Diversity Initiatives, COVID-19 Vaccines Top 2021 Hospice Concerns

COVID-19 vaccinations and diversity initiatives will be among the top priorities for hospice providers during 2021, according to an Axxess survey of home-based care providers. About 22% of the thousands of respondents were hospices.

Dallas-based Axxess is a technology provider to more than 7,000 home health, home care and hospice organizations serving upwards of 2 million patients worldwide. During the course of several weeks in late 2020, Axxess surveyed organizations of varied sizes to gauge their top priorities in 2021, with 66% home health, 36% private duty and hospice providers making up the remainder. Respondents from varied positions included those in management and leadership roles, as well as caregivers working directly with patients and their families.

According to the report, nearly 62% of overall respondents indicated that their organization would require those with direct patient contact to receive the coronavirus vaccine, and almost 75% of larger organizations indicated they would require it among staff.


“Many organizations said they do plan to require staff to receive the vaccination, but a sizable number said they do not,” said Tammy Ross, senior vice president of professional services at Axxess. “Hospices need to study the issue very closely and take steps that ensure that patients, loved ones and staff feel comfortable with whatever decision is made.”

Hospices began preparing for the vaccine’s rollout across the United States in December, facing an array of challenges as distribution processes of the first 11.9 million doses varied from state to state. While many hospice providers have made the vaccine a requirement for staff in direct patient contact, some have not.

Concerns over a limited first supply of vaccines and their efficacy have proliferated. Nearly 30% of health care worker respondents in a December survey from the Kaiser Family Foundation said they “definitely or probably would not”’ get vaccinated, with more than half expressing worries about possible side effects and lack of trust in the government to ensure the vaccines’ safety and effectiveness.


Several hospices have been stepping up support of staff vaccinations, which represent renewed access to patients in closed settings during the pandemic such as hospitals, nursing homes and long-term care and assisted living facilities.

Creating an effective COVID-19 vaccination policy aligned with the U.S. Centers for Disease Control and Prevention (CDC) recommendations and with human resources and legal advice will help to ensure an adequate and healthy workforce, according to best practice recommendations from Axxess based on the report’s findings.

More than 70% of all organizations surveyed stated that they would increase resources in 2021 for staff diversity, equity and inclusion, with 91% of respondents from larger organizations indicating that they are focused on the issue and addressing it.

Racial groups and the LGBTQ+ communities are among the groups most historically underserved by hospice. Ongoing civil unrest nationwide has brought racial inequity issues to the forefront in health care, with many hospice providers making strides to better reach these underserved groups and remove barriers such as mistrust, provider bias and lack of interdisciplinary cultural research that serve as access roadblocks. For example, hospice providers Capital Caring Health and SCAN Group, a parent company of SCAN Health Plan, were among those that intensified focus on programs intended to improve equitable access to end-of-life care among diverse populations.

Getting to the root of racial and socioeconomic barriers to hospice care will be key for hospices working to improve diversity, equity and inclusion programming among patients and staff alike. Ramping up staff sensitivity training, education and awareness will be another crucial part of not only reaching a wider and more diverse patient population, but also a link in building and sustaining a shrinking hospice workforce.

“In 2020, we saw our society reckon with systemic racial inequities that need to change. Many organizations, including hospices, have taken steps to nurture or create a more inclusive workplace,” Ross told Hospice News. “Increasing diversity, equity, and inclusion resources is not only the right thing to do, it also makes business sense for hospices dealing with high rates of staff turnover.”

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