Wages for hospice aides and CNAs are rising faster than those for other interdisciplinary team members as providers seek to stem rampant turnover among those employees.
The national average hourly rate for hospice aides and CNAs rose 9.09% in 2022, compared to a 4.52% increase in 2021, according to the 2022-2023 Hospice Salary & Benefits Report, published by Hospital & Healthcare Compensation Service (HCS) in cooperation with the National Association for Home Care & Hospice (NAHC).
These occupations also represented a large percentage of job vacancies and saw high turnover rates, 19.05% and 29.84%, respectively. Only LPNs and LVNs had higher rates, reaching 31.52% turnover and 25.12% for vacancies.
Workforce pressures and associated costs are overwhelmingly the industry’s most damaging headwind, including the associated wage hikes, enhanced benefits and bonus programs. The shortages also have reduced clinical capacity, which has contributed to drops in patient census and length of stay for many providers.
“We were seeing retention as being harder and harder, competing with other organizations for doctors, nurses, CNAs and other clinicians,” Nathan Adelson Hospice CEO and President Karen Rubel previously told Hospice News. “There’s a shortage of hospice and palliative care trained physicians across the country.”
The recruitment and retention of nurses has also been a sore point, a longstanding problem that has worsened during the pandemic.
Registered nurses also saw high turnover rates at 25.15% turnover and accounted for 16.97% of vacancies. These nurses saw average national salary increases of 5.95% in 2022. Medical directors saw the lowest rate of increase at 0.6% this year.
Medical social workers saw an average 4.07% hourly increase, but in terms of productivity tended to have larger caseloads, with a national average of 29.15 patients compared to 14.12 for nurses. Chaplains had the largest caseloads of nearly 40 patients.
The opportunity to earn a higher salary may be a significant draw for jobseekers, including those who had previously left the health care workforce.
Aveanna Healthcare Holdings (NASDAQ: AVAH) recently conducted an analysis of workforce trends that suggested that higher compensation may be the most important consideration for prospective employees, particularly in light of rising inflation.
“We’ve just finished a pretty deep dive into our work pool, and we’ve learned that right now caregivers that have left the home care space, specifically private duty, have left for more wages,” CEO Tony Strange said at the RBC Capital Markets Global Healthcare Conference. “We need to make sure that we continue to press [reimbursement] rates in order to pass those wages down to caregivers to entice them back into the home care space.”
Coupled with the rising wages are the sign-on and retention bonuses that are proliferating through the space, ranging on average between $2,038 for aides to $9,056 for top executives. The average bonus for RNs hovered around $6,330.
For some companies, these bonus programs are bearing fruit.
Starting in July, VITAS Healthcare, a subsidiary of Chemed Corp. (NYSE:CHEM), implemented a new retention bonus program using $44 million in unspent Provider Relief Funds, offering between $2,000 to $15,000 per licensed health care professional for 12-months of continuous employment. These one-time retention bonuses are designed to fortify the company’s clinical teams, including licensed nurses, nurse managers, home health aides and social workers.
The strategy thus far seems to be working, according to VITAS executives. The company hired 172 clinicians during Q3, coupled with significantly reduced turnover.
“[The bonus program] added fuel to the fire in terms of our ability, not only to continue retaining more of our clinicians, but attracting more to come into the workplace,” VITAS CEO Nick Westfall said at the recent Credit Suisse Healthcare Conference. “It’s exciting because — not only does it continue to build back our clinical capacity — but with that inside of the hospice benefit, we’ve seen some encouraging signs on week-over-week sequential days-of-care growth that, frankly, we haven’t experienced since the start of the pandemic.”