According to the Journal of the American Geriatrics Society, patients near the end of their lives typically wait too long to enter hospice care. The study reports that caregivers too often refer patients to hospice and palliative care only during the last days of their lives, too late to gain any real benefit.
Why is that? Primarily, it’s because most people view hospice and palliative care as “giving up.” Hospice carries a stigma, the equivalent of acknowledging that death is imminent. Accordingly, patients and family resist it until very late in the process.
That’s too bad, because hospice offers real benefits to the terminally ill. Hospice care, which treats those whose life expectancy is six months or less, stresses caring for the patient and making them more comfortable, rather than curing the patient. It aims to improve a patient’s quality of life through a combination of services—ranging from medical to spiritual—for both patient and family members.
Providing these broad-ranging services requires a lot of coordination and management. By becoming a hospice administrator, you will be the person responsible for making sure it’s all done effectively and efficiently.
A hospice administrator oversees the interdisciplinary team providing comfort to the patient through different levels of hospice care (e.g., home care vs. inpatient care). That team can include social workers, clergy, nurses and doctors working together to provide end-of-life care. It takes an empathetic, strong problem solver and good communicator to be a successful hospice administrator.
In this article, we’ll cover:
When someone enters a hospice center, it often means that they began hospice services in their own homes. That’s because people prefer the comfort of being at home in a familiar environment with their family.
At some point, patients require more care than can be provided in the home setting. That’s when they typically move to dedicated facilities, hospitals, or nursing homes. The Centers for Disease Control and Prevention estimates that there are currently 4,300 hospice agencies across the country serving 1.4 million patients.
Whether a person is receiving care at home or at a hospice facility, a hospice administrator coordinates the services provided.
As a hospice administrator, you’ll be in charge of ensuring quality services that focus on easing both the individual’s pain and the family’s stress. You won’t interact with the patient as frequently as hospice nurses and other support staff do, particularly if the patient is in hospice from home. Your work will take place behind the scenes.
Whether working at a small agency or part of a hospital system, hospice administrators—who also may have titles such as hospice directors or hospice managers—have several responsibilities, including:
Common illnesses of hospice patients include:__
Some professionals who go into hospice administration have had experience with hospice care professionally, or from a family experience that passionately affected them. That experience of sensitive care and training encourages them to pursue a career in hospice administration. It also helps them deal with the most challenging aspect of this work: the inescapability and frequency of often-untimely deaths. Hospice professionals must confront this harsh reality and accept that their critical mission requires them to acknowledge tragedy daily.
Along with your patients and their families, you can expect to work as part of a care team to manage patient care.
A care team may include:
Of this team, the patient typically knows the doctor best: in most instances, they’re the same doctor the patient visited before becoming ill. The rest of the team—the team members who will provide the lion’s share of services—will likely be new to the patient.
Hospice caregivers help relieve the patient’s symptoms and provide support for routine care, such as bathing and dressing. Hospice also provides support for family members who may need a break in caring for their ill loved one. Hospice volunteers visit a patient’s house to keep the patient company or bring flowers. Some members of the team—such as the nurse, the social worker, the doctor, and clergy—work with the patient to make difficult end-of-life decisions.
Health administration undergraduates sometimes start out in admissions, marketing, risk management, managed-care analysis, or other non-clinical staff positions and work their way into higher-level administrative roles. While it’s possible to work in healthcare administration without an MHA, it can take a lot longer to climb the managerial ladder without a master’s degree. (
According to the most recent data from the Bureau of Labor Statistics, as of May 2018, the median wage for health service managers was $99,730 per year, with the highest 10 percent in the field earning over $182,600 in base pay. Employment opportunities for health services managers is expected to grow by 20 percent by 2026. This growth is much faster than growth for other occupations. ( )
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Efforts are in motion to help professionals deal with the challenges and difficult decision-making that accompany end-of-life patient care. B.J. Miller, executive director of the Zen Hospice Project (a small hospice in San Francisco), has been recognized for advocating an effort to “de-pathologize death,” as he describes it in a New York Times article focusing on the end of life as a human experience. In the article, Miller describes regularly meeting with doctors who seek this “human experience” outcome for their hospice patients. As an administrator of hospice, you can challenge yourself to be a part of these progressive efforts to help create deeper meaning and more authentic care for patients.
To become a hospice administrator, first, you’ll need a bachelor’s degree. Typical majors for hospice administrators include:
You’ll find, though, that to become an administrator—essentially, a leader—major employers are looking for someone with a master’s degree. Depending on the school and the program, you’ll find relevant graduate degrees listed in several ways:
The choices can be overwhelming. Look for programs that offer courses covering these essential skills:
It can take between two and three years to complete the degree. In addition to resident programs near you, you can find online master’s programs in healthcare administration.
While not required, certification will make you a more attractive job candidate. As the National Board for Home Care and Hospice Certification (NBHHC) explains: “Voluntary certification can provide additional professional recognition and personal rewards.”
Passing a certification exam can lead to greater pay and advancement opportunities. The NBHHC administers the certification tests, with three levels offered: manager, administrator, and executive. Each level of testing has its own eligibility requirements. Additionally, the board offers ways to network with other candidates and form study groups through social media.
In a Washington Post article, hospice workers pointed to “the questions” they are always asked: “Why would anyone elect to spend their workdays so entwined with death and grief? And how can you possibly get up the next morning and do it all over again?” As a hospice administration, you’ll inhabit these emotional trenches, taking charge of a team of warm-hearted spirit healers and comforters. You’ll build behind-the-scenes strategies to improve services that not only comply with healthcare laws, but that also empower your team and the patients and families they serve.
If you’re interested in making an impactful difference at a critical time in someone’s life, a career in hospice administrator may be right for you.
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