Where Hospices Are Investing Their 2024 Recruitment, Retention Dollars

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As hospices zero in on their investments in staff engagement and operational efficiencies, organizational culture is becoming a higher priority.

Hospices nationwide are taking varied approaches around how they fuel staffing investments with sustainable growth in mind. Some have leveraged technology to streamline their operations and reduce documentation burdens, while others have poured resources into sculpting their organizational culture and developing training and career pathways.


Investing in staff engagement channels is key to understanding workforce priorities and using them to shape successful retention strategies, according to Tanya Marion, chief human resources officer, Enhabit Inc. (NYSE: EHAB). Having a window into priorities such as career development and work-life balance is a significant retention factor for the Dallas-based home health and hospice company, Marion indicated.

“Much of our success with our recruitment and retention policies is tied to considering what an individual employee values most — and there can be a wide variety of needs and wants to fulfill,” Marion told Hospice News in an email. “Once we understand these needs, we try to fulfill them by giving employees that flexible schedule or the opportunity to grow in their careers. These are the things that attract employees to an organization and keep them there. Gone are the days of expecting every employee to fit the mold of a job. The workforce wants to be treated as individuals and know that their employer values them for their unique gifts and talents.”

State of hospice workforce

Though hospices are seeing an improved workforce outlook in 2024 compared to previous years, staffing pressures remain a top concern for many organizations.


Staffing was identified as a main 2024 pain point by 36% of 143 respondents to the Hospice News’ 2024 Outlook Survey, conducted with Homecare Homebase. This is down from 54% of respondents in 2023’s survey and 68% of 2022 respondents.

Hospices are increasingly pouring financial resources into staffing development. About 18% of respondents identified staff engagement and satisfaction as a primary driver among their investments this year.

Nearly one-third of hospices plan to invest in operational process improvements this year, while 15% indicated that they would pour resources into staff training technology.

2024 Hospice News Outlook Survey and Report Results
2024 Hospice News Outlook Survey and Report. Created in partnership with Homecare Homebase.

Investing in technology and internal communication is a large piece of creating a collaborative workplace environment, Marion stated. For example, leveraging predictive analytics technology can help staff feel better prepared to assess patient needs, she stated. Operational process improvements can also be key retention levers, Marion added.

“Empowering the interdisciplinary team to collaborate and work together in providing quality end-of-life care 24/7 – especially when caring for high-acuity patients – recognizes [their] clinical decision skills [and] promotes autonomy and teamwork,” Marion said. “We have seen success in adapting the use of technology when driving operational process improvements, especially with improving communication between hospice team members. Any opportunity to decrease the number of emails or phone calls while improving communication allows for better efficiency and time management for clinicians.”

Investing in technology and operational efficiencies is an important but not sole part of the retention equation, according to Craig Dresang, CEO of California-based YoloCares.

Providers should recognize the need to help operational processes run more smoothly, but the way that leadership implements change may be a larger consideration as far as staff are concerned. Organizational culture is a significant retention factor, Dresang indicated.

“It’s required to achieve those operational efficiencies to run smoothly as an organization, but you can’t inject change in any direction without providing context or soliciting employee input,” Dresang told Hospice News. “It all hinges on leadership’s commitment to learning what’s important and supporting it after that education piece goes away. It’s about organizational integrity, even if that’s explaining why you are moving to a different electronic medical record platform.”

The past decade has brought unprecedented high levels of employee turnover for many hospice providers, with the pandemic exacerbating workforce crises, according to Dresang.

A shift from the cost perspective is needed among hospice leaders to move the needle forward, said Cooper Linton, associate vice president of Duke HomeCare & Hospice. The North Carolina-based organization offers home infusion services, along with home care and hospice.

Turnover expenses often carry a more expensive price tag than recruitment and retention costs, Linton said.

“Hospices can greatly underestimate the cost of turnover in terms of dollars, quality of care and organizational performance,” Linton said. “When we truly understand the cost of turnover, it begins to liberate us to invest in what is a potential corrosive and destructive impact of home care and hospice delivery. It’s shifting the way we deliver care, because there’s an incredible cost if we do not.”

Gaining momentum on labor

Investing in cultivating a positive, high-performance organizational culture can make a world of retention difference, Dresang indicated.

Voluntary turnover among YoloCares staff has consecutively dropped below 5% year-over-year for the last eight years, Dresang stated. The number one reason employees have provided for remaining at the organization is because they feel valued and recognized, he said.

“It took time to get here, but it’s not just because our pay is competitive or the importance of benefits we offer. It’s because we really focus on the culture and making sure good people are recognized and feel valued,” Dresang said. “Key to retention is really zeroing in on organizational culture to support the high performers in every way we can while weeding out any toxicity. You’re only as strong as your weakest link. Your culture is your calling card and promise to new and existing employees of how you operate, how you value staff and how you deal with mistakes when they happen.”

You’re only as strong as your weakest link. Your culture is your calling card and promise to new and existing employees of how you operate, how you value staff and how you deal with mistakes when they happen.

— Craig Dresang, CEO, YoloCares

Signs of hospice workforce improvement have begun to emerge. The volume of hospice and palliative care workers in the United States has seen a meager 0.8% increase on average between 2018 to 2023, according to a report from IBIS World.

Many hospices projected forward momentum around labor conditions in 2023, anticipating reduced turnover rates tied to staffing investments/initiatives.

Duke HomeCare & Hospice has seen turnover rates drop dramatically in recent years, according to Linton. A “massive change” in retention policies led to nearly 50% – 80% in reduced turnover rates during the past four years, he said.

The improved retention has in part been a result of increased investments in LEAN business principles, Linton said. The LEAN principles include understanding the values, issues and workflows among staff, along with developing process improvement plans that address workforce challenges, he explained.

The initiative’s main focus areas thus far have included a better understanding of the impacts of staffing workloads, according to Linton. Part of the systematic changes at Duke HomeCare & Hospice have involved technology investments around geolocation tracking for staff providing bedside care.

The technology includes microphone access for staff to communicate and receive emergency support in unsafe environments or conditions, Linton said. Despite the upfront cost, the technology has gone far in terms of promoting workplace safety and retaining clinical and interdisciplinary staff members, he indicated.

Duke HomeCare & Hospice has a daily census that hovers around 2,300 patients. The hospice provider is affiliated with the Duke University Health System.

Being a part of a larger health care system and research and academic center means that much of its patient population has high-acuity and complex care needs, Linton stated. The larger volumes of high acuity patients can weigh heavily on staff’s stress levels, with their well-being at the core of shaping recruitment and retention policies at the organization, he said.

Ensuring employees feel physically and psychologically safe and supported is vital for retention, Linton stated.

“Some things are more quantifiable, such as costs that we put into worker geolocation technology. We know that cost. Others are really a philosophical change in the way we operate, and that doesn’t come with a daily price tag,” Linton told Hospice News. “We deal with a disproportionately higher acuity hospice population compared to others in our region and state. There’s an element of moral injury or distress that comes from seeing people in very difficult situations, especially in the home. It can be demoralizing to dedicate their life to helping patients and feeling helpless if staff are seeing issues such as social determinants of health like food, housing or transportation insecurities and not able to directly impact them. So it’s addressing the well-being of patients and those providing them with care.”

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