeded by demand of a growing aging patient population.

“Demand for hospice specialists is going to outpace supply,” said Matthew Abbott, senior clinical product manager at Axxess, a home health and hospice technology company based in Dallas, and also a hospice nurse. “This is a significant cause for concern as we look at burnout today — especially in light of the public health emergency. Burned out and exhausted clinicians are at higher risk for making mistakes, having accidents while driving and rushing through patient care to get to the next visit on time. That’s a serious problem for any organization, but it reaches a whole new level of seriousness when you’re talking about helping someone have a comfortable end of life.”

Staff burnout is a significant factor of high turnover rates, with limited career growth opportunities and lack of exposure to specialized training in terminally ill and end-of-life care also contributing to a shrinking workforce. Medical, nursing and social work students receive little training in hospice and palliative care during the course of their education, with a 2018 study reflecting that most would not feel prepared to provide family care in the final stages of life.


Expanding educational training and broadening the scope of career path opportunities are strategies being employed to strengthen hospice staff recruitment, as well as retention. Several organizations have developed closer mentorship in their onboarding training programs, with new staff receiving more hands-on learning under experienced supervision to better equip them in meeting the various unique and complex care needs of terminally ill and dying patients.

Stakeholders and advocates in the hospice and palliative care spaces have been working with policymakers to remove barriers preventing workforce growth, with increased education and training opportunities leading the charge towards improvement and support.

“You can educate any clinician and specialty in core hospice and palliative care skills like how to better communicate with patients about their goals of care,” said Bowman. “The workforce shortage is the motivator behind PCHETA, the Palliative Care Hospice Education and Training Act, that would open up new training pathways for more clinicians of all disciplines to get palliative care and hospice education and become certified specialists, including physicians, nurses, social workers and chaplains. Investing in training has the double benefit of reserving that specialty care team for those patients whose needs are most complex and really need that kind of support.”

Offering improved compensation, career growth opportunities and benefits such as reimbursement for education and training or potential student loan debt payoff assistance could ensure greater potential for longevity and a healthier workforce in hospice and palliative care fields. The price tag for increased career advancement and specialized training opportunities can cause significant financial strain.

Making room in the budget and absorbing these costs is a struggle for several providers, especially during an economic downtown caused by the ongoing coronavirus pandemic. Cost-saving strategies to avoid harm against COVID-19 headwinds include increased technology utilization, according to Abbott, with potential for long-term financial gain.

“Full visibility into your operations is required to see where there are potential savings,” Abbott told Hospice News. “Without a system that shows you data, hospices won’t know whether they can afford to increase pay and benefits. We’re in a digital world and you cannot have an analog mindset. I strongly believe that an investment in staff education and support will pay dividends down the line for any organization.”

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