Hospice Buffalo is eliminating 17 full-time-equivalent positions in response to a decline in the use of services the organization provides to terminally ill patients. The drop in usage has been driven in part by increased competition from other health care providers.

The layoffs affect 23 full-time, part-time and per-diem workers – including clinical and nonclinical staff – at the Center for Hospice & Palliative Care in Cheektowaga and go into effect by July 1, the not-for-profit agency announced Monday.

Officials said more patients are using end-of-life services provided by hospitals, nursing homes and other facilities, who continue to refer patients to Hospice Buffalo but do so when the patients are closer to death.

“We’ve gone from a period where, five years ago, people didn’t know what palliative care was to, now, everybody’s offering their own version of it,” said Dr. Christopher Kerr, Hospice Buffalo’s chief medical officer and acting interim CEO.

Hospice Buffalo has 525 full-time, part-time and per-diem – or as-needed – employees, counting those who are being laid off, Kerr said.

The organization last winter temporarily laid off 10 full-time-equivalent workers in anticipation of an $8 million renovation of the inpatient unit at its Cheektowaga campus, a project that would have required a shifting around of employees and patients, spokeswoman Rosemary Collins said.

This project has been delayed until next year, largely because of changes in Hospice Buffalo’s leadership and the need to raise funds for the renovations, but the workers remain laid off and the organization has no plans to bring them back, Collins and Kerr said.

Further, since December the organization has let the equivalent of 38 full-time workers leave without replacing them.

“It’s just been a trend of attrition that we’ve kept with since the fall,” Kerr said.

Hospice Buffalo officials say the overall level of patient referrals has held steady in recent months – though it varies from institution to institution – but the amount of time for which the organization serves each patient has fallen sharply.

Last September, for example, the organization was serving an average of 630 inpatients and outpatients each day through its various facilities, while this month the organization is serving about 500 patients daily, a 21 percent drop.

What explains the decline? Kerr said Hospice Buffalo saw a dramatic, and unexplainable rise in its death rate, meaning patients who would be expected to require Hospice services for a standard length of time are dying much sooner.

And hospitals and nursing homes, which are offering their own end-of-life services, are referring patients to Hospice later in the patient’s life. Hospice workers are spending days or weeks with a patient who otherwise might have used the organization’s services for several months or longer, Kerr said.

“We’re seeing a decline in length of stay,” he said.

Kerr said the other institutions that offer palliative care don’t offer the full range of services provided by Hospice Buffalo, such as 13 months of follow-up bereavement support for survivors.

Hospice care is included in patients’ Medicare benefits, Kerr said.

The not-for-profit organization derives most of its revenue from federal Medicare reimbursements and contributions from private donors.