What is Hospice Administration?
Near the end, the best that can be done is to make passing as easy as possible, for both the patient and their loved ones. And this is where hospice work comes in… easing the suffering, offering counseling to the afflicted, and managing the difficult and mysterious processes of death.
Hospice work requires champions. As the end nears, neither patients and families, or even their primary healthcare providers, want to confront the gritty realities of death or acknowledge its imminence. Hospice is a dirty word in hospital wards and physician’s offices, one that is seen as an acknowledgement of defeat instead of an inevitable phase in terminal illness.
The taboo nature of it all has consequences for patients, consequences that hospice administrators have to work hard to overcome. According to the National Hospice and Palliative Care Organization, in 2017 less than half of eligible Medicare beneficiaries were enrolled in hospice service at the time of death… 40 percent of them received care for less than two weeks, indicating a lack of planning and support for end-of-life care.
This lack of understanding of the importance and advantages of hospice care is, in its own way, a failing of the healthcare industry. A failure to reckon with death ignores the ways in which it can be made easier, for patients and families alike.
Hospice administrators have a unique job in healthcare management, one that demands a blend of sensitivity, empathy, and practicality, and that’s not a combination of traits that’s always easy to find. But it’s a vital role, one that needs more of those quality people in it, and with the right education, it can be both rewarding and well-respected.
What Is a Hospice Administrator and What Do They Do?
Hospice administrators manage the business of dying.
Death remains among the most taboo and least understood mysteries of life, but one that everyone will experience someday. Modern medicine and the American healthcare system has generally focused on preserving and improving life. But no matter how successful doctors and healthcare professionals are in those tasks, it’s a race that ultimately can’t be won. Life can be improved and extended, but not indefinitely.
As sensitive as the subject of our last days on earth may be, the reality of hospice care is that it faces mundane challenges in staffing, facilities maintenance, supply procurement, regulatory compliance, and other important business matters that absolutely require first-rate administrative talent to manage.
So, like other healthcare service managers, hospice administrators oversee their facilities and manage areas of employment, services, standards of care, customer service, finances, all while ensuring regulations are followed. While they run the day-to-day operations of the hospice, they also employ other professionals at various levels to carry out tasks that ensure the facility runs smoothly and in accordance with state, federal, and professional requirements.
In practical terms, that means days of going over spreadsheets, taking meetings with vendors and department heads, talking with patients and their families, and consulting with interdisciplinary care teams that can include:
Hard Decisions When Death is on the Line Require Strength and Sensitivity for Hospice Administrators
Administrators are the final stop for the hard problems that come with managing any organization, whether it’s a staffing shortfall or a budget gap. You’ll spend plenty of time researching solutions to those problems, and making hard decisions—and communicating them gently and respectfully—when the solutions require sacrifice.
To succeed in this role, you should feel comfortable multi-tasking and working with individuals from all walks of life. You should also be someone who can create boundaries between your personal and professional life and not take work home with you.
The unfortunate reality of this job is that all of the patients in the facility you operate will eventually pass away, most likely while under your care. You should be prepared to deal with this reality and find ways to practice self-care… not to mention having the sensitivity and empathy to ensure your staff have the support they need to handle the constant stream of terminal patients.
Hospice work is also unique in healthcare service in that much of the primary care is typically provided by family members or close friends of the patient. This creates an unusual dynamic between hospice providers and the family, requiring the building of a new care team and procedures with basically every new patient. Hospice administrators may be called in to smooth out some of the difficulties that inevitably rise with this process. And with patients passing at all hours, it can be a 24-hour, every day, all year on call position.
Where Do Hospice Administrators Find Work?
While hospices have most traditionally been inpatient facilities, sometimes co-located with skilled nursing homes, a broad recognition in the industry that most people are more comfortable spending their final days in familiar places surrounded by friendly faces. More and more hospice operations have shifted their focus to offering services at home.
