Top 2021 Hospice Worries: Accessing Facility-Bound Patients, Staffing

Regaining regular access to hospice patients in nursing homes, assisted living or other facilities is a top concern for providers, along with ongoing staffing shortages that pre-date the pandemic, according to organization leaders who responded to Hospice News 2021 Outlook Survey. 

The 2021 Hospice News Outlook Survey and Report, sponsored by Homecare Homebase, is informed by feedback from 161 hospice professionals. Survey questions focused on the greatest challenges facing the hospice industry this year, growth opportunities for settings outside the home, and drivers of technology adoption among hospice operators.

Respondents indicated that the patient-access issue gave them the most sleepless nights in 2020 and into the new year. Nearly 45% of those surveyed cited this as a top COVID-related concern.


“Reduced access to any facility means fewer patients and shorter lengths of stay for hospice providers,” Catherine Dehlin, regional vice president of operations and sales for Three Oaks Hospice, told Hospice News. “Not only have facilities reduced our access to their residents, they have also reduced our access to facility staff, making it increasingly difficult to educate them on early identification of hospice appropriate residents.”

Limited access to patients also has clinical implications, according to Dehlin. Many facilities continue to allow nurses in to see patients, they generally are not including the full interdisciplinary teams or volunteers. Social workers, chaplains, aides and volunteers have been doing their best to serve patients virtually, which remains a challenging endeavor, Dehlin said.

Outside of COVID, staffing remains a top industrywide concern. 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.


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.

The aging baby boomer population is both a challenge and an opportunity for hospice. Hospice utilization is rising; a record 51% of Medicare decedents received hospice care during 2019, according to the Medicare Payment Advisory Commission. However, many hospice staff members are also approaching retirement, with nearly half of the total nursing workforce expected to retire within the next decade.

Hospices face unique recruitment challenges, particularly because medical, nursing, and social work students receive very little exposure to hospice or palliative care during their training. A 2018 study concluded that most students in clinical disciplines do not feel prepared to provide family care at the end of life.

The pandemic has exacerbated many of these issues, as staff are experiencing unprecedented levels of stress, burnout and trauma in the workplace. Many companies are seeing higher rates of turnover as the outbreak rages on.

“COVID-19 reinforced the importance of investing in our employees, focusing intently on talent retention and acquisition, and adopting new work-related perks and policies that embody an “employee-first” workplace,” Nick Westfall, CEO of VITAS Healthcare, a subsidiary of Chemed Corp. (NYSE: CHE). “We must continue to ask our employees what they need to feel safe and supported in 2021, both at home and at work, and then find creative ways to meet those needs.”

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