Labor Shortage, Referral Stream Recovery Top of Mind for Hospices

More than 67% of the 203 hospice care professionals surveyed indicated that staffing was their greatest non-COVID related challenge in 2022, according to the 2022 Hospice News Outlook Survey and Report. This is a rise from 33% the prior year.

Staffing shortages have long been a thorn in the side of the hospice industry and anticipated to worsen during the next two decades.

A shortage of nurses has been the greatest bane for hospice providers. The U.S. Bureau of Labor Statistics forecasted the nursing shortage to endure through at least 2024. The agency projects that more than half a million nurses will be needed to replace those reaching retirement or leaving the profession. Nearly half of the total nursing workforce is expected to retire within the next decade.

“Recruitment and retention have always been priorities for us and that continues in 2022,” St. Croix Hospice CEO Heath Bartness told Hospice News. “This will be an important issue for the whole industry now and into the future.”

The pandemic has exacerbated the staffing crisis. More than 20% of health care workers have considered leaving the field due to stress from COVID-19, and 30% have mulled reducing their hours, according to a study published in JAMA Network Open.

A Focus on Workplace Culture

Hospices have engaged a range of tactics to beef up their ranks, including raising compensation, expanding benefit packages, developing education and training programs, and utilizing contracted nurses, to name a few.

St. Croix, a portfolio company of H.I.G. Capital, was among the hospices that made workplace culture a centerpiece of its recruitment and retention efforts. The company last year launched its Career Ladders program to provide career growth opportunities for clinical team members. St. Croix offers additional education and financial incentives to staff at each level of the program aimed to build up their expertise as they move up the “ladder,” according to Bartness.

“When it comes to retention, employees stay because of a great culture, a belief in their work and opportunities to grow,” said Bartness. “In the last 12 months we have added more than 300 employees to our ranks. That’s something that doesn’t happen without intention, commitment and investment in any market, let alone in a health care job market unlike any we have ever seen.”

These labor pressures are also a key consideration in hospices’ technology investments.

About 33% of Hospice News survey respondents indicated that improving employee engagement and satisfaction will drive their tech investment decisions for 2022. Nearly half (47%) of the participants identified solutions designed for process optimization and automation as a key focus, both to improve efficiency and to take some of the administrative burden off of staff.

Electronic health and medical record systems represented the most potential return on investment for 26% of the hospices surveyed.

Hospices are “keenly focused” on processes and technology solutions that maximize clinical efficiency and clinician satisfaction, according to Scott Pattillo, chief strategy officer at Homecare Homebase, which sponsored the Hospice News survey.

“One of the key ways that providers can do this is through optimized decision making in care planning and scheduling,” Pattillo told Hospice News. “Technology can be used to automate back-office and front-office tasks and optimize clinician satisfaction and clinician efficiency, reducing turnover and creating greater clinical capacity while also reducing costs.”

Spread the Word, Expand the Portfolio

Also high among providers’ priorities were the needs to raise awareness of the hospice benefit and build up a larger suite of upstream health care services.

About 12% of the hospice professionals saw the need to improve public awareness of their services as their top concern — the second highest percentage behind staffing.

A lack of awareness or understanding of their services has been a challenge for hospice providers since before the Medicare benefit was established. Many believe that hospice solely occurs in the patients last few days of life or that it hastens death. These misperceptions historically have made many families reluctant to pursue these options.

Meanwhile, more than 52% of hospices surveyed indicated that their organizations would pursue palliative care service offerings in 2022 for the first time. The results reflect a larger trend in which hospices seek to establish relationships with patients earlier in the course of their illness.

“Agencies are establishing longer-term relationships with patients, which involves providing a greater variety of services in the home,” said Pattillo. “By focusing on the patient as a whole and providing multiple care services, agencies can create greater patient outcomes while also growing their census of patients served.”

A rising number of hospices are expanding into palliative care. Roughly half of community-based palliative care providers in the United States are hospices, according to the Center to Advance Palliative Care (CAPC).

In addition to reaching payments sooner,, hospices are pursuing diversified palliative care services as a way to capitalize on value-based payment models that are proliferating in the market, such as Medicare Advantage or the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) program.

Many in the hospice industry see service diversification as a business imperative to ensure that hospices, particularly smaller community-based organizations, remain financially viable in order to support their mission.

As COVID-19 appears to be receding early in the year, providers are also anticipating some normalization in their referral streams.

Access to facility-based settings has been restricted during the pandemic, causing drops in referrals, census and length of stay. In many instances, facility-bound patients did not receive the full benefit of hospice due to COVID-related restrictions, particularly early in the outbreak’s early stages. While restrictions have eased in many states nationwide, referral volume from these institutions has not yet rebounded to pre-pandemic levels.

Other than the home, survey participants identified assisted living and nursing facilities as settings that offer the most promise for growth, at 35% and 30%, respectively.

“We enjoy a good mix of referrals from all settings: senior housing, hospitals and community physicians,” said Bartness. “While we have continued to maintain a healthy referral stream from senior housing throughout the pandemic despite census pressures in those settings, we would expect to see that grow as census pressure alleviates in a new ‘normal.’”