Hospice Staffing Models: Looking at the Big Picture


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Whether your hospice agency is using the productivity, ratio or another staffing model, maximizing the number of team members your agency employs is paramount to the successful execution of your chosen staffing model. Whether large or small, hospice agencies should begin rolling out, or – in some cases – resetting their staffing models by keeping the best number of team members on the payroll.

Why the Number Matters

Payroll and related expenses on average make up 40% of the net revenue of hospice agencies. Payroll dollars and related expenses are driven by the number of hours an individual works. Counting the number of visits a team member makes is helpful. Knowing your hospice aide is assigned to see 10 patients a week according to their plans of care supports the goal of providing the highest quality care. Knowing the exact number of employees you have working will help you better manage your labor expenses. When counting employees, rather than productivity, roles or visits, it is much easier to identify inefficiencies that can lead to excessive payroll costs.

Where the Dollars Hide

Once you know the number of employees on your team, carefully review the hours that they work. This involves comparing the hours worked to their scheduled hours. It is common for an on-call nurse to be used for admissions during the week, or for an RN case manager to be used to admit patients when the team includes an admission nurse. Likewise, you may find that you have an RN case manager reporting hours worked on the weekend when they are scheduled to work Monday through Friday. Upon review of the actual hours worked versus the scheduled hours worked, you will be able to identify an added payroll expense that might otherwise go unnoticed. You can conduct this exercise across all disciplines. And don’t forget your administrative staff. This presents a great opportunity to leverage the reporting within your hospice software to simplify your analysis and to ensure you maximize each dollar of payroll.

Seek to Understand

By and large, hospice professionals make informal adjustments to their schedules or roles to meet the needs of their patients and/or to help their team. It is important to understand why these informal adjustments are being made if you want to make the best decisions to control your payroll expenses. Spending time in IDG meetings is a great way to understand what is going on with a specific team. IDG discussions often reveal the answers as to why two hospice aides are visiting a patient or why a member of the admissions team is continuing to see a patient after their admission to hospice.

Make every effort to understand why employee hours are not in alignment with the budget and help them to understand the reasoning behind your chosen payroll monitoring system. Work together to develop a strategic plan to align the work with the budgeted payroll expense. The results will lead to continued quality patient care, increased employee satisfaction and an improvement to your bottom line.

Just as we count the number of patients whom we care for each day, hospice leaders must count their staff. A wholistic view will ensure you see employees as a single entity outside of their role, productivity and timesheet. Once you understand how many employees you have, maximizing each payroll dollar becomes much easier.

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