This presents a different logistical and administrative challenge for hospice managers, who have to coordinate staff visits at remote sites, organizing medical equipment delivered to homes, and deal with the challenges of securing and accounting for schedule I narcotics floating around in private homes. There is also considerable coordination required with specialist and primary care physicians, and sometimes patients need to be transferred between locations as their conditions change.
You can find both for-profit and non-profit hospice organizations, either focused on home hospice care or running a combination of in-home and hospice facility operations. In some cases, hospice operations are affiliated with larger healthcare systems. The National Center for Health Statistics states that 4,300 hospice care agencies existed in the U.S. as of 2016, serving approximately 1.4 million patients. Of those agencies, 63 percent were registered as for-profit businesses while the remainder operate as non-profits. There are also some government-run hospice agencies, including those managed by the Veterans Administration.
Salary Expectations – How Much Does a Hospice Administrator Make?
Hospice administrators are lumped in to the larger umbrella of medical and health services managers by the Bureau of Labor Statistics (BLS) statistics that track employment and salary figures. The good news is that those positions were pulling in a median annual wage just into the six-figure range according to 2019 data.
The subset of nursing and residential care facilities managers made a median salary of $86,820, however. But the self-reporting site PayScale further clarifies that salaries range from approximately $66,000 to $110,000, depending on experience, location, and education level for hospice managers specifically, so both numbers are well within the range of possibility.
Demand is also high, as is true in the medical profession generally. According to BLS, the number medical and health service manager jobs in the country will grow at a much faster rate than average between 2019 and 2029, hitting an eye-popping 32 percent.
How to Become a Hospice Administrator – A Degree in Health or Business Administration Can Provide the Education You Need
Becoming a hospice administrator requires a commitment to years of education. Although you won’t find any degrees that are specific to managing a hospice, there are plenty of relevant business and hospital administration programs that will give you the right training to start down that path.
A bachelor’s degree will generally be the minimum requirement for hospice administrators, but you’ll also find many roles that will prefer someone who holds at least a master’s degree. And because not everyone can afford the time commitment or money to enroll in a bachelor’s program, you may consider starting off with a two-year associate degree in a similar field that can eventually be used as credit for the first two years of a four-year bachelor’s program. You’ll need to ensure that a transfer agreement exists between the two colleges you plan to attend for these programs, however, to make sure all the credits will count.
Earn a Master’s Degree
As the field of hospice administration continues to become more specialized and formalized, executive search committees are looking for candidates with an advanced degree. A master’s in health administration is a common choice, since it familiarizes students with both the healthcare services management industry and traditional business skills. However, those business skills are becoming increasingly important in a tightening industry, so a business-centric degree like an MBA with a healthcare concentration will also find favor.
Most master’s programs require two years of full-time learning, but several accelerated programs can be completed in approximately 18 months. Coursework may include advanced studies in healthcare ethics, economics, and policy. Some programs require you to research and write a thesis, while others mandate field experience. In many cases, you’ll enjoy superb internship and field placement opportunities to build your practical experience.
Because many learners work while pursuing graduate studies, many online master’s degrees in health administration are available. These programs often allow more flexibility than campus-based options, making it possible for students to complete assignments on their own schedules.
Earn a Doctorate
While few, if any, hospice administration roles require a doctorate, some professionals still decide to go down this path. If you are interested in transitioning to an academic or research-based role in the future, pursuing this option may make sense. The traditional degree for a research or academic role is the PhD, or doctor of philosophy.
There’s another option for students who are looking for more operational roles, however. The doctorate in health administration (DHA) degree is considered a terminal degree just as a PhD would be, but is an applied doctorate, more oriented toward managerial and leadership training than research or academia. Both types of degree usually require three to five years of study and you will spend much of that time in researching, writing, and defending a dissertation on a unique topic or question in the field. This offers you a lot of latitude in what specific subjects you will study, since you can pick your own dissertation topic and build your degree plan around it.
