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hospice executive


The Hardest Thing About Being a Hospice Executive

What is the hardest thing about being a hospice executive?

We asked, you answered.

This article is meant to be a living breathing document. If you’re a hospice executive and you’re reading this and feel inspired to contribute, email us or comment below and let us know what you think is the hardest thing about being a hospice executive and we’ll add it to this article. We, of course, will respect your privacy and keep your submission anonymous.

Here are the hardest things about being a hospice executive:

Preventing Employee Burnout


Managing Your Company Culture

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Lack of Transparency Among Peers


Being the Face of the Company

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Managing Your People

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Staying Out of the Weeds


Keeping Up with the Constantly Changing Regulations


Being Comfortable in Chaos

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Keeping a Balance Between Your Heart and Mind

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The Submissions:

Hardest thing for me is the lack of transparency from other Hospice providers in terms on not only metrics themselves, but also tools they use to accomplish positive economic outcomes based on those metrics.

- Hospice Executive in Texas

The hardest part – or where I feel the weight – is the responsibility of the public face, relationship builder external and internal, overseeing operations & quality, and the financial viability of the agency. It’s not one thing but these pieces come together in daily decision making and long term strategy.

- Hospice Executive in Denver

The thing that is the hardest is also the most rewarding….. PEOPLE.  Having so many people and families that you are ultimately in some way responsible can be stressful.  We have 180 employees, most of which have families plus we have 340 patients and most of them have families.  ALL these people in some way are affected by what we do and how we lead.  Big responsibility.  On the other hand, it’s the most rewarding when you hear and see how our hospice has changed someone’s life for the good.  Nothing better than that.  Quite often you hear leaders say, “you’ve got to keep work separate from personal”….not possible.  It’s all so intertwined that it can’t be separated.  So, when someone is going through a difficult personal issue it’s usually manifested through their work.  So the quicker we can help facilitate help and healing with that the quicker we can get our employee back.

Another really hard thing in our industry is trying to keep up with all the regulation and policy changes.  Ridiculous how often things change and for the most part it’s not for the best for the patient or the business. 

Learning as a business to do MORE with LESS is also another challenging aspect.  With reimbursement continuing to go down and the expectation of coverage going up you have to be really creative if you want to be successful.  Being successful means, Quality is second to none and our bottom line is healthy enough to weather all the storms that come from CMS.

- Hospice Executive in Idaho

The hardest thing about being a hospice executive is keeping the organization firing on all cylinders at the same time, all of the time.  This primarily is due to the constant change in the industry.  Changing regulations and changing interpretations of the requirements can keep various departments in a state of flux.  When that department settles into the new norm, an issue pops up in another area.  This can often cause the leadership team to deviate from strategic visioning, mostly due to a feeling of being overwhelmed with the daily operations.

- Hospice Executive in Kentucky

The hardest part of being a leader in hospice is helping leaders and care-delivery staff manage professional burnout, work-life balance and the urgent needs of our precious patients and caregivers.

- Hospice Executive in Michigan

 I think one of the hardest things is keeping a balance between your heart and mind

Your mind gives the figures, facts, statistics and can over analyze every situation and can sometimes be too careful and not willing to take risk when it may be needed.  Too much mind leads to apathy, unwillingness to interact with others, and rigidness which are not the best attributes when you are working in the hospice industry.  But the mind is great to keep your organization focused, safe with compliance, knowledge, wisdom, and good judgment.   

The heart gives us the love, compassion, sympathy, charity, & hope that is needed and desired for all of us to have but as they say: too much of anything can be a bad thing.  Too much heart is no different for an executive if it does not work hand in hand an in balance with the mind. 

So whether you are working with patients & families, staff, regulations, growth, development, etc, a balance of the heart and mind are necessary to do the right thing and create the FEELING desired for both patients and families as well as being a best place to work for our staff. 

- Hospice Executive in Idaho

It is lonely at the top.  The weight of the responsibility can be very heavy.  Having faith that I have everything I need to do this job.

When I took this position, I underestimated what this part would be like.  I am not even sure that I can adequately describe it.  I have a great team, we work well together, we have accomplished great things, we trust each other.  But there are times when I have concerns, fears or decisions to make that I cannot talk with them about.  My board of directors is volunteer and they have very little actual operational/regulatory knowledge so I generally cannot talk things out with them.  I have received very little feedback from the board in three years.  I have to have the vision for our future and be the motivator for everyone to get there. Finding my motivation to do this right for others can be challenging at times.

Keeping the work I am doing lined up with the vision for the organization  = STAY OUT OF THE WEEDS, leave that to the managers, trust them.  

 Being ok with being uncomfortable.  You have to be calm in chaos!

Public speaking…. :/ still adjusting to that.

Making the tough decisions that aren’t popular – really the decisions aren’t hard to make, it’s the carrying them out that is tough. Communicating about the tough decisions so that people can understand even if they don’t like it.

Staying calm and seeking understanding when others are not.

Listening with the willingness to be altered.  

Managing the organizational culture.  So important.  So very important. 

Wowza, I am not sure if I should delete all this and just say the job is easy??

- Hospice Executive in Iowa

The top 3 challenges of being a hospice executive is managing a budget, ensuring growth, and maintaining compliance.

- Hospice Executive in Arizona

I have thought and thought about this… what keeps me up at night is (I’m a nurse first, I must preface) that we are providing our patients and their family with high quality customer centered care. It is so important that we identify the needs of our patients and their family and quickly respond to such needs/wants while still maintaining regulatory compliance, policy and procedural compliance as well as professional boundaries. What I always preach to our staff is that no matter how many deaths a person has experienced (because we know that staff experience death sometimes daily) we must make sure that it is special and individual to each of those people involved as the families don’t experience death as regularly as our staff.

- Hospice Executive in Kentucky

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Email us at and tell us what you think is hardest about being a hospice executive and we will add it to this article!