As vice president of Florida-based Suncoast Hospice, Marci Pruitt oversees 11 interdisciplinary patient care teams, three inpatient units, bereavement and integrated medicine services. She entered the hospice field in 1985 as a nurse providing direct patient care and rose through the ranks to her current vice president role in 2007.
Suncoast Hospice is a subsidiary of Empath Health, which merged last year with Stratum Health System. The merged company will continue with the Empath Health brand. The merger made the combined organization the largest nonprofit post-acute health system in the United States.
Pruitt will soon retire after more than 30 years as a hospice provider. She sat down with Hospice News to reflect on how the industry has changed during her career and key challenges facing providers, such as ongoing staffing shortages.
As you prepare for retirement, can you talk about what drew you to work in hospice and your career trajectory from nurse to vice president?
I graduated from the University of Pittsburgh with my bachelor of nursing degree back in 1978. One of our projects my senior year was a report on [Elizabeth] Kubler-Ross’s book On Death & Dying. That always stuck with me and intrigued me.
I did about eight years as an [intensive care unit (ICU)] nurse. After that I experienced some burn out. I started thinking back to my studies of Kubler-Ross, I thought I would give this hospice thing a try. When interviewed with them, they said they had never hired a critical care nurse before and asked what drew me to hospice. I said that hospice didn’t seem very different from coming from critical care in a teaching hospital In terms of the amount of death and dying we see and family support that we need to provide. So that’s where I started as a field nurse in 1985.
How your clinical experience as a nurse inform your approach to executive leadership?
As a hospice nurse having a holistic approach to caring for people, I’ve tried to follow a servant-leadership model. I’m always aware, having done it, of how hard the job is for all of our clinical staff, aides, social workers, chaplains and volunteers. I stay mindful that my job is to make their lives easier, help them do their jobs and to maximize their time at the bedside.
What are some of the ways you’ve seen the hospice industry change during your tenure on the field?
Back in the 80s when the Medicare Hospice Benefit was very new, from a regulatory perspective they really hadn’t figured out quite how to survey us or how to oversee us. We were really trailblazing back then to define what hospice should look like. As hospice has become more mainstream in health care, a lot of regulatory scrutiny comes with that. We’re all subject to audits. This is the biggest change I’ve seen.
The best part of hospice is what has stayed the same, and that’s the patient- and family-centered care. I hope and I pray that’s never going to change.
At this point, do you see ways that the industry should continue to change?
We’re going to have to change. The payers are going to define to some degree how hospices model themselves in order to deal with the changing payment system. I really don’t think any of us know for sure what hospice is going to look like 10 years from now. Especially with the Medicare Advantage carve-in and how hospices are going to deal with changing reimbursement, especially here in Florida. We have such a high penetration of Medicare Advantage. Our hospice is definitely going to have to be nimble and figure out ways to meet patient and family needs while probably receiving less money.
Looking ahead, what do you see as the most significant challenges facing hospice and palliative care providers?
It’s staffing. It’s very competitive, trying to recruit and retain qualified staff. The nursing shortage is upon us now, and it’s going to be very challenging for hospices. Bigger health care systems can pay more money than the typical hospice can.
It’s not just the nurses. We see it with social workers and chaplains, as well as home health aides. With COVID and the unemployment benefits some of the aides can make more money on unemployment than they can working. That will probably change in the near future, but trying to attract them back is going to be challenging.
What do you think are some things that that organizations that providers need to respond to the staffing issue?
They need to be proactive, and they have to be able to do things that they probably never were willing to consider before. To attract workers from younger generations, jobs are going to have to look different. We’re going to have to find out what attracts people to work for an organization and to stay there, like developing training programs for aides and coming up with fringe benefits that will be attractive to people.
What are some of the considerations that hospice employers should keep in mind when attracting these workers that may be different from what they did in the past?
There are some who don’t want to or can’t work on a rigid schedule. One question is how can we as a hospice meet the regulatory requirements and the needs of our patients and families while providing some sort of flexible scheduling opportunities for [employees]. I think that [Suncoast] is fortunate that we have our care centers. We have a robust evening and weekend team. To help people move within the organization to areas where they might have the opportunity for flexible scheduling is a great draw for people.