Short answer: Hospice recruiting is hard for two reasons, and only one of them is the labor market. Demand for hospice care keeps climbing as the country ages, while the nurse and aide supply that carries it is not keeping pace. That half you cannot control. The half you can control is your own funnel. Most hospices lose qualified clinicians they already attracted, to slow follow-up, wage-only competition, and a first 90 days that burns people out. Fix the funnel first, then decide whether to rent candidates from an agency or build a pipeline you own.
Why hospice recruiting is harder than general nursing hiring
Hospice does not draw from the same pool as a hospital floor. End-of-life care asks for a specific temperament on top of a clinical license, so the qualified pool is narrower before you post a single role. The work is RN-heavy and credential-heavy, which means licensure, background, and hospice competency all gate the calendar before a candidate can start. Add on-call and rural coverage, and the number of people who can actually take the shift shrinks again.
Then there is pay. The national average hourly rate for hospice RNs was 38.08 dollars in 2023, up 4.58 percent that year, but community hospices still compete against hospitals and travel agencies that can outbid them. On the aide side the math is harder: median earnings for direct care workers sit just under 26,000 dollars a year, which is why that part of the workforce is the most fragile.
What the hospice workforce shortage actually looks like
Start with demand. About 1.72 million Medicare beneficiaries received hospice care in 2023, and hospice was used by 51.7 percent of all Medicare decedents. That share only grows as the population ages: the number of Americans 65 and older will more than double to roughly 80 million by 2040, and the group aged 85 and older will nearly quadruple. The Bureau of Labor Statistics projects home health and personal care aide jobs to grow 17 percent from 2024 to 2034, with about 765,800 openings every year. PHI projects 9.7 million total direct care job openings over that same decade.
Now the supply side, where the numbers turn. Hospice loses clinicians faster than almost any care setting. In 2025, hospice RN turnover ran 25.48 percent and hospice aide turnover ran 29.02 percent. The RN figure improved from 26.82 percent the year before, but the aide figure ticked up. The churn reaches the top of the house too: hospice executive turnover was 18.51 percent in 2025.
Replacing that many people every year is not a hiring cost. It is a subscription to starting over, renewed annually, in a market where the candidates are already scarce.
Where hospice hiring really breaks (and it is not only supply)
Here is the part most operators miss. The shortage is real, but a large share of your loss happens after the candidate has already found you.
Look at the funnel. In the most recent home-based care benchmarking, only 16.4 percent of home health and hospice nurse applicants were actually hired, and just 12.8 percent of home-based care applicants overall. That is not purely a supply problem. Five of every six qualified nurse applicants who raised a hand did not end up on your team, and much of that gap is process: slow first contact, wage bands hidden until a screening call, and a reputation the candidate read before you ever spoke.
The leak continues after the offer. Across home-based care, 57 percent of caregiver turnover happens in the first 90 days. The people existed, applied, got hired, and then left inside three months. That is not a sourcing failure. It is an onboarding and support failure, and in hospice, where the emotional load is real from day one, it is the difference between a hire that holds and a role you reopen next quarter.
You cannot control the labor market. You can control response speed, wage transparency, your public reputation, and the first 90 days. That is the half of the problem that is actually yours to fix. We wrote the full breakdown of those funnel leaks here: why you cannot find qualified caregivers.
Agency or software: which one fits hospice
A hospice staffing agency fills one urgent clinical seat fast, and you pay a placement fee every time. That works when you have a single hard-to-fill role and no time to build anything. It breaks when you hire clinicians every month and turnover is your real cost, because the fee resets on every replacement and you never build a pipeline you own.
Hiring software flips that. It sources around the clock, verifies credentials before a candidate reaches your calendar, and follows up in minutes instead of the next business day, which is exactly the window where hospices lose people. The setup is higher on day one than a phone call to an agency, but the cost per hire falls the more you use it, and the candidate list is yours to re-engage the next time a shift opens. We put the full comparison, with the placement-fee math, here: caregiver recruitment agency vs software.
How ProHireHQ fits
ProHireHQ is the software side of that choice, built for senior care and hospice operators rather than general hiring. It works your open clinical roles around the clock, runs license and background checks up front so you are not interviewing people who cannot be credentialed, and responds to applicants fast enough to win them before the hospital across town does. If you are hiring hospice nurses and aides every month, that is the difference between paying to fill a seat and building a system that fills the next one too. See how it maps to your setting on the hospice hiring overview, or get a read on where your own funnel leaks with a free hiring audit.
Sources
- Hospice RN, aide, and executive turnover and vacancy, 2024 and 2025: LeadingAge and HCS Hospice Salary and Benefits Report.
- Hospice turnover by role and hospice RN hourly wage, 2023: LeadingAge and HCS.
- Applicant-to-hire rate and first-90-day turnover across home health and hospice: Activated Insights recruitment and retention and Activated Insights on 90-day turnover.
- Medicare hospice utilization, 2023: NHPCO and Alliance Facts and Figures.
- Direct care workforce openings and median earnings, 2024 to 2034: PHI Key Facts 2025.
- Home health and personal care aide employment projections: U.S. Bureau of Labor Statistics.
- Aging population projections to 2040: Urban Institute.