Tackling the Challenges of Workforce Retention in Hospice Care 

While the demand for hospice care continues to rise due to an aging population and increasing awareness of hospice services, hospice organizations still face challenges retaining skilled and compassionate workers. Shifting workforce demographics, economic factors, and the emotional impact of end-of-life care all impact staffing. Hospice leaders are using innovative approaches to attract and retain a key hospice asset: its workforce.

Trends in hospice employee turnover

As the industry experiences average vacancy rates of around 14 percent, hospices have had to contend with even higher average vacancy rates for some critical roles, such as 18 percent among hospice aides. The 2024-2025 Hospice Salaries and Benefits Report found an improvement in hospice clinician turnover, largely due to pay increases and other initiatives. Hospice aides, LPNs, admissions staff, executive directors, and communications and marketing staff received 4 to 5 percent average increases in wages, which helped counter turnover.

While pay is important, other factors impact retention, such as:

• Aging population. With 1 in 5 Americans reaching retirement age by 2030, the existing hospice workforce is under strain, since many hospice workers are also entering retirement.

• Workforce demographic shifts. Millennials and Generation Z tend to place a greater emphasis on work-life balance, mental health, and job fulfillment than their Baby Boomer and Gen X counterparts. Failing to recognize that employee motivation is changing can result in increased turnover. Hospice leaders must find ways to provide meaningful engagement that resonates with the values of the changing workforce.

• Increasing patient diversity. Increasing diversity among the hospice-eligible population requires greater cultural competency among the hospice workforce and can also indirectly impact retention as hospice workers navigate cultural, linguistic, and other differences.

The true cost of employee turnover

Direct expenses incurred as a result of turnover include recruitment and training, as well as premium pay such as overtime or agency fees. Indirect costs, which are more difficult to quantify, include quality of care, morale, loss of institutional knowledge, and loss of productivity. Some estimates suggest that the loss of a hospice nurse can cost an organization the equivalent of 6 to 9 months of salary.

Strategies to retain hospice workers

The following are just some of the strategies have been used successfully by hospice agencies to lower turnover:

Alignment

Aligning your employees with your organizational values ensures greater long term success through a strong, committed workforce. Employees who feel an emotional connection to their employer’s mission experience enhanced job satisfaction, motivation, and loyalty. The agency’s purpose and mission set the direction of the work performed.

Employee engagement

 Hospices with below average turnover rates cite employee engagement as a critical factor driving quality and growth. Leadership should be visible and implement regular feedback mechanisms, such as town hall meetings, open door policies, and one-on-one check-ins. Creating a culture of recognition and appreciation can also increase engagement.

Career Development Opportunities

Providing ongoing development opportunities is key to employee retention. Employees appreciate employer investments in their professional growth. For example, some hospices have created programs for emerging leaders to mentor clinicians who aspire to managerial roles.

Innovative benefits offerings

To make a benefits package attractive, ask employees what they want. Surveys can be used to find out what types of benefits carry the most weight—such as generous paid time off, career development programs, or tuition reimbursement. Some innovative offerings hospices are using include:

Employer student loan repayment programs

With 43 million borrowers owing over $1.74 trillion in student loan debt, employer student loan repayment programs can offer a way to attract and retain workers saddled with student loan debt. These programs often involve work commitments for a certain number of years, increasing the likelihood of retention.

Vehicle programs

With higher interest rates, patient care staff such as hospice aides often struggle to afford a reliable, safe vehicle. Additionally, the vehicle that arrives at patients’ homes contributes to the perception of the hospice in the community. While many hospices reimburse employees on a cents-per-mile basis based on the IRS rate, some hospices are implementing vehicle programs as a way to attract and retain staff. Company owned fleet programs allow hospices to hire workers who might not otherwise have safe, reliable transportation. Fuel efficiency presents an opportunity for cost savings as well.

Flexible schedules

The demands of the hospice care, such as variable hours and emotional strain, can lead to burnout and stress. By offering flexible scheduling options, organizations can empower employees to customize their work hours to better align with their personal lives and responsibilities. Shift-swapping policies and part-time options can accommodate varying needs, enabling staff to balance personal and professional obligations. This flexibility not only enhances job satisfaction, but also reduces absenteeism and turnover, as employees feel more in control of their work-life balance.

By facilitating open discussions about scheduling preferences, management can foster an environment of trust and collaboration. When employees feel that their needs matter, they are more likely to develop a strong connection to the organization. Flexible scheduling can serve as a practical solution for addressing the unique demands of hospice work while strategically building a dedicated workforce.

Wellness programs

Innovative wellness programs can enhance retention by addressing the physical, emotional, and mental health needs of care providers. Recognizing the high levels of stress associated with hospice care, organizations can implement holistic wellness initiatives that encompass areas such as mental health support, physical fitness, and emotional resilience. Some examples include mindfulness workshops, nutrition counseling, and exercise classes. Offering these types of resources demonstrates a commitment to employee well-being and empowers workers to manage their personal lives in ways that lead to higher job satisfaction.

Furthermore, incorporating peer support and mentoring programs into wellness initiatives can help create a strong sense of community among hospice employees. These programs provide opportunities for staff to discuss challenges and develop coping strategies in a safe and supportive environment while building a sense of community. 

The takeaway

Demographic and cultural shifts within both the patient population and the healthcare workforce are making employee retention critical for hospice organizations. To improve employee retention, hospice leaders should be visible, accessible, and routinely ask employees what benefits and programs are important to them. By designing retention initiatives that address what employees value and prioritize, hospices can minimize turnover costs and maintain a competitive advantage.

Resources:

2024-2025 Hospice Salaries and Benefits Report

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