I spent years in hospice operations before helping launch Solvr, and in that time I had a front-row seat to how agencies grow — and how they don’t. The pattern I see most consistently in agencies that struggle with growth isn’t a lack of effort. It’s a confusion between activity and results.
Busy teams feel productive. Lots of calls, lots of visits, lots of marketing initiatives, lots of meetings about strategy. But census doesn’t move. Or it moves for a month and then stalls. Leadership adds more activities — a new social media push, another referral event, a revised script for the sales team — and the cycle continues.
The agencies that consistently grow have usually figured out something that sounds obvious once you say it out loud: a small number of things actually drive referrals, and everything else is noise.
The One or Two Things That Actually Work
For most hospice agencies in the 50 to 200 census range, the referral funnel ultimately runs through a handful of high-volume discharge planners at a handful of hospitals, and a small number of trusted relationships with skilled nursing facilities or home health agencies. Everything else — the website, the community events, the cold outreach — matters at the margins.
That doesn’t mean you ignore those other channels. But it does mean that your best reps should be spending the majority of their time maintaining and deepening the relationships that actually move volume — not spreading attention equally across every potential referral source.
The leaders who figure this out tend to be very specific about what their top three referral relationships need to stay strong, and relentless about making sure those relationships get the attention they deserve. That’s a discipline problem, not a strategy problem.
Infrastructure Before Scale
The second thing I see consistently is agencies trying to scale activity before they’ve built the infrastructure to support it. You can generate more referral interest with better marketing, more outreach, more visibility. But if your intake process is slow, if your clinical reputation has any cracks, or if your communication with families is inconsistent — more referrals just means more pressure on a system that isn’t ready for them.
The agencies that grow sustainably build the back-end first. They make sure intake runs cleanly. They make sure families are getting consistent communication. They make sure their clinical quality is something their referral sources can stand behind. Then they grow.
Growth that runs ahead of infrastructure creates a different kind of crisis — and it’s a harder one to fix than simply being behind on census.
What This Looks Like in Practice
If you’re a hospice leader who’s frustrated with your growth trajectory, the question I’d start with isn’t: what are we not doing enough of? It’s: what are the one or two things that have actually driven our best referral months, and are we making sure those things happen every week without fail?
The answer to that question usually points to fewer initiatives, not more. That’s a counterintuitive place to land, but it’s almost always the right one.