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Hospice Employee Turnover Challenges Quality Of Death In America

Hospice Employee Turnover Challenges Quality of Death in America

In the past two years, more than six out of ten hospice nurses have changed jobs. At present, a little more than one in four hospice nurses stay on the same job five years or longer. Meanwhile, 60% of hospice nurses stay on the same job two years or less. Turnover in other hospice positions is also on the rise. This represents a huge challenge to hospice agencies.

In palliative care and nursing professions, high staff turnover is associated with lower family satisfaction and generally lower quality of care.2,3 Increased staff attrition leads to a reduction in clinician expertise, intellectual capital, and a weakening of organizational culture.4 Additionally, the situation puts significant financial strain on hospice agencies. The cost of a nurse switching jobs reaches $88,000 per nurse. This cost stems from productivity loss, recruitment, screening, training, and other factors.

Those outside the industry may be surprised to know that hospice clinicians used to find the work rewarding. Traditionally, hospice has enjoyed higher staff retention rates compared to the rest of healthcare.2 However, those tables seem to have turned. In hospitals, the 2020 staff turnover rate of 19.5% was on par with their 2018 staff turnover rate of 19.1%. In February 2021, Hospice News reported the results of their survey including 161 hospice agencies nationwide. More than a third listed staffing challenges among their top concerns for the year – second only to concerns about access to hospitals during the pandemic.

For example, look at the trend among hospice aides.

Hospice Aide Employee Turnover Rates:

2015: 20.55%
2016: 23.52%
2020: 25.72%
2021: 26.6%

The Role of COVID in Hospice Employee Turnover

Many focus on COVID’s likely effect on healthcare employee retention. Some staffing woes are attributed to burnout from stress the pandemic has put on the healthcare system as well as clinicians’ concern for their own personal safety. Additionally, as hospitals, states, and the federal government implement vaccine mandates, some attribute portions of staff attrition to vaccine hesitancy. However, the White House has signaled that they believe vaccine mandates may have a less than a 1% effect on healthcare employee turnover.  

The Role of Economics in Hospice Employee Turnover
Perhaps the problem of hospice employee turnover in America goes far beyond the current pandemic. Notice that turnover rates have been rising sharply well before COVID-19 reached America’s shores. Is talk of COVID distracting the hospice industry from the real source of hospice employee turnover? The other issue is that America is in a nursing shortage. Medicare reimburses hospice less than other end-of-life care settings. Patients who enroll in hospice cost Medicare $8,697 less, with savings much greater among patients who have more than 11 days in hospice. While hospice has traditionally shown pride in its cost-saving capacity, it may be time for Medicare to stop looking for ways to cut costs with dying patients and start looking at protecting the quality of death in America. The lower Medicare reimbursement in hospice leads to a trend of lower nurse pay. Payscale finds that hospice nurses make about six percent less than all staff nurses on average.

Perhaps the only real solution to hospice employee turnover in America is better policies from the federal government. This could certainly include squeezing less savings out of America’s end-of-life care. It could also include helping alleviate the nursing shortage with nursing scholarships and helping colleges add nurse and CNA training programs.


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  2. Natan MB, Matthews P, Lowenstein A. Study of factors that affect abuse of older people in nursing homes. Nursing Management. 2010 Dec 8;17(8).
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  4. Kirby EG. Patient centered care and turnover in hospice care organizations. Journal of Health and Human Services Administration. 2018 Jul 1;41(1):26-51.
  5. Li YI, Jones CB. A literature review of nursing turnover costs. Journal of Nursing Management. 2013 Apr;21(3):405-18.