This commentary is by Briana Kohlbrenner, a volunteer coordinator with University of Vermont Home Health and Hospice and a member of the Hospice United union bargaining team.
University of Vermont Home Health and Hospice (UVMHHH) is at a crossroads. As Vermont’s population ages, the demand for hospice care is growing.
We encourage community members to access hospice services early, as it allows patients and their families more time to focus on individualized goals and be supported by an interdisciplinary team. It also reduces hospitalizations and enables better pain management.
However, we need to have an honest conversation about growth. Expanded hospice services benefit both our health care system and the community we serve, but as a volunteer coordinator with UVMHHH, I see the strain it puts on our organization.
This is why my colleagues and I voted this past June to form our union, Hospice United, which reflects the unique interdisciplinary nature of hospice.
We are nurses, social workers, chaplains, volunteer coordinators, bereavement coordinators, kitchen staff and administrative staff. This holistic, wrap-around approach is one of the things that makes hospice care so special.
Our organization has a deeply committed staff who value providing excellent, around-the-clock care. UVM Health can ensure that quality end-of-life care continues to be core to our mission — or it can allow our program to succumb to the pressures of the health care industry and permit unmitigated growth to drive policy.
Hospice care is often an afterthought in the broader discussion of health care. It’s time for UVM Health to recognize the crucial role of hospice, and agree to a first contract that will lay the foundation for equitable and sustainable growth for our staff members and community.
We are asking for fair and transparent pay scales, safe staffing and equity within the UVM Health system. Though we wear the same logo on our badges, we are paid less than our counterparts in other parts of the UVM Health system. A new nurse starting at UVM Home Health and Hospice earns $6.72 less per hour than a new nurse at the UVM Medical Center.
Furthermore, UVM Home Health and Hospice isn’t competitive with other hospice care in the state. The posted starting rate for a volunteer coordinator with UVMHHH is $20.84 an hour. At Bayada Hospice, also in our county, the volunteer coordinator is posted at $33 an hour — 65% higher.
I have been with this team for a year and a half now, and during that time, I have watched the complexity and volume of our work grow exponentially.
We are seeing a higher volume of patients, with more complex care needs, both at the McClure Miller Respite House and among those receiving hospice services wherever they call home. In the past year, our team has also begun supporting patients in the hospital.
It is essential that our community can access this form of care, but the growth of hospice services is only sustainable when staff are supported. Our union members are on the front lines, and we know the conditions that are necessary to provide safe and dignified care.
We have created thoughtful proposals to ensure adequate staffing, including staffing ratios and caseloads for nursing staff, and protections for our family services staff who very often work above and beyond their mandated hours. Management has rejected these improvements.
Our ability to provide quality care is proportional to the amount of time we can spend with each patient. Without staffing guidelines, we will continue to lose valuable team members and our quality of care will diminish. Our team, our patients and our community deserve better.
The wage disparity for hospice workers and the issue of safe staffing ratios are the core of our staffing issues. We talk often about recruiting and retaining talented staff in this field, but this challenge is not because people don’t want to do hospice work — they simply cannot afford to.
When the cost of dedicating yourself to a professional mission is personal or financial instability, the organization suffers.
Our experiences are a window into the systemic undervaluing of all hospice workers. Dying is a part of life, and end-of-life services are an essential part of health care services — so why should we be viewed differently by the system that serves patients throughout the continuum of care?
These issues are not going to go away, especially as the need for our services grows.
We hope our community will support us in our fight for equity, safety and respect, so that we can continue to do the unique and specialized work we love.
