Hospice Leaders: Dollars Alone Won’t Solve the Turnover Conundrum

Money isn’t everything when it comes to recruitment and retention.

While compensation is an important factor for attracting and keeping staff, hospices need to consider other crucial aspects. Employee benefits, a career path, organizational culture and leadership engagement also weigh into workers’ decisions to join, stay or leave a hospice.

Hospices should take a close look at the employee benefits that their organizations offer, according to Terese Acampora, COO of MJHS Hospice and Home Care, which is part of the New York-based MJHS Health System. The hospice has reassessed its benefit packages with employee feedback in mind, including a revised look at paid time off policies aimed at reducing burnout.


“We took an opportunity to reassess our benefit package and [hospices] can’t understate how important your benefit package is — including paid time off,” Acampora told Hospice News. “Having generous paid time off was really, really important, and [having] a good strong health benefits package. They know that there is support for when they’re feeling that burnout.”

Staff also indicated that having career growth potential was another factor in their employment decisions, she added. This led to the launch of a mentoring program to help clinicians realize their career aspirations, thus increasing retention, Acampora said at Hospice News’ virtual Staffing Summit.

“The other piece we did is develop an Emerging Leaders Program to grow our own clinical leaders, and that was really important to make our clinical staff feel that they have an avenue for career progression in the organization,” Acampora said.


Staffing shortages have long plagued the hospice industry, but the pandemic’s impacts have spelled heftier headwinds against sustainability.

Turnover among registered hospice nurses, for example, reached 25.15% during 2022, 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).

Turnover rates among aides and CNAs were as high as 19.05% and 29.84%, respectively. Only LPNs and LVNs had higher rates, reaching 31.52% turnover and 25.12% for vacancies, the report indicated.

High clinical turnover rates have put strains on clinical capacity and adversely impacted patients’ access to care. Meanwhile, turnover and rising labor costs have resulted in margin compression for hospices nationwide.

One major expense has been the need to offer sign-on and retention bonuses in order to compete in the labor market.

Having a sense of balance when it comes to bonuses is critical, according to Jennifer Nycz, chief clinical operations officer of AccentCare. The Dallas-headquartered hospice provides care in 30 states and also offers palliative and personal care, among other services.

“It’s an extremely competitive landscape right now across the country. We see in some markets, it doesn’t matter how high the signup bonuses, it’s really hard to pull in [clinicians],” Nycz told Hospice News during the Staffing Summit. “In some areas, we’ve seen the signing bonuses are very, very, very high. What we found is that it can be off-putting to some of our current staff when they see these large sign-on bonuses, and so we’ve had to be very thoughtful and balanced about that. We’re judicious and we’re thoughtful in really trying to be protective of our current employees as well.”

Leadership engagement has emerged as another key element to understanding both the driving forces behind clinical turnover and responding to the negative trend, according to HopeHealth President and CEO Diana Franchitto.

During the pandemic roughly 25% of staffing turnover at the organization occurred among its clinical workforce, she told Hospice News. HopeHealth has seen improvement as the outbreak eased, with more than 700 employees caring for roughly 2,000 patients daily, Franchitto stated during the summit.

In addition to improving workflows and patient case workloads, striking the right balance between “aggressive recruiting” and “attentive retention” involved executive engagement, she told Hospice News.

“It was rocky and it was rough, but we’ve operationalized all these workflows and processes that the pandemic sort of forced us to and as the PHE comes to an end, these are part of our daily operations,” Franchitto said at the summit. “Post-pandemic, having your CEO attend [interdisciplinary group meetings] is so important. It’s so meaningful to the staff that the CEO takes the time to sit in IDG. It is time consuming, and you learn a lot and you get a sense of what the vibe is. Not only is it a shot in the arm, but you do pick up on some of the areas of concern and frustration and bringing it back to your team.”

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