Staffing Shortage Closes Iowa Hospice House

An Iowa hospice provider is closing its inpatient hospice house as of Dec. 31 due to the industry-wide staffing shortage. The organization will continue to provide care in patient homes, skilled nursing and assisted living facilities. 

The name of the organization is simply, “Hospice,” which serves Davis and Wapello Counties in the southeast portion of the state, near the Missouri border. The nonprofit, established in 1982, opened the Hospice House in 2004. The hospice house is currently the only inpatient hospice facility in the organization’s two-county service area.

“Hospice has been struggling to adequately staff both our in-home hospice care program and our Hospice House,” Executive Director Angie Rozenboom said. “Having fewer nurses available to spread the workload is guaranteed to add layers of stress onto other staff. With most patients being cared for with hospice services in their own home, Hospice has been forced to match our available workforce to the greatest number of patients served.”

Worsening workforce shortages have been keeping hospice leaders awake at night for several years running. Rising turnover due to the COVID-19 pandemic has exacerbated the crisis, and some hospice providers and health systems are starting to shut down their programs or sell off their operations because they cannot recruit or retain a sufficient number of employees.

The Idaho-based Minidoka Memorial Hospital home health and hospice program was shuttered in September, also due to insufficient staffing. In Oregon, Grande Ronde Hospital and Clinics recently closed its hospice program due to labor shortages. The organization indicated that the COVID-19 pandemic exacerbated industry-wide workforce issues, leading to the decision to close.

The Dare County Board of Commissioners in North Carolina earlier this year approved the sale of its local home health and hospice agency to BrightSpring Health Services for $2.9 million. Louisville, Ky.-based BrightSpring is a portfolio company of the global investment and private equity firm KKR & Co., which purchased the company in 2018 for approximately $1.32 billion.

Dare began a bidding process in late 2020 after determining that operating the agency themselves was no longer financially sustainable. They also cited a lack of sufficient staff to meet growing demand for hospice in their region.

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 matter may be even more complicated for providers like Hospice that operate in rural communities.

Only 16% of the nation’s registered nurses reside in rural areas, according to a 2013 study from the U.S. Health Resources & Services Administration.

Rozenboom indicated that Hospice hopes to reopen their facility if and when they can recruit enough employees.

“Our goal is to re-open Hospice House if sufficient qualified Hospice healthcare staff becomes available in our area,” she said. “We know that Hospice House holds a special place in the hearts of many patients, families, friends, volunteers, and staff.”