To sustain the Medicare Hospice Benefit, staffing needs to be a top-of-mind issue for organization leaders, according to Patty Husted, executive vice president of patient and family supportive services at VITAS Healthcare, a subsidiary of Chemed Corp. (NYSE: CHE).
Husted has worked in the hospice space, and at VITAS, for 37 years, following a stint as an oncology nurse.
In her current role, she oversees volunteer, bereavement, social worker, chaplain and veterans’ programs. This year, she received the National Alliance for Care at Home’s Lifetime Achievement Award. Next year, she will transition from a full-time employee to being a hospice volunteer.
Hospice News sat down with Husted in Washington, D.C., to discuss the ways the hospice community has evolved during her nearly 40-year tenure, as well as the industry’s biggest problems and how providers should tackle them.
What have you seen change during your time in hospice care?
So many different things. I laugh when I look at what it was like when I started and where we are today.
Even simple little things, I started in the inpatient unit, but within a year I was out doing home visits. I’m a little geographically challenged, and so we had Rand McNally maps back then. I was so excited when they had a Garmin, and now you have your cellphone, and they really get you where you need to go, much better than interpreting the map. So, technology has kind of changed some things.
Something I enjoy that has stayed the same is that people want to be here. People weed themselves out. They know shortly after starting, and I’m talking more about bedside staff, whether this is something they feel that they can do or not do.
I’m a firm believer that people don’t wake up in the morning saying, “How can I mess up today?” If we can empower them, they’ll do the right thing at the bedside. If this really isn’t the right journey for them, they will often say that they need to move on.
Clearly documentation is a lot different, even having started before we had computers. The recertification periods are still the same, but we actually had a calendar. We’d count the days on the calendar, and then we had a manual log, and so those type of things I kind of chuckle about to see the evolution.
I wonder where things will be in the next 10 to 20 years, but the benefit essentially has stayed the same.
I had the good fortune of working with the founders of [VITAS] and so was able to talk with them about what was envisioned when they did their grassroots efforts to have the benefit enacted, and what they were hoping for.
There’s a few things; I think of the [payment] cap, for example. There’s certain ways we get reimbursed, and there wasn’t a wage index. So, I think that sometimes they look back and sometimes say, “Well, probably if we had done this, we might have thought that a little bit more through.” But at the core, it’s still the same.
What would you say are the most important lessons you’ve learned in your career in hospice?
Sometimes to just sit back and breathe. I spent so much time at the bedside, and I’m always one who likes to sneak in time at the bedside. I’m probably more spiritual than I am religious, and I think that you just can’t take certain things for granted, and sometimes you have to allow yourself to just sit down and take a breath. I do think that that’s something important.
I’ve learned about different things through my own life experiences. I think that that sometimes physicians are a little more uncomfortable to talk about death and dying. They feel as though the patients are still coming to them for a cure and give them sometimes permission to think of our industry as just another specialty, like cardiology, pulmonology.
I have learned that patients and caregivers at the bedside are truly different, and you have to take the time to not only ask the questions but to really listen to the answers. If you just ask the questions as though it’s a task, you’re not really understanding the unique differences, and a lot of times they’re just afraid. They’re afraid of the unknown, and having that comfort level to sit down eye-to-eye with a patient or a caregiver to allow them the ability to address their fears.
I’ve just learned not to take life for granted, and I have a passion for this industry and truly a passion for wanting to make a difference in someone’s end of life journey.
What do you think are the biggest problems facing the hospice industry right now?
I think they’ve changed, but not a lot. To me, staffing is really a concern. The silver tsunami is coming, which means that, for the first time, we’re going to have the greatest number of Medicare-aged individuals.
There are still students who are interested in going to nursing school, but especially with COVID-19, the number of instructors has declined, and they are having to turn away students. And as the 65+ population ages, there are going to be different types of medical needs that those same nursing students, physician students, social worker students will have to address.
But there’s not as many students available, and now they’re going to have different specialties because healthcare has evolved. There are different healthcare opportunities out there for patients and then for staff.
Between 9/11 and COVID-19, people also have, in my mind, looked at life differently and make different types of decisions. So that’s what makes me worry about staffing, because there’s different choices. And years ago, nursing was more of a female career, and I’m so happy I’m seeing men in nursing because we needed that such a long time ago. But there’s other opportunities. That part makes me a little bit nervous.
What should hospice companies be doing to address these issues?
As healthcare companies, we need this new generation. We have to keep in touch with what’s important to the current generation because those are our future employees.
Even though they love tech, they’re also now enjoying a little bit of hands-on volunteering because that is their socialization, and they want to be able to feel as though they’ve made a difference. For hospice, we have to really talk about the reward of being able to make a difference and really talk to some of those younger students and get them volunteering.
It used to be that some of the staff in hospice were a little older. You used to kind of go through your career, and then that was something you transitioned over to. I actually started when I was around 25 or 26. and I can see that you can make that a career and understand the value that you can bring.
We need to make it easier for them to do those types of transitions and yet feel as though they’ve been able to grow within their line of work.
We need to think outside of the box and really think of these students as our future employees, and we need to make to draw on their heartstrings and allow them to see what they would be and not have them as afraid of death and dying.
Companies featured in this article:
