Staff turnover and burnout have been higher since the coronavirus pandemic first hit the nation. Hospices are adopting strategies to stem the tide, with providers increasingly working to build career paths for nurses and other hospice staff.
The coronavirus pandemic has taken a heavy toll on hospice staff since its onset. Slightly more than 20% of health care workers have considered leaving the field due to stress brought on by the pandemic, and 30% have considered reducing their hours, according to a recent study publishing in JAMA Network Open today.
The weight of COVID-19 has led to overwhelmed and understaffed clinical teams and back-office operations. Fostering staff resilience has been a top priority among the health care system at large, with hospice leaders learning valuable lessons from the past year’s challenges.
“Staff retention is one of the most important quality measures and has a huge impact on the bottom line,” said Dianne Hansen, CEO of Partners In Home Care, Inc. “Our agency saw a much higher number of nurses and hospice aides leaving the workforce or moving out of the area, primarily related to family needs. Labor pools are extremely tight in many areas of the country.”
Hospices have struggled to fill their ranks long before COVID-19. More than 35% of hospice leaders surveyed by Hospice News and Homecare Homebase earlier this year cited staffing shortages as a top concern for their organizations, along with regaining access to patients in facilities.
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.
Hospices have increasingly sought ways to boost staffing recruitment and retention. Hospice and home health provider Amedisys (NASDAQ: AMED) is embracing data analytics to reduce staff turnover amid staffing shortages exacerbated by the pandemic. The company’s system predicts with 80% accuracy whether an employee may be leaving their positions, allowing opportunities for intervention.
LHC Group (NASDAQ: LHCG) is stepping up efforts to recruit clinical staff to match the home health and hospice provider’s rate of expansion, foreseeing rising demand of clinicians amid an 8% growth in same-store hospice admissions during 2021.
Compounding the problem, nursing and medical schools may not have enough open slots in their programs to meet the growing demand.
“Even for the residents who are interested in health care careers, and specifically nursing careers, we don’t have enough nursing faculty,” said Johanna Beliveau, president and CEO of Visiting Nurse and Hospice for Vermont and New Hampshire (VNH). “We saw the potential of bringing new graduate nurses directly from their undergraduate education programs and into the practice of home-based care, which has not historically been the pathway.”
While hospices contend with rising turnover, they are also seeking solutions for educational barriers to building the hospice workforce. LHC Group recently invested $20 million in the University of Louisiana at Lafayette College of Nursing and Allied Health Professions to help grow interest in hospice employment and help their own staff advance their careers.
VNH partnered with the VNA Health System of Northern New England to offer registered nurse graduates a one-year nurse residency program as a way to address the ongoing home health care nursing shortage. The residency is intended to promote the development of competency and role transition from student to professional nurse, supporting the resident professionally, emotionally and socially during the first year of clinical practice.
“Together we recognized the increasing demand for nursing within our region, the increasing competition for recruitment of experienced nurses in our environments,” Beliveau told Hospice News. “This is an early novel approach. We will be piloting expanding the home health model to really learn from it and understand how to do this successfully, and then adapt it for our hospice team.”
With the aging population growing, hospice and palliative care providers will need to increasingly invest in a shrinking workforce to sustain rising demand for end-of-life and serious illness care. According to a 2018 U.S. Census Bureau report, more than 617 million people were 65 and older in 2015, representing about 9% of the world’s overall population, with projections that this aging population will grow to about 1.6 billion, or 17%, by 2050.
Providers face unique challenges when it comes to recruiting medical, social work and nursing students, largely due to limited exposure to hospice and palliative care during training. Most students in clinical disciplines do not feel prepared to provide end-of-life care, according to a 2018 study.
One goal is to adapt the nursing residency program for hospice in the near future, according to Beliveau.
“It’s a great example of the culture in our organizations and what we’re striving to achieve, which is really continual learning and development through various stages of people’s careers,” said Beliveau. “From a retention perspective, our hope is that clinicians see programs that we are beginning to develop and see that we are also working on a career ladder or career progression model where someone can come into our organization who is less developed than the residency program. These are the things that we are exploring, because we have to invest in the workforce.”