Home Health & Hospice Staffing: Expert Success Strategies

The home health and hospice industries are experiencing unprecedented growth, bringing significant staffing challenges. In a recent SimiTree webinar, industry experts Judy Connelly and John Rabbia shared valuable insights on addressing these challenges and building sustainable staffing models.

Watch the full webinar for in-depth strategies and expert advice

Understanding the Financial Impact of Staffing Decisions

At the heart of effective staffing lies a solid understanding of financial metrics of home health and hospice. Gross and net margins play a crucial role in determining the health of your organization.

As Rabbia explained:

“Your gross margin is your direct revenue… minus your direct expenses and your direct expenses is the money that you’re spending on your field staff. So it’s their salaries, their benefits and actually your supplies, your patient care supplies as well.”

For home health, aim for a gross margin of about 40% with a net margin of 5%. Hospice organizations should set their sights slightly higher, with benchmarks of 50% gross margin and 10% net margin.

Best Practices in Hospice Staffing

Hospice staffing comes with its own unique set of challenges. Different regulations, payment models, and customer expectations all play a role in shaping staffing needs. Efficiency is key, especially when it comes to admissions. 

As Connelly pointed out:

“One thing we often find is that individuals are working 10 hour days, it’s not a really efficient model for an admission RN to be working 10 hour days. They can do 2 within eight hours typically depending upon your admission model and they can do 3 within a 12 hour day.”

Read our FAQ Guide for Hospice Agencies here

Home Health Staffing Models

When it comes to home health, an interdisciplinary approach is crucial. The ideal model includes one clinical manager overseeing a team of 125 to 175 patients, supported by a clerical assistant and 7-10 field clinicians acting as case managers. Rabbia emphasized:

“Nowhere in the regs and nowhere in anything that the surveyors are looking for, is a silo between nursing and therapy.”

Rabbia also introduced the concept of a “buddy system” in case management, pairing two case managers with one visit clinician to allow case managers to work at the top of their license.

Team-Based Care and Regulatory Requirements

Both experts stressed the importance of team-based care, particularly in hospice settings. Connelly noted that this approach is not just best practice, but a regulatory requirement that needs constant reinforcement.

Scaling Strategies

As your organization expands, it’s crucial to scale intelligently. The key lies in centralizing, standardizing, and optimizing home health/hospice recruiting processes. But what about staffing composition? Rabbia suggests a strategic mix:

“70% full-time case managers… and 30% part-time or per diem.”

This balance provides the flexibility needed during growth periods. But when is it time to split into multiple teams? For home health, consider this move around the 200-patient mark. Hospice organizations should think about team division at about 120 patients.

Geographic and Referral Considerations

One size doesn’t fit all when it comes to staffing models. Different areas have varying referral patterns and expectations. It’s essential to factor in these geographical nuances when making staffing decisions. A staffing strategy that works in one county might need tweaking in another.

Addressing Staff Shortages and Contingency Planning

It’s no secret that the healthcare industry is facing widespread staffing shortages. From nurses to aides and social workers, finding qualified professionals is a challenge. In this climate, flexibility and contingency planning are more important than ever. As Connelly advises:

“Look at the team culture practices, make sure you have a contingency plan. Somebody’s off every day on vacation or off sick on family medical leave. What is my contingency plan?”

HR Partnerships and Recruitment

Your HR department is a crucial ally in the quest for top talent. Fostering a strong relationship with HR can make all the difference in recruitment and retention. Connelly emphasizes the importance of a structured approach:

“Create a structured interview plan. Try to be consistent so you can really compare your candidates well and look at your candidates. Keep them engaged.”

Building a Strong Workplace Culture

In the competitive landscape of home health and hospice, culture can be your secret weapon. It’s not just about attracting talent; it’s about keeping them. Connelly poses some thought-provoking questions:

“How is your culture feeding your team? Why do your employees stay? There’s a multitude of information available as to how to manage your staff and foster that awareness of culture and the importance they play in everything that you do every day.”

From meaningful work to recognition and growth opportunities, culture touches every aspect of your organization.

Growing Your Own: A Long-Term Staffing Solution

Why limit yourself to external hiring when you can nurture talent from within? Rabbia introduced the concept of “growing our own,” suggesting that visit clinicians could be developed into case managers over time. This approach not only fills staffing gaps but also boosts morale and retention.

Outsourcing Considerations

For smaller organizations feeling the staffing pinch, outsourcing could be a game-changer. Rabbia suggests considering this option for high-cost functions:

“Some of the really high ticket items that you might want to look at first are revenue cycle management and coding and OASIS. To it could bring in a huge return on investment to have somebody else doing that for you.”

The webinar provided comprehensive insights into creating sustainable staffing models in home health and hospice. By focusing on financial impacts, best practices, scaling strategies, team-based care, contingency planning, and workplace culture, organizations can build resilient teams capable of meeting the growing demand for quality home-based care.

How SimiTree Can Help

SimiTree offers expert assistance in implementing these strategies. With our industry-leading satisfaction ratings and specialized focus on home health, hospice, and behavioral health, we’re uniquely positioned to help you build a strong, stable workforce. Our services include executive search and management recruiting, interim leadership solutions, retention strategy development, organizational culture assessments, and compensation and benefits consulting.

For more in-depth information or to discuss how these concepts apply to your specific organization, request a consultation.