The Employment Outlook for Hospice Aides

Rising wages, reimbursement pressures and immigration policies are fueling high turnover rates for hospice and personal care aides.

Similar trends are proliferating among hospitals and health systems that provide these services.

Current reimbursement structures for aide services represent the most significant challenge in maintaining a sufficient workforce, according to Kenneth Albert, president and CEO of Maine-based Androscoggin Home Healthcare + Hospice. These issues are compounded by a limited resource pool of interested and trained professionals, Albert stated.

“It is rare to find individuals who perceive personal care as a career choice, or path. These roles are often per diem or part time to supplement income, or to allow flexibility for those with other caregiving responsibilities, such as children or elderly family,” Albert told Hospice News in an email. “Additionally, this particular workforce is challenged to align with an employer of choice where benefits may be important. Most view these roles as gig-economy work where the hourly wage is far more important than the hidden paycheck, which includes all other benefits contributing to a much larger overall total income.”

Fluctuating supply and demand

A teeter-totter effect is taking place in terms of supply and demand when it comes to aides.

On one side, the number of these workers entering the workforce is anticipated to swell in the coming years. Employment of home health and personal care aides is projected to grow by 22% between 2022 and 2032, according to a recent U.S. Bureau of Labor Statistics report. This occupation’s growth rate is “much faster than the average for all occupations,” the report found.

An annual average of roughly 684,600 openings for home health and personal care aides are anticipated to become available during the next decade, the report projected. Many of those openings are expected to result from the need to replace workers who transfer to different occupations or exit the labor force due to retirement, among other reasons, researchers indicated in the report.

On the other hand, workforce growth will be offset by climbing turnover rates that were exacerbated by the pandemic. For example, the average length of employment for home health aides is 1.3 years, a lower rate than other health care occupations, according to the U.S. Bureau of Labor Statistics.

However, turnover rates may be showing signs of improvement, said Josh Klein, founder and CEO of Royal Care and Emerest Health Companies. The home-based care provider operates in New York, New Jersey, Connecticut, Pennsylvania and in St. Louis, Missouri.

The company has seen reduced turnover among aides in its New York service region, Klein said. Nearly 60% of its workforce in that state have been with the company for more than five years and roughly 30% for a decade or longer, he stated.

One of the larger pieces of the company’s continuum of home-based care include home health and personal care services. These workers are key to connecting with patients, family caregivers and their support systems, according to Klein.

“We were able to not just grow [but also] strengthen this workforce,” Klein told Hospice News. “It’s making them feel that they are valuable. It’s putting yourself in their shoes. What are their potential risks that are not being addressed? How do we address these things with our staff and pick up on the telltale signs of distress? What are the things keeping them engaged with the patient?”

The influence of immigration

Evolving immigration policies in the United States also are straining hospices’ ability to grow and retain their workforce. Immigrant workers help to fill aide positions. But state and national policies are contributing to a diminishing pool of these workers, putting pressure on providers’ clinical capacity.

A large majority of aides are immigrant women, making these a key demographic to focus on when shaping recruitment approaches, according to Klein.

“The majority of this workforce are women, many of whom are immigrants,” Klein said. “So, it’s how you empower them to not just do their daily routine for patients, but also make them part of their health outcomes through your programs and initiatives.”

Immigrant workers in aide roles are often granted Temporary Protected Status (TPS), Klein added. This is a temporary immigration status that allows workers to have temporary visas, which need to be renewed within certain timeframes.

The renewal process can be “painful and worrisome” for workers and providers alike, Klein stated. Aides must stop working while going through the authorization process, with these immigration policies causing “stumbling blocks” as far as providing stable and reliable home health and personal care services, he explained.

Technology can be a key to helping providers navigate immigration hurdles in retention, according to Klein.

“We as companies need to be doing everything we can at dotting our I’s and crossing our T’s and always ensuring that there are things in place to help them through the process,” Klein said. “Whether that’s having software that helps reapply for certain things, getting authorizations. With some software types, you can know exactly where their TPS status is and help them reapply on time so that they don’t have a gap in performing and working.”

Balancing pay with benefits in retention battle

Wages for hospice and home health aides have risen in recent years, but at a slower pace than many would like.

The national average wage rate for hospice aides is $18.23 per hour, according to Hospital & Healthcare Compensation Service’s (HHCS) 2023-2024 Hospice Salary & Benefits Report. Among stand-alone hospice agencies, this rate was slightly higher at an average of $18.37 per hour, compared to $18.15 per hour among hospices affiliated with a parent organization or home care agency. Home health aides working for hospices affiliated with hospitals had the highest average rate at $19.22 per hour.

The report found that average hourly pay in 2023 increased by 6.83% among aides, a smaller increase than the 9.09% that occurred in 2022, said Roseanne Zabka, director of reports at HHCS.

“This workforce has been underpaid for a long time,” Zabka told Hospice News. “There’s more increases coming, but not as hefty as we’ve seen in the past few years. The minimum wage went up in many states, and increased salaries are catching up with that. We’re going to start seeing lesser increases, though, than we’ve seen. We’re not there yet, but positive factors are showing signs towards normalizing.”

Employers can also gain from understanding their workers’ long-term goals. Educational and career pathways are priorities for many aides, according to Albert.

Employee benefits packages can be a retention lever, including those related to career goals, psychosocial support and practical needs, he said. Androscoggin, for example, offers workers no-interest auto repair loans that can be repaid through payroll deductions, said Albert.

Additionally, offering these workers tuition reimbursement or providing training and educational opportunities can allow them to seek other aspects across the interdisciplinary professional team such as clinical roles in nursing or direct care, Albert indicated. Providing the financial and educational support can be particularly impactful in retention for workers who typically are not able to support these initiatives on their own, he said.

“We are marketing these positions as gateway opportunities for professional development within the health care sector,” Albert said. “Whether a clear path out of poverty, or individualized professional development opportunities, we believe that we must recruit for alignment with the concepts of belonging [and of] professional opportunity for those so inclined. We need to include benefits such as child care incentives.”