Hospice providers have unveiled two key themes that are impacting the ability to sustain and grow their workforce.

Staffing shortages have long topped the concerns of hospice executives nationwide. Rising demand for hospice care has been outpacing the supply of clinical resources for several years running. Labor strains have also mounted among nonclinical and back-office administrative, billing and IT roles.

Today’s hospice leaders need a deep understanding of the challenges, needs and priorities of their interdisciplinary teams, according to Cathy Wozniak, executive director at Massachusetts-based Hospice & Palliative Care of Martha’s Vineyard. This knowledge is critical to developing successful retention strategies, Wozniak said during the Hospice News virtual Staffing Summit.

“There’s not enough people or clinicians for the growing demand, and that has become difficult in recruiting,” Wozniak told Hospice News during the summit. “They want some flexibility and that work-life balance, particularly some of the younger generations of professionals. We have to figure out as leaders how to help give them that.”

Trend #1 New generations, educational opportunities

The scope of hospice workers is seeing an evolution of younger generations increasingly stepping into the industry, according to Cooper Linton, associate vice president of North Carolina-based Duke HomeCare & Hospice. The hospice and home care provider is part of Duke Health, which is integrating with the Duke University Health System.

Personal experiences with sick or dying loved ones have been among the common threads drawing interest to the hospice field, Linton said. More volunteers and staff have engaged in hospice care from historically under-represented communities, he added.

“There’s one trend that’s always been out there: People have an experience with hospice and then they have a desire to spread the word. They want to give back,” Linton said during the summit. “We are connected at Duke University [and] we’re seeing an interest in younger college and graduate students who have a passion around this. We’ve seen an uptick in young people wanting to engage with hospice. We found real volunteer interest in people [who] historically might not have been a market who wanted to engage with hospice in the past.”

The rising interest comes at a time of growing need.

Current training initiatives are insufficient to keep up with population growth and demand for hospice services, research has found. Researchers projected the national need will range from 10,640 to nearly 24,000 hospice and palliative care physicians by 2040. However, the actual supply of these professionals will fall far short of demand between roughly 8,100 and 19,000 physicians. Currently, the supply/demand ratio of hospice and palliative care specialists in the United States is equivalent to 13.35 professionals per 100,000 seniors 65 and older, the research found.

Educators have increasingly been ramping up efforts to broaden medical students’ exposure to hospice and palliative care, Wozniak indicated.

Educational initiatives have been spreading at regional levels in high schools, at community colleges and across universities nationwide.

“There’s several colleges and universities that are trying to recruit professionals who want to get into the health care arena.” Wozniak said. “They’re working with them when accepting credits from a different degree. I hope that trend within the academic community continues, because those people bring other skills that will help strengthen the industry.”

Trend #2 Rising costs compounding shortages

Despite rising awareness among future workforce generations, financial pressures are challenging the ability for hospices to recruit and retain sufficient staff volumes. Labor-related financial struggles have crystallized in recent years, causing some hospices to shutter or temporarily close their programs.

Lagging reimbursement rates amid wage hikes, inflation surges and steep compensation competition have put hospice between a rock and hard place in the staffing battle. Hospices have lost staff to competitors with greater financial ability to offer workers larger salary and compensation packages.

Among the most pressing concerns for staff are rising housing costs, according to Wozniak.

“What we see here on the island as our biggest challenge is the lack of affordable housing,” she said. “We have staff that struggle with year-round affordable housing. Housing goes up so high, and I know throughout the United States in some areas the housing is not affordable as well. The cost of travel nurses is very expensive, and that is a barrier as the nursing shortage continues nationwide. That’s why we work so hard on the retention piece, because it can be so expensive”

Housing costs in the United States are roughly five times higher than the average median household income, according to research from the Joint Center for Housing Studies of Harvard University. Additionally, half of all renter households spend more than 30% of their income on housing, the research found.

The financial housing burdens have resulted in a ripple effect of difficulties in both retaining staff and balancing clinical capacity, according to Linton.

“Our market has gone up in the cost of housing. So, we’re seeing people therefore moving further and further away from the core of our triangle area [and] into these lower-cost surrounding cities,” Linton said. “That creates a challenge for us when we try to have staff travel to see patients … that is driven by that cost of housing. So one challenge begets another challenge.”