Grief Care’s 2024 Outlook in Hospice

Finding the right balance of support and career development for bereavement care professionals is key to recruitment and retention as hospices combat labor strains.

Grief care specialists take on challenging roles as they help families navigate the financial and emotional aspects of a loved one’s loss.

The weight of providing bereavement care can take a heavy toll on staff and impact turnover rates, according to Jennifer Kincaid, chief people officer at Hospice of the Piedmont. Compassion fatigue is the leading factor fueling burnout among grief care team members, she said.

Having supportive resources and balanced workloads is crucial to retention, Kincaid stated.

“Bereavement work is emotionally demanding,” Kincaid told Hospice News in an email. “It’s important for an organization to implement strategies to identify and address signs of burnout, provide resources for employee assistance and encourage open communication. Staff’s well-being must have a work-life balance through work flexibility, a good support system (including peer support) and a sense of community and camaraderie among the team members.”

Grief’s care largest staffing gaps

The U.S. Centers for Medicare & Medicaid Services (CMS) requires hospices to offer bereavement care for a minimum of 13 months following a patient’s death. Many providers extend this care to communities across their service regions, regardless of whether the deceased was a patient.

Bereavement care can include various services and different types of therapies. Federal rules do not contain specific standards on how this care should be provided, or what services it should include. CMS to date also has not developed quality measures to evaluate their effectiveness.

Grief care can come in a variety of forms, with specialists encountering a wide range of situations surrounding a death, according to Chloe Bishop, bereavement supervisor at Maryland-based Frederick Health Hospice. It can be challenging to find and train bereavement professionals to help families with different types of losses, she said.

“You work with people across all age groups and a number of different types of loss, not just those related to illness,” Bishop told Hospice News. “We’ve seen more people affected by traumatic deaths from violence, accidents and overdoses. It’s tough to find individuals that are versatile and are comfortable working people across the lifespan. It’s recruiting someone willing to constantly pivot as needed, whether it’s individual or group counseling or running a grief camp for kids.”

Care coordinators and counselors are among the bereavement roles in shortest supply, Bishop stated.

Some hospice providers have begun to diversify their bereavement services, casting a wider net for recruiting interdisciplinary professionals.

Music, art and meditation therapists have increasingly stepped into grief care teams, along with clinicians seeking less medically-focused roles, according to Marissa Watson-Bane, manager of AccentCare’s bereavement center.

Having a diverse mix of bereavement professionals can come with challenges and benefits, she said.

“We’re seeing more people from all types of counseling and clinical disciplines holding that grief counselor role,” Watson-Bane told Hospice News. “It’s really this growing specialty. When recruiting, it’s finding someone with the ability to really easily engage and connect with the bereaved, with other staff and with community resource providers. Making sure you have the right person fluent in both grief care needs and the range of services is challenging, because the practice changes with the needs of the community. But that also helps create opportunities to develop more skills and find a wider base of talent.”

Biggest levers in bereavement staff retention

Retaining bereavement professionals requires a supportive workplace environment, according to Kincaid. Regular supervision and feedback, professional growth opportunities and work-life balance are significant pieces, she said.

Compensation and employee assistance programs are two top priorities among bereavement staff, according to Rebecca Hauder, mental health counselor and founder of Resources For Grief and Rebecca Hauder Counseling. Having access to mental health resources is also a significant factor in the retention equation of bereavement specialists, Hauder said.

“Besides being offered and paid a competitive wage, bereavement professionals and others involved in bereavement care need to know they’re valued,” Huader said. “Demonstrating value through generous compensation and building a hospice care team that prioritizes bereavement care is key to recruitment and retention. Grief care workers need tangible resources to assist them in providing care to the bereaved”

One complication in offering competitive pay to bereavement staff is the lack of Medicare reimbursement for these services. Many hospices offer this care at no cost following the death of a loved one, without sufficient payment streams to cover it, according to Hauder.

The business model for bereavement care is flawed, according to Jordan Phillips, grief and healing manager and counselor at Hospice of the Piedmont.

Grief can have prolonged impacts on individuals, requiring long-term support from professionals – key issues when it comes to sustainability in today’s current reimbursement system, she stated.

“Counselors who are able to accept Medicare and Medicaid are difficult to find, but it is even more difficult to find counselors who do that and specialize in working with grief,” Phillips told Hospice News in an email. “A lot of the folks we see because our bereavement services need support that is free, on a sliding scale or paid for by Medicaid and Medicare outside of just individual counseling or groups that we offer. It is truly hard to find a lot of counseling agencies and support out there that can provide this, and the places that do typically have long wait lists.”

Apart from improved reimbursement pathways, bereavement providers need access to the same types of resources and support that they offer to grieving families, Phillips stated.

Resources for self-care and mental health support are particularly important parts of keeping bereavement staff “for the long haul,” according to Bishop. Employee assistance programs that include health and wellness programs, and benefits that provide assistance with legal issues, child and elder care and counseling services can be important considerations.

These benefits can be key reasons a grief professional chooses to stay with an organization, particularly when it comes to preventing burnout due to compassion fatigue, Bishop stated. For example, health insurance coverage can include a limited amount of mental health therapy sessions, leaving the rest of this cost up to employees. Having benefits that support and cover these expenses can be significant for staff, she added.

Peer-based interactions can also play a role in retention, Bishop stated.

“It’s absolutely necessary to have some opportunity for staff to have individual and group peer support,” Bishop said. “We need a space to unload some of the things we hear about, share the difficult situations and walk through it all together, exchanging tools that we can use for clients and for ourselves that reduce burnout and compassion fatigue, that’s huge for bereavement counselors.”

Providing career advancement opportunities is another lever in bereavement staff retention, according to Watson-Bane.

Another consideration is tying grief specialists to ongoing training and education in emerging bereavement therapies and practices, as well as peer-based learning opportunities, she stated.

“Bereavement professionals especially want to make an impact,” Watson-Bane said. “Allowing space for them to lean into their passions and expertise is key to keeping your bereavement staff engaged and energized. It’s giving them opportunities to have a say in program development, community involvement and making sure they feel like a contributing member of the hospice team, not something separate.”