Non-Clinical Staff Shortages Cause Hospices ‘Sleepless Nights’

Hospice providers are nearly desperate to recruit nurses, but their labor woes do not end there.

A shortage of non-clinical staff is an additional sore spot. Providers are anticipating demand for non-clinical staff to rise as they compete for resources in an increasingly fierce labor market.

Providers have seen no lights at the end of the staffing shortage tunnel across the board. The widespread need for nurses is much discussed among professionals in the field, but hospices are also in serious need of personnel who can work in information technology (IT), human resources (HR), administrative support, billing, sales, marketing and accounting.

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“We have seen a substantial increase in the competitive nature of recruitment for non-clinical staff over the past two years,” David Jackson, CEO of Choice Health at Home, told Hospice News in an email. “IT, HR and finance will continue to be pivotal service fronts. I anticipate HR taking a front-row seat in health care as our nation faces clinical staffing shortages over the next two decades.”

Widespread workforce shortages of hospice and palliative care providers are expected to worsen during the next 25 years. Recent research has indicated that supply of trained clinicians will be outpaced by demand for serious illness and end-of-life care as the country’s aging population swells.

Yet concerns over non-clinical staff availability is gaining momentum as well. Similar to the clinical workforce pressures, factors such as burnout, rising wages, inflation and a competitive labor market continue to imperil employee retention. 

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“This is a worry that is fast becoming equal to the sleepless nights that many hospice leaders are having over their clinical workforce supply,” according to Susan Ponder Stansel, president and CEO of Florida-based Alivia Care.

As with clinicians, hospices face intense competition from companies that can offer higher pay and more flexible schedules, according to Ponder Stansel. An added complication is the need to find qualified staff who understand the nuances of hospice billing and regulatory compliance — and how those factors tie into operations.

When it comes to back office staff, the competition is not limited to other health care providers. A vast range of companies are hungry to recruit IT staff and other professionals.

As many as 11.5 million job openings currently exist across employment sectors nationwide, the U.S. Bureau of Labor Statistics(BLS) reported. This is the  highest number of job openings since 2000. 

As many as 4.5 million of those openings were due to workers leaving their jobs, the report indicated.

Like many nurses, non-clinical employees also place a premium on achieving a greater work/life balance, particularly after the stressful years of the pandemic.

“A huge factor for us is that many of these folks are being recruited by businesses that offer a fully remote work opportunity, and they can [often] pay more,” Ponder Stansel said in an email to Hospice News. “Competing for these types of staff with companies that offer fully remote work is really challenging now. The complexities of our business also really require a certain quantity and quality of staff, and there is definitely a very limited supply and lots of competition for good people with excellent skills now.”

Staff who can manage the intricacies of hospice billing are also in demand. With regulatory scrutiny on the rise in the industry, hospices are zeroing in on trained and qualified jobseekers who can prevent billing and documentation errors, which are often red flags that bring surveyors or auditors to their doorstep.

As the back-office workforce dwindles, hospices have begun outsourcing these roles to third-party organizations. Some have turned to staffing companies that specialize in areas such as finance, operations and billing. They try to fill in the knowledge gaps through training and education onboarding, Ponder Stansel told Hospice News.

While these workers do not come to patients’ homes or manage symptoms, their absence nevertheless can adversely affect care delivery and quality.

Without enough office staff in place to field patient concerns and questions, the burden of additional communication falls back on clinicians. Many of whom are already experiencing burnout, according to Shelley Henry, founder and president of The Amity Group.

Leadership positions are not immune, Henry indicated. The Louisiana-based hospice staffing agency has seen recent spikes in leadership turnover, largely due to clinical staff burnout, Henry told Hospice News.

“We’re seeing turnover in leadership as these clinical leaders often end up serving dual roles filling in staffing gaps,” Henry said. “One of the biggest areas that we’re seeing turnover in is administrators, medical directors, executive directors and directors of nursing. It’s the strain of never having peace because their staffing positions aren’t getting filled. It’s very stressful [and] it’s having a huge impact. I’ve never seen these positions change as much as they have right now.”

Hospices live on referrals, which took a dip in many markets during the pandemic. Providers are seeking to build up their sales and marketing teams with new levels of urgency. And in many cases, the people just aren’t there to hire.

Despite the obstacles the industry is seeing, demand for hospice care is expected to grow. But more people coming to hospice doesn’t mean that they will come to any particular organization. Providers need robust sales and marketing to stay competitive.

The pressure to sustain referral streams has led to “tremendous burnout” among sales and marketing teams, according to Jane Shekman, president of JS Healthcare Advisory.

Staff in these roles face high levels of stress, which can lead to work fatigue, Shekman told Hospice News’ sister site Home Health Care News during its virtual Sales First Summit.

“[There’s] tremendous burnout because sales and marketing are expected to deliver referrals; it’s a referral-driven business,” said Shekman. “They are also at the same time — unfairly so — expected to deliver clinical outcomes, because they’re the first person who the referral source will go to if there is a good outcome or a bad outcome. Sales and marketing people, being the face of the company, have to honestly respond to all kinds of issues.”

Even when those referrals are pouring in, hospices will need to beef up their non-clinical hiring efforts to address the anticipated growth in volume, according to SilverStone Hospice CEO Alfonso Montiel. The Texas-based hospice provider has seen its census quadruple in the last year, during which the company launched its palliative care program.

Service diversification has been a watchword for the industry as providers seek to engage patients further upstream, but building new business lines requires more people, not all of them clinicians.

“Our needs for non-clinical staffing continue going up. If our current growth curve continues as is, by this time next year our hospice census alone should be three to four times what it is today,” said Montiel. “Most of the non-clinical team members we need to address the growth coming our way are already in place, and our focus now is processes optimization and culture.”

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