As workforce shortages worsen throughout the hospice space, providers are pulling out all the stops to enhance recruitment and retention. Hospices have faced this problem for years, but the COVID-19 pandemic has led to higher turnover rates, exacerbating the shortage. Key strategies involve working directly with nursing schools to recruit new graduates who will learn hospice on the job and engaging the networking potential of existing staff.
More than 35% of hospice leaders surveyed by Hospice News earlier this year cited staffing shortages as a top concern for their organizations, along with regaining access to patients in facilities. Many hospice providers have seen staff turnover rise during the pandemic, as have organizations in other health care settings. 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 published in JAMA Network Open.
“The staffing shortage now is the worst it’s ever been,” said Shelley Henry, founder and president of The Amity Group, a Louisiana-based hospice staffing agency. “With hospice being such a small sector of nursing, we already had a small pool. We’ve seen such rapid, exponential growth in hospice during the last 10 to 15 years. There’s many more hospices competing for the same small pool of nurses, and it can have a really detrimental effect.”
The need to build up the hospice workforce has providers of all stripes losing sleep. 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. The company recently invested $20 million in the University of Louisiana at Lafayette College of Nursing and Allied Health Professions to help bring new clinicians into the hospice space.
“Unfortunately, we’re dealing with a national shortage of nurses across all sectors of the health care industry,” LHC Group Chairman and CEO Keith Myers said. “We believe this [$20 million investment] is an innovative and forward-thinking way for our company to step up and help address this need.”
Other hospices have also heard the call to innovate. While most providers seek clinicians and other staff who have experience working in end-of-life or palliative care, SilverStone Hospice in Dallas has begun reaching out to local nursing schools to identify potential new hires.
The company has been in talks with the University of Texas at Arlington to attract nurses entering the field, and then training them on the nuances of hospice care on the job. New hires undergo a two-week orientation process before they begin shadowing more experienced staff.
The hospice has experienced particular difficulties in recruiting case managers since the onset of the pandemic. Silverstone has encouraged their existing employees to recommend other people they know in the field who might be interested in working for a hospice.
Nevertheless, SilverStone has faced steep competition for candidates.
“It’s become three times harder to find people, and once you make someone an offer they have two or three others,” Alfonso Montiel, founder and CEO of SilverStone, told Hospice News. “Some of the nurses were being offered way above-average packages. One nurse we spoke with had been offered a company car by another hospice and asked us if we could match it.”
Silverstone has been able to find employees through another atypical source — their pool of volunteers.
Under the Medicare Conditions of Participation, volunteers must account for 5% of a hospice provider’s patient care hours. Some hospice providers consider volunteers to be a member of their interdisciplinary care teams along with nurses, chaplains, social workers, the medical director, and other professionals.
Silverstone CEO Montiel first entered the hospice space as a volunteer, and that experience drove him to establish his own company. Prior to SilverStone, Monteil established a $150 million private equity hedge fund, worked in strategy development for Fortune 500 companies and was CEO of the charitable organization the Lemon Tree Trust.
Silverstone’s Director of Operations Nischelle Reagan also came to hospice initially as a volunteer during her college years. She participated in an organization that paired students with volunteer opportunities in the local community when she was contacted by a hospice. The company also has nursing staff and aides who first joined them as volunteers.
At Amity, Shelley has implemented a robust interview process with the goal of really getting to know candidates prior to hiring. Amity also takes pains to ensure that as much as possible clinicians new to hospice understand the benefits and difficulties associated with end-of-life care, including the emotional toll of caring for dying patients.
“I am brutally honest with nurses during the interview phase. I go over all the good points, but I don’t want them to come in thinking that everything will be rosy and wonderful,” Shelley said. “Letting the nurses know that and letting them make an informed decision is very important. We spend a lot of time training our nurses and making sure that they are well supported.”
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