Though most U.S. hospice providers have the same problem — a workforce shortage — many seek to address it using unique solutions.
Worsening workforce shortages have been keeping hospice leaders awake at night for several years running. Rising turnover due to the COVID-19 pandemic exacerbated the crisis, leading some hospice providers to shut down their programs or sell off their businesses because they could not recruit or retain a sufficient number of employees.
Hospices, in turn, have taken new steps to gain or keep their staff, particularly clinicians.
Enhabit Inc.
At Enhabit Inc.’s (NYSE: EHAB) hospice segment, the implementation of a new case management system has been bearing fruit, according to Jeanne Kalvaitis, the company’s executive vice president of hospice.
“About a year ago, we did a kind of a deep dive into some of our challenges, and we realized that we needed to do a new staffing model, one that would attract dedicated, experienced hospice nurses,” Kalvaitis said at the Hospice News ELEVATE conference in Chicago. “So we put together an RN case management staffing model that really focuses on a caseload of patients, that improves your continuity of care, your [interdisciplinary] team members. Patient satisfaction went up; our quality scores went up.”
Dallas-based Enhabit’s footprint includes 252 home health locations and 105 hospice locations across 34 states. The company emerged from the 2021 spinoff of Encompass Health’s (NYSE: EHC) home health and hospice segment.
Early on the company would implement a set of case management processes that were symmetrical with those in its home health business, but agencies in its hospice segment experienced some difficulties with those transitions. This contributed to a spike in turnover, which in turn slowed Enhabit’s rate of growth, CEO Barbara Jacobsmeyer said at the Credit Suisse Annual Healthcare Conference last November.
From that feedback, the company learned that bringing a home health type of model into hospice realm meant nurses were on 24/7 call in a way that was unmanageable with their available workforce, Jacobsmeyer explained. This led some employees from acquired agencies to leave the company post-acquisition.
Enhabit in late 2022 began piloting this strategy in some of its markets and soon rehired some nurses who had left the company citing caseload issues. Now, the company is rolling out the new system across its footprint.
“We were able to hire nurses. They liked the model that we were giving them, and we’ve had to increase our salaries as well,” Kalvaitis said. “So we’ve had a lot of net gains, and at the end of the last quarter we only have four of our 107 [hospice] locations that had some staffing constraints.”
Guaranteed
The California-based hospice startup Guaranteed found staffing to be a challenge as they launched in 2022. As a new company, they had to start recruiting without brand recognition or established reputation, which complicated the process.
Entrepreneur Jessica McGlory founded Guaranteed two years after her own father passed away. She came to the space with the goal of returning hospice care back to its roots, while integrating a more modern approach to meet the changing needs and expectations of patients and families, she told Hospice News.
Her idea was to return hospice to its mission-focused roots, leveraging technology for the timely identification of patient needs and reduced burden on staff, as well as developing a culture that has an emphasis on supporting employees as well as family caregivers.
The company’s growth momentum is already accelerating, propelled by a $6.5 million infusion of capital in a seed round led by the investment firm BrandProject. Precursor Ventures, Springbank Ventures, Lakehouse Ventures and Cake Ventures also participated in the round.
Technology is a cornerstone of Guaranteed’s business model, and hiring is no exception. Solutions implemented to help build efficiency and manage care delivery are also becoming effective recruitment tools.
“There are a lot of hospices in the greater Los Angeles area, and it’s very competitive,” McGlory said at ELEVATE. “So we really try to make sure that we can focus on some of the different benefits that we’re able to provide and that we think are interesting to nurses. We also find those that are intrigued by technology and want to be able to learn more about it.”
Guaranteed is leveraging its AI platform to “supercharge the team,” McGlory said. This includes systems designed to speed and automate aspects of clinical documentation to allow clinicians to focus on patient care. The company’s current goal is to ensure clinical staff can spend 80% of their work time at the bedside and only 20% on administrative tasks.
Among the benefits of these technologies is the opening up of new and different career paths for clinicians, according to McGlory.
“Whereas maybe a nurse thought their future path could only really get to a director of nursing or director of patient care services, which is a great role,” McGlory said. “But some of them are realizing that they might be able to go to the product side and help build out some of our technology products as a clinical product manager. So they’re seeing that there’s more various opportunities available at our company.”
Empath Health
At Florida-headquartered Empath Health, leaders are investing in management development as well as leveraging its mission as a nonprofit hospice provider to attract prospective employees.
Empath provides hospice, home health care, primary care, palliative care, PACE, AIDS and sexual wellness care, and adult day services to a combined total of more than 23,000 individuals. The organization is the parent company of 17 affiliates and two philanthropic foundations.
Empath offers hospice care through several brands, including Tidewell Hospice, Suncoast Hospice, Empath Hospice, Hospice of Marion County and Suncoast Hospice of Hillsborough.
“My general sense would be that most colleagues really don’t look at tax exempt status regarding whether or not they want to work for an employer,” Fleece said. “I think for us it has been a lot about culture, communication, and really building connectedness, especially as a new organization, even though we have many legacy organizations coming together under one brand.”
Fleece came to Empath via its 2020 merger with Stratum Health, where he had been CEO. The two Florida-based companies combined forces in February of that year and later unified under theEmpath Health brand.
In 2011, Fleece co-authored the book “The New Age: The Future of Health Care in America,” with the futurist David Houle, which examined the ways the system could evolve in the coming years.
“We’ve been very focused on our mission, vision and values, and doing a lot around connecting with colleagues that may have worked for legacy organizations in the past, but are now a part of a new family,” Fleece said at Elevate. “Certainly, with the tremendous growth that we’ve had over the years, we’ve been investing a lot in leadership and management and bringing thought leadership and industry experts to the Empath brand and strategy.”
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