Silverstone Hospice Leverages Volunteerism to Grow Workforce

Silverstone Hospice has a growing presence in its home state of Texas. The company emerged last year with the acquisition of Comfort Care in the Dallas-Ft. Worth market. Since its inception, Silverstone has been built on a foundation of volunteerism. A number of staff, including CEO Alfonso Montiel, first came to the hospice industry through volunteering.  

Under the Medicare Conditions of Participation, volunteers must account for 5% of a hospice provider’s patient care hours. Some hospice providers consider volunteers to be a member of their interdisciplinary care teams along with nurses, chaplains, social workers, the medical director, and other professionals.

“Volunteering with my first patient, who was named Harry, is something I will never forget. It led me into saying, ‘I want to do it again.’ That’s when I thought about buying a hospice company,” Montiel told Hospice News. “That’s why I called myself a volunteer CEO, because it became part of who I am.”


Prior to Silverstone, Monteil established a $150 million private equity hedge fund, worked in strategy development for Fortune 500 companies and was CEO of the charitable organization the Lemon Tree Trust.

The nation’s 420,000 trained hospice volunteers generate more than $469 million in annual savings for hospice providers while administering and supporting essential services for patients, according to the National Hospice & Palliative Care Organization (NHPCO).

Hospice volunteers provide more than 19 million hours of service annually. The estimated financial value of a hospice volunteer’s time is an estimated $24.69 per hour, NHPCO reported.


Silverstone’s Director of Operations Nischelle Reagan also came to hospice initially as a volunteer during her college years. She participated in an organization that paired students with volunteer opportunities in the local community and was contacted by a hospice volunteer coordinator.

Reagan’s attraction to volunteering began with her childhood experience of helping care for her grandmother who ultimately received hospice care.

“I saw my mom take care of her in our home. Being able to be a part of the experience with the loved one being in the home as she transitioned into her passing, it felt to me like it was something that I wanted to explore more,” Reagan said. “There was something about that experience that drew me to want to dig into hospice a little more and be able to be there for folks at the end of life.”

Silverstone has hit upon a strategy of bolstering its paid workforce by fostering volunteerism. Staffing shortages have been weighing heavily on the minds of hospice and palliative care organization leaders in recent years. More than 35% of hospice leaders surveyed by Hospice News and Homecare Homebase earlier this year cited staffing shortages as a top concern for their organizations, along with regaining access to patients in facilities.

Initial training for volunteers involved in direct patient care can include education on the hospice philosophy of caring for the patient’s whole being (physical, social, emotional, spiritual) as well as supporting the patient’s family. They also learn communication skills; background on the types of diseases that are common among hospice patients, safety issues and precautions, and a range of cultural beliefs about dying. Volunteers helping with back office work also need to understand the company’s procedures and workflows.

Reagan began her tenure at Silverstone as a volunteer coordinator. During that time she recruited several volunteers who went on to become full-time employees. Among them was triage nurse Christina Germaine.

Germaine decided to volunteer with patients while she was working in the records department of a small hospice provider. The experience inspired her to become a nurse. After spending a number of years in the hospital setting, she came back to hospice.

Germaine told Hospice News that her time volunteering informs her current work as a nurse.

“I believe that volunteer experience allows me to stay mindful that we are treating the whole person, not only symptoms, not just immediate needs and not clinical data,” Germaine said. “Hospice truly does incorporate the care of the whole person.”

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