Hospices Hustle to Staff Inpatient Units as Demand Grows

Hospices are working to strike a harmonious chord between increased demand for inpatient care and the workforce resources to support it.

Some hospice providers have seen a rise in demand for inpatient care. While a number have been able to expand to address this need, others have had to shutter their inpatient programs due to labor pressures.

One factor is that hospitalized patients often need additional inpatient care for a few days after electing the benefit, according to Kerry Hoerner, chief hospice officer at Empath Health. Empath’s affiliate Suncoast Hospice of Hillsborough recently opened a new 10-bed inpatient unit at St. Joseph’s Hospital. The Tampa-based hospital is part of the BayCare Health System.

Advertisement

“The hospital itself is one of our largest referrers for general inpatient care,” Hoerner told Hospice News. “We have seen that [demand], certainly in patients that are cared for in the hospital oftentimes have a need for that higher level of care before they can go home with hospice services.”

Florida-based Empath Health provides hospice and home health, primary and palliative care, among other services. The organization is the parent company of 17 affiliates and two philanthropic foundations.

The Hillsborough office is a second location for Suncoast, which opened in December 2021. Since then, the organization identified a need for inpatient care in the community, Hoerner told Hospice News.

Advertisement

“Even our hospice home patients that are receiving services at home will be eligible to come in if they need short-term, acute symptom management,” Hoerner said. “We really do try to maintain that level of care and support in the home setting if that’s the patient’s goal, but any patient that’s eligible is a patient who is in need of some acute short-term symptom management.”

Chemed Corp. (NYSE: CHEM) subsidiary VITAS Healthcare also recently opened a hospital-based inpatient unit in Florida. 

The new facility at Broward Health Coral Springs features 12 patient beds and replaces a temporary unit with eight inpatient beds that VITAS had operated in the hospital since 2021. The company anticipates serving more than 350 patients annually with the expanded patient capacity.

But as some inpatient doors open, others have closed under heavy financial and operational weights around labor issues.

Ohio-based HMC Hospice of Medina County, an affiliate of Hospice of the Western Reserve, temporarily closed its inpatient unit in 2020, reopening the facility in 2022. The hospice cited high operational costs and staffing shortages as reasons for the shut down, which coincided with other cost-cutting measures until the hospice was able to rebuild its ranks and reopen.

The lack of a sufficient clinical workforce caused an Iowa hospice facility to close in 2021. The organization, branded simply as “Hospice” was the only provider with an inpatient facility across the two counties it served.

Clinicians represent the greatest gap when it comes to staffing inpatient units, according to Dr. Ismael Roque-Velasco, president and CEO at OpusCare of Florida. But the organization is seeing signs of improvement.

“The largest turnover has been in the certified nursing assistants. Even if we didn’t experience a drastic turnover, it was larger than in the nursing category,” Roque-Velasco told Hospice News in an email. “We have seen more availability of nurses and the labor cost stabilized during the last two months. Overall, we feel that things are getting back to normal.”

Organizational culture, employee benefits and education and career growth opportunities have aided retention in recent years, Roque-Velasco indicated.

For some hospices, inpatient facilities can be a financial loss leader and difficult to keep afloat. The keys to sustainability hinge on the ways an organization structures its human resources, operational efficiency and revenue management, hospice leaders told Hospice News on background.

Keeping inpatient capacity manageable relative to the clinical workforce is an important element, according to Alisa Gerke, executive director at Unity Hospice & Palliative Care. This includes understanding where both clinical and nonclinical gaps may exist, she added.

“We found that we had some of the greatest needs and gaps within the clinical care delivery,” Gerke told Hospice News during the virtual Staffing Summit.

The Wisconsin-based hospice provider operates a 12-bed inpatient facility with a “relatively small” support staff team, Gerke said. The hospice hasn’t struggled with nonclinical staff vacancies at the facility, but it has faced clinical workforce challenges that reached into inpatient care, she explained.

The only nonclinical staff working at the inpatient unit are maintenance and nutrition services, she told Hospice News in an email. All services offered at the inpatient facility are taken care of by Unity’s organization-wide support services team, Gerke added.

To more quickly relieve some of the labor pressures, the company is working to accelerate its onboarding processes, Gerke indicated.

“We’re undergoing some pretty significant revisions to onboarding, because we found what got us here isn’t what is going to get us there,” she said. “It was really taking a pause and [asking], ‘Where are the gaps? What are we missing?’ It’s looking at what are some of the core pieces that we need, regardless of job function, to get employees set and ready. It’s not a one-size fits all.”

Companies featured in this article:

, , , , , , , , ,