Shortages of non-clinical staff cause ‘sleepless nights’ in hospices

Palliative care providers are almost desperate to recruit nurses, but their labor issues don’t end there.

The shortage of non-clinical staff is an additional sore point. Providers anticipate increased demand for non-clinical staff as they compete for resources in an increasingly tough job market.

Suppliers saw no light at the end of the staff shortage tunnel at all levels. The widespread need for nurses is much discussed among professionals in the field, but hospices also have a serious need for staff who can work in information technology (IT), human resources (HR), administrative support, billing, sales, marketing and accounting.

“We have seen a substantial increase in the competitive nature of hiring non-clinical staff over the past two years,” David Jackson, CEO of Choice Health at Home, told Hospice News in an email. “IT, human resources and finance will continue to be essential service fronts. I predict that HR will occupy a prominent place in healthcare as our country faces clinical staffing shortages over the next two decades.

Widespread labor shortages among hospice and palliative care providers are expected to worsen over the next 25 years. Recent research has indicated that the supply of qualified clinicians will be exceeded by the demand for critical illness and end-of-life care as the country’s aging population grows.

Yet concerns about the availability of non-clinical staff are also gaining ground. Along with pressures on the clinical workforce, factors such as burnout, rising wages, inflation, and a competitive job market continue to put employee retention at risk.

“This is a worry that is quickly equating to the sleepless nights many palliative care leaders have on their clinical workforce supply,” according to Susan Ponder Stansel, President and CEO of Alivia Care, based in Florida.

As with clinicians, hospices face intense competition from companies that can offer higher salaries and more flexible hours, according to Ponder Stansel. An added complication is the need to find qualified personnel who understand the nuances of palliative care billing and regulatory compliance – and how these factors relate to operations.

When it comes to administrative staff, the competition is not limited to other health care providers. A wide range of companies are hungry to hire IT staff and other professionals.

As many as 11.5 million job openings currently exist across employment sectors nationwide, the US 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 quitting their jobs, the report said.

Like many nurses, non-clinical employees also place a high value on achieving a better work-life balance, especially after the stressful years of the pandemic.

“An important factor for us is that many of these people are recruited by companies that offer a completely remote work opportunity, and they can [often] pay more,” Ponder Stansel said in an email to Hospice News. “Competition for these types of staff with companies that offer fully remote work is really tough now. The complexities of our business also require a certain quantity and quality of staff, and there is certainly a very limited supply and a lot of competition for the right people with excellent skills now.

Staff who can handle the intricacies of palliative care billing are also in demand. With increasing regulatory oversight in the industry, hospices are focusing on trained and qualified job seekers who can avoid billing and documentation errors, which are often red flags that lead investigators or listeners at their doorstep.

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

Although these workers do not come to patients’ homes or manage symptoms, their absence can nonetheless affect the delivery and quality of care.

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

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

“We see leadership turnover, as these clinical leaders often end up fulfilling a dual role filling gaps in staffing,” Henry said. “One of the main areas where we see turnover is in administrators, medical directors, executive directors and directors of nursing. It is the constraint of never having peace because their positions are not filled. It’s very stressful [and] it has a huge impact. I have never seen these positions change as much as they do today.

Hospices live off referrals, which have plunged in many markets during the pandemic. Suppliers are looking to bolster their sales and marketing teams with new levels of urgency. And in many cases, people just aren’t there to hire.

Despite the obstacles facing the industry, the demand for palliative care is expected to increase. But more people coming to hospice does not mean they will come to a particular organization. Suppliers need strong sales and marketing to stay competitive.

According to Jane Shekman, president of JS Healthcare Advisory, the pressure to maintain referral flows has led to “considerable burnout” among sales and marketing teams.

Staff in these positions face high levels of stress, which can lead to fatigue on the job, Shekman told Hospice News sister site Home Health Care News during its Sales First virtual summit.

“[There’s] huge burnout because sales and marketing are supposed to provide referrals; it’s a referral-driven business,” Shekman said. “They are also supposed to provide clinical results, unfairly, because they are the first person the referral source will go to if there is a good result or a bad result. Sales and marketing, being the face of the business, need to respond honestly to all kinds of issues. »

Even when those referrals are pouring in, hospices will need to bolster their nonclinical hiring efforts to keep up with the projected volume growth, according to SilverStone Hospice CEO Alfonso Montiel. The Texas-based hospice provider has seen its census quadruple in the past year as the company launched its hospice program.

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

“Our needs for non-clinical staff continue to grow. If our current growth curve continues as it is, by this time next year our palliative care census alone should be three to four times what it is today,” Montiel said. “Most of the non-clinical team members we need to support future growth are already in place, and we are now focused on process optimization and culture.”

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