Why Hospice Workers Fare Better Than Other Home Health Workers

CFAR | January 26, 2014

Hospice workers fare better than other categories of home health workers and are less likely to leave their jobs, according to a new paper in the . Robyn Stone and Natasha Bryant of the LeadingAge Center for Applied Research were among the paper's authors.

Hospice workers fare better than other categories of home health workers and are less likely to leave their jobs, according to a new paper in the Home Health Care Services Quarterly.

Robyn Stone and Natasha Bryant of the LeadingAge Center for Applied Research co-authored the paper with Janet P. Sutton and Annelise Adams of Social and Scientific Systems Inc., and Marie Squillace from the Office of the Assistant Secretary for Planning and Evaluation (ASPE) at the U.S. Department of Health and Human Services.

The paper is based on the findings of a research project that the Center for Applied Research and Social and Scientific Systems are conducting with funds from ASPE. 

Researchers are using a database linking the 2007 National Home Health Aide Survey with the 2007 National Home Health Agency Survey to examine how home health workers and subgroups of home health workers differ in terms of:

  • Socio-demographic characteristics.
  • Compensation.
  • Benefits.
  • Satisfaction.
  • Retention. 

Categories of Home Health Workers

Most research to date has examined home health workers as a group, but has not made distinctions between worker categories, according to the paper.

The paper describes those categories as follows: 

  • Home health aides and certified nursing assistants (HHA/CNA) are employed by certified home health agencies and work under the supervision of a registered nurse. HHAs/CNAs who provide home health services to Medicare or Medicaid recipients must meet federally and state-mandated training requirements and pass a competency exam. 
  • Hospice aides provide assistance to individuals who need end-of-life care and are often in the active stage of dying. They are hired by a Medicare and/or Medicaid certified hospice agency, must meet federally mandated training requirements, and must pass a competency evaluation exam. 
  • Home care aides or personal care attendants are hired by an agency to assist clients with activities of daily living. They also help with housekeeping chores, meal preparation and medication management. They do not provide medical care, and do not have federally mandated training requirements. They may be subject to state training requirements.

“Lacking understanding of how these workers differ makes it difficult to assess the extent to which public policies and private sector attempts to strengthen the home health workforce by enhancing training requirements, improving retention, and other efforts are likely to succeed,” the authors write.

Hospice Workers: Better Pay and Benefits

Hospice workers earned an average of $12.40 per hour in 2007, compared with an hourly rate of $11.60 for all home health workers, according to the paper. Hospice workers earned about 32% more than home care aides ($9.40 per hour) and 8% more than HHAs/CNAs ($11.50 per hour).

Hospice aides also received better benefits from their agencies. For example:

  • 97% had access to employer-sponsored health insurance, compared to 74% of home care aides and HHAs/CNAs. 
  • 4.7% were medically uninsured, compared to 21.9% of HHAs/CNAs and 17% of home care aides.
  • 83.9% received paid sick leave compared to only 53.1% of HHAs/CNAs and 43.7% of home care aides. 
  • 88.3% received paid time off, compared with 53.2% of HHAs/CNAs and 32% of home care aides. Hospice workers were also more likely to be offered pension benefits.
  • 91.5% received travel reimbursement, compared to 67.9% of HHAs/CNAs, and 52.4% of home care aides.

The paper notes several possible explanations for the differences in job quality between hospice and other home health workers. These include:

  • Differences in Medicare and Medicaid regulatory and reimbursement policies for hospice and home health.
  • A perception that hospice work is even more demanding and emotionally draining than working for agencies in other settings.
  • The fact that employers may view hospice workers as “more valuable” because they typically function as integral members of the care team. 

“Given the increasing attention to hospice and palliative care by policy makers and consumers and the growth in this sector, more research is needed to understand why the hospice worker occupation is more competitive than other agency-based frontline home health jobs,” says the paper.

All Workers: Highly Satisfied but Looking for Another Job

Overall, rates of satisfaction among all home health workers are high, according to the paper.

Nearly half of all workers indicated that they were “extremely satisfied” with their job. One half of all workers also said they were “extremely satisfied” that they were learning new skills.

Despite these endorsements, however, almost 1 in 5 workers indicated that they were “looking for another job.” Almost one-half of home care aides reported that they were likely to leave their job in the coming year, compared to about one-third of HHAs/CNAs and one-fifth of hospice aides.