Staffing shortage plagues hospices

Home Health Columnist / Guide · Oct 9, 2001

Aging population strains resources

By Amanda Vogt

Tribune staff reporter

Published October 2, 2001

http://www.chicagotribune.com/news/local/chi-0110020235oct02.story?coll=chi%2Dnewslocal%2Dhed

Over the past six months, Willie Palmer has learned to care for his wife, Jessie, 74, who is dying of Parkinson's disease. The retired steelworker does everything for her in their tiny South Side condominium, including giving here baths and intravenous antibiotics.

"It's better to have her home," said Palmer, 81. "That way, I can look at her face and tell when she's in pain."

During his wife's illness, Palmer has received guidance from Barbara McEwen, a hospice nurse with Rush Hospice Partners of Oak Park.

The days are often long for hospice professionals like McEwen, who are in short supply, particularly as more aging Baby Boomers face end-of-life decisions, according to experts.

Because hospice care is a cottage industry of 3,500 loosely organized programs, statistics on staffing shortages aren't readily available, experts say. Still, officials with national associations and hospice groups from Waukegan to Barrington to Aurora acknowledge that they have trouble filling openings.

Patricia L. Higgens, director of Vista Star Hospice in Waukegan, employs a team of 22 professionals and said she needs two nurses, a social worker and a health aide. "We pay through the nose for temporary staff," she said.

Carol Peltier, head of Hospice of Northeastern Illinois in Barrington, said the group is trying to hire two nurses and two certified nursing assistants.

A tremendous growth in the demand for hospice services has contributed to the shortage, officials said.

From 1989 to 1999, the number of dying Americans who sought hospice services grew almost 300 percent, from 180,000 to 700,000, according to Virginia-based National Hospice & Palliative Care Organization.

Dottie Deremo, president of Hospice of Michigan, the largest statewide non-profit hospice in the country, said nursing school recruitment needs to be encouraged, or in 20 years hospice will face the equivalent of the "perfect storm."

The U.S. Bureau of Labor projects that in 2020 the nation will need 400,000 more nurses, Deremo said. Underscoring the shortage, U.S. Department of Health and Human Services Secretary Tommy Thompson announced Friday that the agency will provide almost $28 million to fund nursing education and training.

The projected nursing shortage will coincide with nearly 50 percent of the population being age 55 or older, Deremo said.

"This cohort will be making end-of-life decisions, including demanding the right to die at home," she said. "If we don't account for this group, we face mass warehousing of the elderly."

Efforts to alleviate the hospice nursing shortage are complicated by two factors: low pay and the need for more experienced nurses.

Hospice nurses earn 20 percent to 50 percent less than their colleagues in other fields, industry experts say.

And because hospice work requires crisis management and acute-care skills, only the most experienced nurses are generally hired, according to a survey conducted by Project on Death in America, a New York-based foundation that promotes understanding of death and dying.

The average age of a hospice nurse is 48, four years older than the average age of a registered nurse, Judy Lentz said. "As these professionals approach retirement, there will be fewer experienced nurses to replace them," she said.

Officials with VNA Hospice of Fox Valley in Aurora recently began hiring nurse practitioners to fill nursing vacancies, according to VNA President Linnea Windel.

Windel said because they have a master's degree, nurse practitioners earn more than registered nurses. But because they can prescribe medication and make medical diagnoses, they can also take on more responsibility, she said.

Lost in the concern over worker shortages is the fact that many independent-minded health professionals want to work in hospice, according to Dr. Monica Malec, a medical director for Rush Hospice Partners.

"Workers have more autonomy and the opportunity to alleviate suffering in all arenas of care: patient and family, physical, mental and emotional," she said.

Meanwhile, patient advocacy leaders are concerned the industry is not adequately regulated.

"There are some hospice programs that short-change patients of needed services, but without the proper regulation these groups aren't being held accountable," said Ron Panzer, head of the Michigan-based Hospice Patients Alliance, a watchdog group.

Under federal law, the Illinois Department of Public Health is responsible for regulating the state's certified hospice programs. Each year, agency inspectors are required to visit 15 percent of the state's 85 hospice programs, according to Tom Schaefer, a department spokesman.

"Compare that to the nursing home industry, where we inspect 100 percent of nursing homes," said Schaefer.

In the past two years, the department has not cited a single hospice program, he said.