‘Unsung Backbone of Care Delivery’: The Growing Need for Hospice Aides

As workforce shortages persist in health care, some operators are struggling to recruit and retain essential members of their care teams — hospice aides.

The demand for hospice aides is expected to grow in the coming years. However, factors such as turnover, retirement, slow wage growth and immigration policy could complicate hospice’s ability to fill those positions.

Many companies are focused on bolstering their nursing workforce, who are also in high demand, but providers also need to prioritize hiring a sufficient number of aides, according to Cooper Linton, associate vice president of Duke HomeCare & Hospice. The North Carolina-based organization offers home infusion services, along with home care and hospice.

“One of the things that we’re struggling with is finding really experienced committed home health or hospice aids, and that is an area that I’m afraid gets overlooked,” Linton told Hospice News during its recent Virtual Staffing Summit. “We’ve spent an enormous amount of time appropriately looking at nurse training and nurse recruitment and the shortages that came out of COVID, but our home health aides and hospice aides are absolutely critical to the delivery of care.”

Recruiting and retaining aides is often a balancing act between the number of new entrants into that occupation and the specter of high turnover.

The number of these workers entering the field is anticipated to increase in the coming years. Employment of home health and personal care aides is projected to grow by 22% between 2022 and 2032, according to a U.S. Bureau of Labor Statistics (BLS) report. This occupation’s growth rate is “much faster than the average for all occupations,” the report found.

However, this may not be enough. An annual average of roughly 684,600 openings for home health and personal care aides are expected to become available during the next decade, the report projected. Many of those openings will likely result from the need to replace workers who transfer to different occupations or exit the labor force due to retirement, among other reasons, researchers indicated in the report.

On the other hand, workforce growth will be offset by climbing turnover rates that were exacerbated by the pandemic. For example, the average length of employment for home health aides is 1.3 years, a lower rate than other health care occupations, according to the BLS.

Many hospice aides leave their jobs in search of higher wages. Compensation growth for those workers has see-sawed in recent years, with many hospices seeing a need to increase their pay to remain competitive in the labor market, according to Cathy Wozniak, executive director of Hospice & Palliative Care of Martha’s Vineyard in Massachusetts (HPCMV).

“There’s a lot of older adults on [Martha’s Vineyard] and I would think in other communities as well, with the growing population of older adults that are hiring caregivers, so we’re really competing with what they’re paid as as private personal aides for families and patients, versus coming to work with hospice,” Wozniak told Hospice News at the Summit. “We have had to, as a result, really increase what we’re paying our aides to sustain them. They’re immensely important in the work that we do in hospice, and they’re the ones that see the patients you know at a higher frequency than others.”

Pay for hospice aides has been fluctuating. The national average hourly rate for hospice aides and CNAs rose 9.09% in 2022, compared to a 4.52% increase in 2021, according to the 2022-2023 Hospice Salary & Benefits Report, published by Hospital & Healthcare Compensation Service (HCS). The report indicated that wages for hospice aides and CNAs are rising faster than those for other interdisciplinary team members as providers seek to stem rampant turnover among those employees.

These occupations also represented a large percentage of job vacancies and saw high turnover rates, 19.05% and 29.84%, in 2022 respectively. Only LPNs and LVNs had higher rates, reaching 31.52% turnover and 25.12% for vacancies.

However, wage growth slowed the following year. In 2023, aides received a smaller pay bump at 6.23%.

Recent crackdowns in immigration by the newly inaugurated Trump Administration could also have an impact. A high proportion of aides are immigrant workers, many with Temporary Protected Status (TPS), allowing them to have visas that must be renewed within certain timeframes.

Close to 40% of home health and hospice aides are immigrants, according to a National Immigration Forum report.

Easing restrictions on immigration could help ameliorate aides shortages, according to a 2024 study published in Health Affairs.

“With the aging baby boom population, there is a growing shortage of potential caregivers in the U.S. One part of the solution to the caregiving shortage could be increasing the number of immigrants in the US, which reached nearly 48 million in 2022,” the study indicated. “As many immigrants come to the U.S. seeking better economic opportunities, they are often willing to take on labor-intensive direct care roles.”

With all these considerations in mind, providers should take a careful look at their hiring practices when it comes to aides, Linton said.

“Aides are often overlooked, and that’s a population that I think we need to be more attuned to as they are often the unsung backbone of our care delivery model for hospice and also for home health,” he said.