Hospices Use Education, Career Incentives to Grow Clinical Workforce

More hospices are building up their clinical ranks through education, training and programs like tuition reimbursement.

Investing in these education and career-building programs could yield big returns when it comes to hiring and keeping personnel, according to Phillip Heath, board chair of New Jersey-based Samaritan Life Enhancing Care. Heath will become the organization’s CEO effective October 1.

“Whether a hospice establishes some kind of scholarship bond, tuition reimbursement or training program, it’s creating an opportunity for people to continue to grow and learn with you,” Heath told Hospice News. “It’s investing in people who will in turn give you their time for sustainable services. As demand grows, we know we’ll need more resources from different avenues, with the bulk needed in our operations.”


Building career paths for hospice clinicians

Clinical workforce shortages in hospice and palliative care are among the biggest threats to patient access, say some providers. Demand for end-of-life and serious illness care is outstripping the supply of qualified clinicians, resulting in capacity constraints, accelerated industry consolidation, and some hospices shutting down entirely.

More providers are employing “grow your own” incentivization tactics that include a range of tuition reimbursement, training, and fellowship programs aimed at recruiting and retaining clinicians of all walks.

Samaritan in 2013 launched its first hospice and palliative care fellowship program in concert with the Rowan University’s School of Osteopathic Medicine. The program was put on hold in the past few years as the organization fine-tuned its scope. With its forthcoming relaunch, the program will be offered to a wider range of physicians in other health care disciplines.


The program has gained traction in recruiting and retaining clinical staff, and the organization will continue investing in fellowships and other training programs in the long-term, according to Heath.

“One of our first fellows is still working at Samaritan as a practitioner,” said Heath. “We continue to grow our hospice and palliative medical partners practice with our fellowship program. It’s important that individuals grow and develop in the profession and see opportunities to expand in the workforce.”

Samaritan also established and operates its Institute for Education, Research and Innovation, a program dedicated to cultivating hospice and palliative care talent development and spreading public awareness about career opportunities in the field. The institute not only trains employees, but also educates the community about end-of-life and serious illness care, according to Heath.

Other providers have also looked within to grow their clinical workforce.

Among these is Las Vegas-based Nathan Adelson Hospice, which developed its hospice and palliative medicine fellowship roughly seven years ago. The fellowship has seen “great success” in terms of bringing more physicians into these speciaties, according to Nathan Adelson Hospice CEO and President Karen Rubel.

Similar to Samaritan, the fellowship program was initially rolled out to doctors in osteopathic medicine, but has since opened up to physicians with other professional backgrounds.

This expansion was in large part due to growing recruitment and retention challenges in a competitive playing field, said Rubel.

“We were seeing retention as being harder and harder, competing with other organizations for doctors, nurses, CNAs and other clinicians,” Rubel told Hospice News. “There’s a shortage of hospice and palliative care trained physicians across the country. This program certainly helps our physician groups to grow. It’s our way of being able to boost that workforce and train interested doctors. We’ve had great success, with some doctors staying local after graduation and completion of the fellowship program.”

The one-year program accepts two or three fellows annually, who each choose a specialty area within hospice and palliative care (such as pediatrics or veteran populations).

Other hospices are also ramping up opportunities in continuing education and career development.

Hospice of Southern Maine recently launched a tuition reimbursement program that supports health care workers interested in pursuing registered nurse or certified nursing assistant licensure.

The program was developed in response to a “critical shortage” of hospice nursing professionals statewide anticipated to reach a tipping point in the next three years, according to Hospice of Southern Maine CEO Daryl Cady.

“Maine will face a shortage of 3,200 registered nurses in the state by 2025,” Cady wrote Hospice News in an email. “It’s our hope that through this program we’re able to encourage more individuals to gain experience while pursuing their studies, so that they’re able to quickly assimilate into these high-demand occupations and help meet the growing demand and need for hospice care.”

Managing the costs

The cost of running these educational programs can run high for hospices.

For example, Hospice of Southern Maine’s reimbursement program covers not only tuition, but also the cost of books, lab fees, and other educational expenses. Each employee is granted a maximum of $5,250 per calendar year of their education.

The program also includes a path to employment at the hospice. Students interested in working at the hospice can “earn to learn,” at a rate of $19/hour while they attend class and clinicals and be “workforce ready” upon graduation, according to Cady.

Other costs include compensation for fellowship program directors, coordinators, and teaching staff, along with the cost of fellows’ salaries, added Rubel. Nathan Adelson Hospice establishes a target amount each year in its annual budget process to continue offering the fellowship program.

The sustainability of fellowship and continuing education programs often hinges on philanthropic support. The philanthropic and fundraising arms of Nathan Adelson Hospice, Hospice of Southern Maine and Samaritan each play a large role in keeping these programs afloat, leaders told Hospice News.

“We spend a lot of time and financial effort on recruitment, retention and talent development programs, investing resources in these areas that will continue to expand,” Heath said. “We’ve sustained these programs through many years of generous donor support and through our own operating budget.”

Other avenues for sustaining educational opportunities include developing partnerships or scholarship funds with local universities and community-based learning institutions, Heath added.

Some hope rests that in the long term payers will take the costs of workforce-building into account when determining reimbursement rates, Heath told Hospice News.

Planting seeds for sustainable growth

Providers who have pursued fellowship and education incentive programs have high hopes for long-term, sustainable workforce growth.

Beyond ensuring sufficient numbers in their ranks, hospices can leverage the training their employees receive to develop diversified service lines. Fellowship and education programs that offer clinicians a range of new can foster expansion with the ability to “broaden the spectrum” of care, according to Heath.

These programs can also plant the roots of interdisciplinary collaboration within a hospice’s care community, according to Rubel.

“Even if these fellows don’t decide to stay at our hospice, they may work within the community doing palliative care in hospitals or clinics, for example,” Rubel told Hospice News. “They work alongside our clinicians during their fellowships, learning as part of the interdisciplinary team. It’s adding resources of people needed to manage patient care across the community. Having doctors with the familiarity and comfort level there really helps with collaboration.”

Offering continuous education and training opportunities can also play a key role in leadership succession planning, according to Heath. These programs allow clinicians to grow professionally within a hospice and encourage ways for them to seek advancement towards leadership as their careers progress, he added.

“These programs are one way we create opportunities for staff to become leaders in the organization,” Heath told Hospice News. “Succession planning is very important as we see the workforce aging and a need to invite more people into these opportunities. We’re looking years ahead and beyond to ensure individuals come onboard and want to stay, grow and develop in their professions and also lead in developing others.”

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