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Rising patient populations, smaller workforce challenge hospice, palliative care providers

A continually growing aging population coupled with seniors’ desire to age in place has meant more interest than ever in alternative, non-hospital end-of-life care. For some patients that is palliative care, which can begin at diagnosis and treatment, or hospice care, which also can begin during treatment but stops when death is imminent. In both cases, consumer interest has led to growth in both in-home services as well as the use of specialized facilities dedicated to end-of-life care.

According to a presentation, “Palliative Care and the Healthcare Workforce,” by Helen B. McNeal, executive director of the California State University Institute for Palliative Care, 90 percent of those over age 65 have at least one serious or chronic condition. That population is rising by thousands every day, meaning that more treatment, and treatment providers, will be needed.

And that, in turn, has squeezed providers who must have a steady pipeline of qualified employees to provide the various elements of care, as well as deal with geographical distances that are particularly challenging in rural areas.

Worker pool tight, competition for skilled staff will only increase

The lack of overall workers in palliative care and hospice also comes with issues around reimbursement, both of which can turn some providers of other healthcare services away from these options. How dire is the situation? Very, and likely to worsen in the coming months, if not years.

The American Academy of Hospice and Palliative Medicine (AAHPM) reports that the gap between healthcare professionals with palliative care training and the number needed to meet the needs of that rising pool of people with serious illness or multiple chronic conditions will continue to grow. To make the point, academy references National Palliative Care Registry data showing that in 2015, only 44 percent of hospital programs met national staffing standards as set forth by the Joint Commission.

Further, the George Washington University Health Workforce Institute has said that current training capacity for hospice and palliative care won’t be enough to provide workers to maintain hospital care alongside the non-hospitalized over-65 population. Another concern? Fewer doctors entering the workforce, including those who might specialize in palliative care, which means that the medical community will be stretched very thin when it comes to taking care of this population of seriously ill and terminal patients.

And not only hospital care, but home care, are affected by worker shortages in the palliative and hospice care arenas. The vast majority of seniors say they want to age in place, according to the AARP, and it can be inferred that they wish to die in place as well. That’s led to a rapid and ongoing expansion in community-based palliative care like outpatient facilities and home care.

Attracting workers requires multifaceted effort

Hospital systems and other healthcare providers are aware of the issue and are addressing it. More than five years ago, Becker’s Hospital Review was reporting that about 70 percent of hospitals had put a palliative care program in place, and that number that has continued to rise in the ensuing period. That means concurrent staff recruitment, training, and retention programs have come online as well, and even though they may not be keeping pace with demand, they are at least addressing the issue.

Physician training may be addressed by allowing board certification in palliative medicine without full fellowships, for example, a path to faster patient care backed by the AAHPM. Other organizations are working to create opportunities to promote palliative care and drive interest in it for workers across the healthcare spectrum. Programs such as the Palliative Care Center of Excellence with the University of Washington in Seattle, and the Palliative Care program at University of Utah Health Care in Salt Lake City, for example, are broadening awareness and encouraging collaboration within the field.

And finally, the Palliative Care and Hospice Education and Training Act, or PCHETA, is making its way through Congress. Should it be signed into law, supporters hope it will help coordinate care between all the players in the hospice and palliative care world, as well as make those avenues of care more accessible and affordable for the patients and families who seek safe, secure and high-quality end of life care.

 

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