Nursing Shortage Spells Longer Wait Times for Hospice

Turnover in hospice nursing has left facilities scrambling to fill gaps

Nursing is one of the fastest-growing professions in the United States according to the Bureau of Labor Statistics, but hospice facilities have not seen the surge. In many states, nursing shortages have forced facilities to delay patients’ enrollment or to turn them away entirely.

Hospice care is only available to patients within six months of death. For half of the 2.3 million Medicare beneficiaries that die each year, there’s little time to delay care.

Even with nursing’s popularity, employers are struggling to fill open spots nationwide. Partially struggling under pressures brought on by Covid-19, the hospice’s staffing issues follow a domino effect in many cases. Skilled nurses retire or leave the profession due to burnout. Without the experienced nurses to teach new classes, nursing programs cannot train the volume of nurses required to fill all the available roles. With fewer nurses working in any given facility, the caseloads increase and the available nurses are overworked to the point of burnout.

It’s not just the workload, however. Hospices cannot keep up with the pay rates of private agencies as nurses are lured away to more lucrative areas in the field. Traveling nurses in Washington state can expect to make $130 an hour, compared to the $40-60 hourly wage earned by hospice workers in the state.

“No hospice can match that,” Barbara Hanse, Director of Oregon and Washington’s hospice and palliative care organizations, told The New York Times.

Even if wages were competitive, hiring would have to keep pace with an overtaxed healthcare system that needs 1 million nurses by 2030. That is on top of the expected 175,000 openings expected to crop up due to nurses expected to retire or leave the profession. Shortages are not expected to rebound anytime soon. More than 35% of hospice leaders cite staffing as a top concern for their organizations looking forward.

Nursing shortages have forced companies to innovate to curb employee turnover | Credit: Healthline

Some look to close the gap financially to draw in new staff. Evergreen Health Hospice Care in Seattle has offered signing bonuses of up to $15,000 for registered nurses to compete with better-paying private agencies.

Hospice networks have re-energized their recruitment at nursing schools or even pools of their own volunteers. Silverstone Hospice in Dallas has begun identifying volunteers, who must account for 5% of a hospice provider’s patient care hours under the Medicare Conditions of Participation. 

Silverstone would know a thing or two about the skills volunteers bring to full-time work. CEO Alfonso Montiel and Director of Operations Nischelle Reagan first entered the hospice space as volunteers before working up the ranks.

Other organizations turn their eye on metrics for staffing solutions. Louisiana-based home health care giant, Amedisys uses its predictive-analytics engine to determine with up 80% certainty whether an employee is going to leave. The company then offers guidance and interventions for managers to retain employees determined to be “at-risk”.

As hospice facilities pivot to adapt to prolonged staffing shortages, patients are still waiting in line for spaces to open up.

“Basically, I have to wait for people to die,” Anne Cotton, a patient on a wait list in Oregon, told the New York Times,  “and that’s not a pleasant thought.”