Hospice leaders have lost sleep over workforce pressures plaguing the industry for several years running, a trend that is not anticipated to abate anytime soon.

Staffing challenges were cited as the leading concern among 35% of 112 hospice professionals who participated in this year’s Outlook Survey by Hospice News and Homecare Homebase. This represented an 18% decline compared to the 2023 survey results.

The first piece of this three-part Hospice News series will explore one the top issues facing hospices in 2025 – starting with the struggle for clinical capacity amid rising demand. Hospices are traversing through a challenging and competitive employer landscape wrought with financial headwinds, according to Community Hospice & Palliative Care CEO Phillip Ward.

“There simply are not enough people for the growing demand, and that problem is only going to get worse over the next five to 10 years,” Ward told Hospice News in an email. “That increasing lack of supply is going to continue to drive costs higher through increased wages. We are seeing it now, and I think it is only going to get worse.”

Photo by Hospice News

Biggest staffing issues in hospice

Workforce shortages exacerbated by the pandemic have impacted hospice operations in detrimental ways during recent years. Some hospices have temporarily or permanently shuttered their programs due to insufficient staffing resources or financial constraints related to labor pressures.

But spread of the deadly COVID-19 outbreak has also come with a few key recruitment and retention takeaways. Organizations often found success in offering sign-on bonuses and greater scheduling flexibility to new staff while also focusing on efforts to boost morale and hone organizational cultures.

The most pressing issue facing hospice leaders is fueling a sufficient supply of qualified staff to meet a diverse range of end-of-life care needs among patients and families, according to Robert Love, executive director of California-based Butte Home Health & Hospice. The California-based hospice provider received its fourth consecutive great place to work certification in 2024.

Butte Home Health & Hospice has seen a growing volume of nurses from other health care settings applying for hospice positions, Love stated. The organization has also seen an increasing number of recent nursing graduates seeking hospice roles, he added. These two trends represent an interesting and important element in the evolution of today’s hospice workforce, according to Love.

“Plenty of nurses believe that hospice is where they want to be and that they are drawn to end-of-life care as a career,” Love told Hospice News in an email. “Still, we can’t get past the need for skills and experience in end-of-life situations. We are encouraging these applicants to obtain experience in relevant settings and then re-visit hospice. The most significant concern is qualified staff.”

Providing more bereavement services to staff has become an invaluable piece of retention at Butte Home Health & Hospice, with this support becoming a permanent part of its program, according to Love.

These bereavement services have helped provide a more supportive culture – gaining the organization a reputation for being focused on employees’ quality of life, Love said. As a result, staff “longevity is rising,” and Butte Home Health & Hospice has seen more candidates referred by current team members, he added.

Hospices have a fairly small pool of professional resources compared to the greater health care industry, according to a spokesperson at Enhabit Inc. (NYSE: EHAB). The home health and hospice provider recently received a 2025 Great Place to Work certification.

“The competition is fierce,” an Enhabit spokesperson told Hospice News in an email. “The growth and expansion of the hospice industry has resulted in a supply and demand challenge to locate these registered nurses and then compete with other hospice providers — not only with competitive salaries, but also work-life balance measures.”

Developing sustainable practices to engage and grow hospice workforces is significant to retention, according to the Enhabit spokesperson. The hospice provider has implemented a registered nurse case management staffing model that has been a “game changer,” said the company’s spokesperson. The model has allowed for more timely after-hours responses, helped to foster greater flexibility and autonomy among staff, as well as improve continuity of care. The model has also led to better work-life and clinical capacity balances, the spokesperson said.

Addressing staff priorities

Hospice worker satisfaction can be broken down into two categories of psychological well-being and logistical support, according to David Payne, chief customer officer at the workforce training and development agency Pathways.

Hospice staff value having strong mental health support, open communication with supervisors and leadership accountability, Payne indicated. Flexible scheduling and greater autonomy in decision making are also large contributors to staff satisfaction, he indicated.

Placing an emphasis on the meaningful work involved in hospice care is an organization’s strongest recruitment and retention tool, Payne stated.

“Most hospice professionals are drawn to the field because of their connection to the mission, not because of differences in job responsibilities,” Payne told Hospice News in an email. “This means recruitment and retention aren’t about changing the work itself, but about differentiating the experience of doing it. Just as quality of care defines a hospice’s reputation for patients and families, employees are looking for ‘employee quality of care,’ [or] how well an organization supports, values and invests in its staff. Hospice workers want an environment that not only allows them to fulfill their calling, but also sustains them in doing so.”

To improve recruitment and retention, hospices must invest in professional development and mental health support, according to Payne. An important step toward improved retention is often a shift in organizational culture mindset, recognizing that long-term growth in hospice is driven by a connected and engaged workforce, he added.

Word of mouth can be a hospices’ best recruitment tool, according to Ward. Florida-based Community Hospice & Palliative Care was among the recent recipients of the Great Place to Work certification. Staff satisfaction has been largely driven by having strong onboarding and training processes in place, Ward indicated.

Providing end-of-life care can be a taxing experience for employees, and having ongoing support as they acclimate and grow into their roles is a vital piece of retention, he stated. Supported staff feel less overwhelmed and more connected to the mission of providing high quality care, according to Ward.

Growing a strong hospice team requires development of leadership skills and improving the work experience by simplifying processes and improving technology while also ensuring that compensation does not become a “demotivator,” Ward said.

Roughly 17% of organizations indicated that staff engagement and satisfaction were primary drivers behind their technology investments in 2025 on the Hospice News outlook survey. More than a quarter (29%) expect that investments in operational efficiencies would yield the greatest return, with others anticipating that new staffing training technologies would also have beneficial outcomes.

Hospices must carefully consider all the factors that go into using technology in workforce development prior to making these investments, he added.

“People do not leave jobs but instead leave poor managers,” Ward said. “Our clinicians are here to take care of patients, not computers. These are adages we know and need to keep in mind when we are building our systems and people.”

Demographics also play a role in retention as more hospice leaders reach retirement, said Debbie Shumway, executive director at Hospice of the Valley. The Arizona-based hospice provider saw retirement rates reach just under 12% among its workforce in 2024.

Attracting a new generation of hospice workers involves diverse recruitment and retention approaches, according to Shumway. Having an organizational culture of caring is a critical aspect, she stated.

Employees need a reliable avenue to both give and receive feedback, Shumway stated. Hospice of the Valley holds ongoing staff meetings to share updates at locations across its service region. These interdisciplinary meetings have helped reduce frustrations and barriers for employees by allowing them to be more involved and part of the solution process, she indicated.

Having a built-in infrastructure to support staff at each location across a hospice’s service region is vital to an engaged workforce, according to Shumway. Equally important is having a multitude of resources available, such as employee assistance programs that help ensure “their cups are getting and staying filled,” she said.

“At every level and layer of leadership is a focus of showing care for our employees,” Shumway told Hospice News. “It’s a daily balance to ensure they have the flexibility they need and are equipped to handle all the nuances of caring for patients. It’s not a one size fits all approach, and that focus has really increased morale and made a significant difference.”