Earn a Post-Degree Certificate
A certificate is a fast-track academic path to specialized knowledge in healthcare administration, usually designed for individuals who have majored in a completely different subject but are looking to switch career paths. In the hospice management field, this usually means doctors or nurses who have specialized in geriatric medicine or palliative care but want to make the jump from clinical positions to administrative work.
That means most will already have a bachelor’s or master’s degree in their own profession, and returning to school for another two or four years would duplicate much of that work.
A graduate (designed for students who already hold a bachelor’s) or post-graduate (designed for students who have earned a master’s) certificate distills the healthcare administration coursework out of the college programs and presents it in a format that can take a year or less to progress through, and cost much less than a full degree. They are also frequently offered online and are designed to be convenient to working professionals.
Considering Accreditation for MBA and MHA Degree Programs
An American college degree doesn’t really count as a college degree unless it comes from a school that has been fully accredited. General institutional accreditation is offered by independent regional accreditors in the United States, six of them across the country for schools offering bachelor’s and higher programs. These agencies operate with approval from the Department of Education and the Council of Higher Education Accreditation to evaluate the scholastic and administrative qualities of schools to assure consistently high standards.
Almost all colleges you have ever heard of hold one of these accreditations already, so you don’t have to dig into the weeds to verify them. If you’re coming into the field with an undergraduate degree, this form of institutional accreditation is totally sufficient.
But at the master’s degree level in the field of healthcare administration, there’s another level of accreditation to consider, a specialty accreditation that evaluates programs specifically on curriculum, field experience and faculty qualifications as it relates to the highly specialized field healthcare administration. For MHA (Master of Health Administration) and MSHA (Master of Science in Health Administration), as well as MBA programs with a Health Administration focus, that accreditation is provided through the Commission on Accreditation of Healthcare Management Education (CAHME) (only healthcare administration programs; only master’s degrees).
If you are serious about a Bachelors in Business Administration (BBA) with a major or minor focus in Health Services Management, or even a Master of Business Administration (MBA) with a Health Administration focus, you will find the three business school accreditation agencies recognizing plenty of schools offering BBA and MBA programs focused squarely on the management of healthcare facilities:
A program that doesn’t hold one of these shouldn’t necessarily be automatically disqualified, but finding one that does certainly adds an additional layer of assurance that you’re looking at a quality program. Since many high quality healthcare admin programs fall through the cracks because they land just outside the purview of business accreditors, you can still find plenty of non-accredited degrees in both health and business administration that meet industry and employer expectations.
Should You Become Certified as a Hospice Manager?
A point that’s worth clarifying is that a graduate or post-graduate certificate is not the same thing as earning a professional certification.
Academic certificate programs deliver the education you need to get into the field; certification verifies that you absorbed that knowledge and have proven your capabilities through testing, and sometimes testimonials from your peers. Certification is viewed as a stamp of approval that employers often consider in hiring, and that can have a real impact on your earning potential.
To confuse things further, it’s also important to distinguish professional certification and educational certificates from the certification process that hospice providers may have to go through for state-level approval or Medicare/Medicaid compliance. Those are steps required for the organization as a whole, not individual administrators.
You have a few choices for professional certification paths to pursue as a hospice administrator:
These organizations each offer at least one, and sometimes several, different professional certification options for hospice care administrators. Some combination of testing, education, and professional experience are usually required, as well as membership in the respective organization; check each website for details.
Each certification also has its own requirements for maintaining the credential. This usually means taking continuing education training, which those organizations may also provide. However, you can typically count many other kinds of courses and activities toward meeting those requirements.
Professional Resources for Hospice Administrators
Hospice care is all about offering shoulders to lean on in trying times. As an administrator, you are not exempt from needing a helping hand every now and again. And there is no one better to offer it than your fellow hospice professionals. There are many organizations (in fact, many of the same organizations that offer professional certification in the field) you can look to for more information about the job, networking events, recent news and regulatory developments, and even just a sympathetic ear after a hard day on the job.
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