Professional Practice

What is a healthy caseload for a Hospice Chaplains?

Dr. Saul Ebema

Glad you asked. Many of you Hospice Chaplains and Hospice supervisors have been wondering what the acceptable caseload for a full-time Hospice Chaplain is. Instead of answering you all individually, to avoid a big caseload, here is the answer for all those who may be wondering the same thing.

Every hospice agency in the United States agrees that the spiritual needs of their patients and families are important and are all doing what they can to meet those needs. However, the process of going about meeting those spiritual needs differ from hospice to hospice.

Some hospice agencies expect their staff chaplains to visit all patients on the team unless chaplain services are specifically declined.

Secondly, some hospice agencies only arrange chaplain visitation at the specific request of the patient and family. Therefore, they rely on PRN (per required need) hospice chaplain services.

Other hospice agencies rely on the patient’s faith community to provide primary spiritual care with support and guidance from their staff hospice chaplain.

Furthermore, the hospice chaplain’s caseload can also be impacted by the hospice agency’s requirement for their staff chaplain to be routinely involved in providing or participating in funeral and memorial services for their patients who have died.

Last but not least, the hospice chaplain’s caseload can also be impacted by the hospice agency’s requirement for their staff chaplain to be involved in hospice presentations, community education on end of life care and other office administrative duties.

All the above unique characteristics heavily influence the Hospice Chaplain’s work, caseload and perceived productivity.

Now that we have established the fact that the hospice chaplain’s caseload is heavily influenced by the above factors, here is what the Hospice Chaplaincy Board recommends as a standard caseload that sustains quality productivity.

In this recommendation, we assume the following:

  1. The hospice chaplain is expected to visit all patients apart from those who decline chaplain services.
  2. The hospice chaplain is expected to be available as needed to provide funeral and memorial services
  3. The hospice chaplain is expected to be available as needed for death visits
  4. The hospice chaplain will have some on call responsibilities
  5. The hospice chaplain is not the only spiritual care provider for the patients but will also coordinate care with the patient’s faith community and clergy. Thereby making him/her available for where they are needed most when spiritual needs arise.
  6. The hospice chaplain is not required to do a lot of administrative work to free him/her to be on the field.
  7. The hospice chaplain is not required to attend every funeral or memorial service but only attending those invited to attend by the families.

Based on the above assumptions, we recommend:

For a hospice agency with a census of under 50 patients. The fulltime chaplain can handle the caseload of 40 patients without affecting their productivity. Some of these patients will only need once a month visits, others will hold off on visits until their health worsens etc.

For a hospice agency with a census of 50-80 patients. The fulltime Chaplain can handle the caseload of 50 patients without affecting their productivity. But the agency should begin thinking about hiring a part-time or a cost per call chaplain to support the fulltime chaplain.

For established hospice agencies with a caseload of over 100 patients. The full-time Chaplain can handle a caseload of 60 patients. But begin to form a good spiritual care department by hiring more part-time and cost per call chaplains. Remember this, proper end of life care does not need overburdened staff but requires a well supported staff.

“Proper end of life care does not need overburdened staff but requires a well supported staff.” Saul Ebema

Hospice Chaplaincy is committed to promoting excellence in spiritual care at the end of life. Our mission is to advance research initiatives that promote a better understanding of the psychosocial and psycho-spiritual aspects of end of life care. We are dedicated to providing patient advocacy, support and education services to individuals, clergy and medical professionals resulting in improvements in providing quality spiritual care at the end of life.

6 comments on “What is a healthy caseload for a Hospice Chaplains?

  1. Saul, I deeply appreciate this reflection. I manage my load, but you help me understand that I am indeed working with a fuller load than I should be (and I don’t feel supported). In our company, they consider a chaplain per 80 patients to be a normal load. And that’s a lot. I feel that. These days, under Covid-19, everything is different, but before (and I hope there will be an after), the sense of feelings overly burdened was there. Moreover, the caseload made it difficult to decide to see patients more often, which some needed. So I was not giving the care that a proper assessment would suggest, and that is hard to live with. Anyway, I appreciate all that you do. Niels

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    • Hospicechaplaincy.com

      80 patients? That’s not normal. I hope they change that kind of mindset. It’s not good for the chaplains and for the company.

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  2. John Smith

    The hospice company that I work for has me in a dual role as chaplain and bereavement coordinator. The chaplain role has 45 patients on average and the bereavement coordinator has approximately 175 patients CB on average. I feel overwhelmed and I am told that this is normal.

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    • John, that’s not normal! That’s a very heavy caseload. They need to be thinking of hiring someone to help you to thrive on the good work you are doing for them.

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  3. Paul Ferguson

    I believe you also have to take into consideration the amount of travel necessary to see the patients. I have patients that live locally all the way to about 50 miles away. My visits have to be coordinated with the nurse, Home Health Aide, and Social Worker. Sometimes, due to schedule conflicts and family preferences, I have to make several longer distance trips per week. So maintaining a case load of 40-45 is a very full load. 30-35 allows for much better care for each patient and caregiver/family. I put anywhere from 4-500 miles on every week.

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    • For those who have to drive long distances between patients like you, distance has to be factored into the case load. We hope your hospice understands and takes good care of you to avoid burnout.

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