Fargo-based Hospice of the Red River Valley laid off 11 employees Wednesday due to a declining economy.
The cuts represent about 3 percent of the nonprofit agency's 231 employees, said Susan Fuglie, executive director.
Fuglie said three employees will be offered other positions within the organization.
Nine Hospice employees lost their jobs in April 2008 when patient census numbers were lower than expected, she said.
Hospice of the Red River Valley provides end-of-life care to about 1,100 terminally ill patients annually in 29 counties in Minnesota and North Dakota, she said.
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Fuglie said Hospice is not facing serious financial problems.
"This is a preemptive strike," she said. "We are looking for ways to ensure the long-term provision of hospice care in a very rural service area at a time when reimbursement is threatened and the economy is not very stable."
Fuglie said a decline in financial donations also is affecting Hospice.
"Philanthropy is certainly in jeopardy for all of us who are dependent upon donations," she said.
Hospice lost about $250,000 in revenues when many of its patients were evacuated from nursing homes during the 2009 flood, she said.
Hospice of the Red River Valley and a lot of other health care providers are having to make some hard decisions in order to continue providing future care, she said.
"The time to do it is not when we're on the verge of more serious financial problems. The time to do it, and be smart, is now," Fuglie said.
Kathy Hanish, Hospice board president, said she could not comment on Wednesday's actions because the board hasn't met yet this week.
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Hospice of the Red River Valley opened its doors in 1981. Its main office is at 1701 38th St. S. in Fargo.
Hospice also has Minnesota offices at Detroit Lakes and Crookston, and North Dakota offices at Grand Forks, Mayville, Valley City and Lisbon.
