Guide to the Hospice Workforce Shortage (2022)

Over the next 20 years, the aging baby boomer generation will lead to an increase in home health, hospice and palliative care eligibility. This increasing demand will require a fast-growing supply of specially trained, end-of-life healthcare workers. On the current trajectory, we expect a deficient supply of qualified healthcare workers to meet the home health, palliative care and hospice demand of the next two decades.

Prior to the COVID-19 pandemic, the unequal supply and demand trend was already causing concern. Those concerns have grown stronger as some healthcare professionals begin to rethink their careers and work-life balance after the burnout many faced during the pandemic.

The Numbers

End-of-life care training is overlooked

According to a 2018 study published in PubMed, over the next 20 years:

• The US is projected to train 20-40% less hospice and palliative care specialists than needed to keep up with the aging population (10,000 people turn 65 each day).

Hiring healthcare workers prepared to offer end-of-life care continues to be an uphill battle as an overwhelming number of students in clinical disciplines and critical care nurses do not feel prepared to provide end-of-life care.

• A survey of undergraduate nursing students in junior and senior year overwhelmingly showed they felt unprepared to offer family care at end-of-life. In particular, they did not feel comfortable to:
  • properly communicate with and support patients and families
  • manage families’ emotional responses to their loved one’s condition
• In a 2019 survey of critical care nurses, less than 40% of respondents reported being “highly competent” in any palliative care domain while 38% reported no palliative care education in the past 2 years.

The pandemic is making some healthcare workers rethink their roles

A recent JAMA study published in April 2021 surveyed over 5,000 health workers, faculty, and trainees found that:

• 21% have considered leaving their current roles because of stress brought on by the pandemic.
• 30% are interested in reducing their hours on the job.

A deeper look shows that among the workers surveyed:

• Around 50% of parents said that parenting and virtual education caused stress.
• 47% were worried about the pandemic negatively impacting their career development.
• Over half saw decreased productivity working remotely.

In 2021, the demand for healthcare workers grossly outweighs supply

• Based on data published by Axios, across the US in Q2 2021:
  • Job postings for registered nurses have outnumbered applicants 53 to 1
  • Job postings for home health and personal care aides have outnumbered applicants 43 to 1
  • There were 363 nurse practitioner job postings for every applicant
• According to the American Nurses Association, more registered nurse jobs will be available through 2022 than any other profession in the country.
• The U.S. Bureau of Labor Statistics projects that 11 million additional nurses are needed to avoid a further nursing shortage.

There are signs of hope

Medical and nursing school applications have risen significantly in the last year. Of particular note, a higher percentage of males have entered nursing school than ever recorded.

The Direct CARE Opportunity Act was introduced to the U.S. House of Representatives in May 2021 with the intention of “awarding grants for the recruitment, retention, and advancement of direct care workers” which includes hospice works. We’ll add more details as it works it’s way to the Senate for approval.

The News

• October 2021 – The University of Maryland has created the first fully remote PhD in Palliative Care in the United States. The program is designed for all members of the interplanetary team and will focus on developing research, leadership and clinic palliative care skills.
• July 2021 – The Jung Center’s Mind Body Spirit Institute and Houston Hospice established the Compassionate, Professional, Renewal (CPR) Wellness Initiative to prevent the burnout and emotional hardship among end-of-life healthcare workers. The self-care program spans across events, tools and nutritional counseling.
• April 2021 – Visiting Nurse and Hospice for VT and NH and the VNA Health System of Northern New England have partnered to create a one-year nurse residency program for registered nurse graduates hoping to improve the nurse shortage in the region.
• April 2021 – Amedisys shed light on the success of their new data analytics system aimed at increasing employee retention and recruitment. With the help of this new tool, Amedisys decreased nursing turnover from 29% last year to 20% in Q1’21.
• March 2021 – Louisiana based LHC Group invested $20 million over the next 10 years in the University of Louisiana at Lafayette’s College of Nursing and Allied Health Professions.
• January 2021 – Analytics company Home Care Pulse purchased the Home Care Institute to help hospice and home health workers advance their careers and fill in skill gaps through further clinical education.
• October 2020 – In an effort to confront the limited number of graduate specialty programs and the significant costs they incur on students, The Medical University of South Carolina (MUSC) developed an “externship” program to speed up the professional development of advanced practice registered nurses (APRNs), physician assistants (PAs), nurse practitioners (NPs), clinical nurse specialists (CNS), and other non-physician licensed independent practitioners.
• June 2020 – To help with employee upskilling, the Hospice of Southern Maine partnered with Granite State College to offer its employees reduced tuition in pursuing higher education applicable to hospice care.
• March 2021 – Social workers that have worked for Unity Hospice for 3+ years can now apply to a professional development program that recertifies them in topics related to hospice and palliative care.
• August 2020 – Ohio’s Hospice, the regional partnership of 9 Ohio Hospice providers, launched the Cope & Hope program aimed at improving the mental well-being of employees amid the global COVID-19 pandemic.

The Takeaways

There still is time to act. While staffing shortages are a risk to growth and delivering quality care, the oldest of the baby boomer generation are not at the age of needing consistent home health and hospice services yet.

The floodgates may open soon. Some projections suggest that the first large wave of baby boomers needing consistent home health and hospice services will be in the next 5 years.

Strategies to consider

• Empower local nursing students to learn specialties related to end-of-life care
  • Get creative if a financial investment in education is unrealistic. Partner with local institutions who have the same goals and priorities as you. Invest in building relationships with institutions and promising graduates.

• Expand and broaden your volunteer programs
  • The US has nearly 500,000 trained hospice volunteers that save providers over $469 million each year.
  • Make it easy for your community to get involved and learn about volunteering opportunities
  • Build pathways for volunteers to become full-time employees

• Design career paths for your employees
  • Opportunities for advancement can improve retention and boost employee morale, as well as recruitment.

• Incentivize continued education
  • Offering improved compensation or subsidizing education and training programs for employees that want to grow can be a worthwhile investment for building a skilled and fulfilled workforce.

• Balance employee workloads evenly
  • Burnout, especially during the pandemic, was one of the biggest contributors to turnover at hospice providers.
  • Pay close attention not only to the number of patients each employee is responsible for but also the acuity of those patients.

• Build self-care into your company’s DNA and into each employee’s daily routines.
  • Hospice employees continue to request increased opportunities for self-care during working hours to avoid burnout.
  • Make sure your paid-time-off policy is allowing employees to take the breaks they really need.

• Use software to monitor early signs of burnout or stagnation
  • Tracking employee satisfaction and growth can be seamless with software solutions that automate employee check-ins and regular reporting to managers

• Understand the generations shifts within the workforce
  • Dig deep into the JAMA study and understand that various groups within your organization have differing needs and concerns.
  • Account for the fact that baby boomer staff are nearing retirement.

• Develop a more diverse employee pool that reflects the communities you serve
  • Not only is it crucial that employees understand the needs of the diverse communities it serves but employees should also come from each unique community.
  • This helps build an inclusive work place and tapping into all communities may even open up your potential employee pool.

Be smart about the cost of implementing hiring, training and retention initiatives. Think long-term while having a realistic view of your finances over the next few years.