Hospice Administrator – A Day in the Life

Hospice administrators oversee the operations of a hospice agency. While a nursing home or a long-term care facility will focus on patient longevity, hospice services are provided to people who are believed to be in their last six months of life. As such, the care here is less about prevention and recovery—and more about comfort and peace of mind.

Rather than seeking out cures, the hospice philosophy prioritizes the concept of care. Hospices are dedicated to supporting the patient, and the patient’s family, in their physical, mental, emotional, spiritual, and social needs. Hospice administrators, therefore, are experts at managing end-of-life care, taking into account both pragmatism and compassion.

Due to the demographic warp of the aging Baby Boomer generation, hospice facilities and hospice administrators are expected to be in greater demand in the near future. As part of the broader category of medical and health services managers, the Bureau of Labor Statistics (BLS 2021) expects jobs in this field to grow 32 percent between 2019 and 2029—a rate that’s eight times faster than the national average for all professions. As for compensation, PayScale, a self-reported aggregate of salary data, shows that the average annual salary for hospice administrators is $86,195 (PayScale June 2021).

Everyone deserves to die with dignity. And while that may be a topic that the average person spends most of their time avoiding, it’s something that hospice administrators dedicate their lives to achieving. This requires a careful balance of technical knowledge and compassionate understanding. Read on to get a glimpse into a day in the life of a hospice administrator.

While hospice care can occur in a patient’s residence, a nursing home, or a long-term care facility, most hospice programs are independent agencies. Other hospice programs are considered a part of a specific nursing home, home health agency, or hospital network. In each instance, a hospice administrator’s base of operations will be an office.

The National Hospice and Palliative Care Organization (NHPCO) reported in 2020 that the vast majority of hospice care was provided in private residences and in nursing homes, residential care facilities, and hospitals. Medicare, the federal health insurance program for individuals over 65 years of age, provides four levels of hospice care depending on need:

• Routine Hospice Care (RCH): in-home hospice care
• Continuous Home Care (CHC): care provided from 8-24 hours a day for terminally ill patients
• Inpatient Respite Care (IRC): temporary relief for a patient’s primary caregiver
• General Inpatient Care (GIP): for pain control or acute symptom management

Regardless of the work environment, hospice administrators must retain a personal touch in their daily responsibilities. Data from Statista shows that in 2018 there were 1,550,000 hospice patients and the National Care Planning Council (NCPC) indicates that there are approximately 3,200 hospice programs in the United States. These numbers show that, on average, hospice administrators maintain relationships with about 500 patients and their families every year.

A primary responsibility of a hospice administrator is to oversee a hospice facility’s staff. End-of-life scenarios require a true concert of different specialties. In the course of their work, hospice administrators will interface with social workers, spiritual counselors, nurse practitioners, dieticians, and pharmacists, among others. Hospice administrators’ responsibilities include fostering collaboration between these different groups with the shared goal of providing physical and emotional comfort to the patient and their loved ones.

According to the National Hospice and Palliative Care Organization (NHPCO), hospice teams include:

• Clergy or other counselors
• Home health aides
• Hospice physician (or medical director)
• Nurses
• Social workers
• Trained volunteers
• Speech, physical, and occupational therapists
• The patient’s physician

Grief support is a vital part of hospice care for surviving family and friends. Hospice administrators and their teams stay in touch with family and friends through phone calls, letters, support materials, and support groups designed to help people grieve their loved ones.

The prominent role of a hospice administrator is to run a very delicate and compassionate business. On a purely administrative level, this includes overseeing financial operations and staff specifics. Management is a critical part of the hospice administrator position, and they’ll need to maintain a supply chain of sanitation equipment, medical devices, food, staff, and medicine. In each of these avenues, a hospice administrator must keep the bottom line and strategic goals in mind. Even though the stakes are human, hospice care is, ultimately, a business—and one that hospice administrators need to be adept at running.

Some typical daily responsibilities of a hospice administrator include:

• Implementing new organizational policies
• Developing a budget to match operational strategies
• Authorizing new expenditures
• Coordinating communication between patients, families, and staff
• Ensuring a hospice facility’s compliance with local, state, and federal regulations
• Managing a supply chain of medicine, food, sanitary supplies, and medical devices
• Assigning work schedules
• Recruiting, hiring, firing, training, and disciplining hospice staff

No two end-of-life scenarios are identical. A hospice administrator must ensure that the staff is attending to the individual needs of both the patient and the patient’s family. The balance between administrative obligations (to financial and management issues) and humanitarian obligations (to compassionate communication and intra-staff collaboration) requires repeated recalibration and a solid educational background.

While it’s not a universal requirement, almost all hospice administrators will have at least a bachelor’s degree in an area like healthcare administration, business administration, or finance. And it’s becoming increasingly common for hospice administrators to pursue graduate education, such as a master of healthcare administration (MHA). At this stage, hospice administrators learn the intricacies of complex, industry-specific topics like healthcare finance, health law, health informatics, and marketing. It’s also possible to earn an MHA in a specialized concentration related to hospice care.

There are some skills a hospice administrator needs that can’t be taught in the classroom. Compassion is the most precious resource in hospice care, as dealing with end-of-life issues never gets easier—and if it does get easy, that can be a symptom of compassion fatigue.

Other skills, however, can be taught and learned over time; communication skills, for example, are at a premium in hospice administration. This role requires delicate conversations about serious issues and requires having those conversations with many people from different personal and professional backgrounds. Hospice administrators are responsible for running a business, but they can never lose sight of their product: providing compassionate care for those at their most fragile.

While hospices must be licensed in the states in which they operate, hospice administrators themselves do not need state-level certification or licensure. Voluntary certification, however, can be both professionally appealing and personally rewarding. While several designations have been retired over the years, the gold standard of professional certification for hospice administrators is still the National Board for Home Care and Hospice Certification (NBHCC).

The NBHCC offers three different levels of certification for hospice administration: certified hospice manager (CHM), certified hospice administrator (CHA), and certified hospice executive (ACHE). The application fee and the exam fee cost a total of $598.

• The CHM certification is for staff moving into higher leadership and management roles at smaller agencies. Candidates for the CHM certification need at least one year of experience as a manager in a hospice environment.
• The CHA certification is for senior staff in a hospice environment who have worked as an administrator for one year or have worked as a manager for five years.
• The ACHE certification is for senior administrators who have at least three years of experience in a medium to large agency.

For each certification, a bachelor’s or master’s degree is preferred; applicants with only a high school diploma or associate’s degree will need to show proof of additional work experience. Once deemed eligible, a certification candidate must pass a two-hour, 80- to 100-question exam.

Those who hold an NBHCC designation must recertify every four years by showing proof of employment for 12 out of the last 48 months and completing 50 contact hours of professional development. These hours must be split between community support activities and continuing education. The renewal fees total $398.