Hospices have applied a variety of tactics to curb workforce shortages during the last two years, finding some success as well as lessons learned.
Alfonso Montiel, CEO of Texas-based Silverstone Hospice, spoke with Hospice News during its recent Staffing Summit to discuss how they responded to labor challenges that worsened when COVID-19 struck.
None of it has been easy, and in a few instances the quality of the available labor pool was as worrisome as the quantity.
“The past few years were awful,” Montiel told Hospice News. “It became very, very difficult to retain and attract good nurses. Under normal circumstances, we would have been able to read and react quickly and determine that a person wasn’t right.”
Compounding the difficulty, the dwindling supply of labor coincided with rising demand.
Montiel entered the hospice arena by purchasing Silverstone in 2019. Since that time the company has tripled its patient census, he said. This growth is not slowing down, and the company also recently launched a palliative care program.
Last year Silverstone acquired the hospice provider Comfort Care, further expanding its reach in the Dallas-Ft. Worth market.
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. He also did humanitarian work in third-world countries, including Iraq.
After spending some time as a hospice volunteer, Montiel realized that he wanted to direct his life’s work towards end-of-life care, he told Hospice News. He is among a number of leaders and staff at Silverstone who entered the space as volunteers.
During the pandemic, Silverstone found itself competing for nurses seeking “unsustainable” levels of compensation. Prospective candidates told Montiel that other health care employers had offered them wages as high as $5,000 a week — including one who said their new employer had given them a car.
Unable to make similar offers to these candidates, Silverstone pursued a number of strategies, some more successful than others.
“One that I thought was an amazing idea ended up being a disaster. That was going to nursing schools and finding graduate nurses and bringing them into hospice,” Montiel said. “To my very unpleasant surprise, nursing schools do not go into hospice in great detail, so the nurses didn’t know what to do.”
In some cases, nurses fresh out of school not only lacked technical skills, but also the emotional resilience necessary to care for the dying on a daily basis, he told Hospice News.
As demand for care rose, the need to resolve staffing issues became “a mother of invention,” said Montiel. The hospice became increasingly proactive in reaching out to prospective candidates, ramping up its screening processes and examining data around referral trends and new hires.
Silverstone managers saw that employers could identify jobseekers on networking websites who had recently updated their resumes and proactively reach out to them. This strategy proved more successful than the nursing school outreach.
Like many hospices, Silverstone also increased its reliance on contract nursing. This has exacerbated costs for many providers, and in a few cases led to some unforeseen labor issues.
“We had to hire [through] an agency, and a nurse made a mistake with a dose of medication. We detected that mistake right away. We reported it, and the patient survived the mistake,” Montiel said. “But we’ve decided not to outsource anybody anymore.”
Silverstone has developed an improvement-oriented culture centered around inclusivity, integrity and transparency, Montiel indicated. Communicating this approach to current and potential staff has made a substantial difference in recruitment and retention.
Employees are able to voice concerns directly to leadership and discuss situations openly and immediately as they arise. Every employee has Montiel’s cell phone number and can reach out to him directly when necessary. The explicit intent is to create an environment where staff are invited to share and create new ideas.
Listening to current and prospective employee priorities and concerns, which often centered about scheduling flexibility and workload, helped the organization hone its approach.
“Almost unequivocally, people had issues with working in places where the work was not aligned with their values or integrity. People would talk about things they saw at their prior employers that weren’t right, or tell me that their voices were never heard in that place,” Montiel said. “We also spoke to case managers who had 20-plus patients. There’s no way you can do your job right well with a workload that was not humanly possible.”
Discussions with candidates about these concerns and Silverstone’s culture of transparency and improvement led to more significant strides than many of the company’s prior efforts, according to Montiel.
Currently, these approaches seem to be paying off.
Silverstone now has a waiting list of jobseekers in a variety of disciplines and occupations. This includes nurses, case managers, social workers, marketing staff and aides, among others.
“If you want to attract and retain the right team, there’s no room for lack of integrity. There’s no room for falsehood,” Montiel said. “There’s room for mistakes, but the mistake cannot be in the intent that you have to care for people.”
Companies featured in this article:
