Having a business model that prioritizes organizational culture can enhance patient and staff satisfaction while fanning the flames of sustainable growth, according to Cadre Hospice CEO Sonnie Linebarger.

Founded in 2024, the hospice startup is a portfolio company of the private equity firm Rubicon Founders and has three locations in Ohio, Illinois and Texas. Each of its location’s geographic service regions span across major metropolitan areas of Chicago, Cleveland and Dallas.

Linebarger has more than two decades in the hospice space. She has served in executive roles at Bristol Hospice, Compassus, Hospice of Arizona and California-based memory care provider Silverado. Linebarger began her career as a registered nurse at Phoenix Children’s Hospital. 

Hospice News recently sat down with Linebarger to discuss Cadre Hospice’s approach to steady growth as the provider unfurls a new palliative care service line and expands its geographic footprint in new markets.

Photo courtesy of Cadre Hospice

What led to the launch of Cadre Hospice?

It was almost more of an intimate idea born out of a vision to return hospice to its roots. So we think that returning to its roots means compassionate, high-touch care while preparing for the future of what hospice looks like. That was the significant element in forming Cadre. We launched in 2024 with Rubicon Founders as our capital partner as a value-oriented provider. We have the opportunity to blend operational excellence with innovation and real soul.

The name Cadre actually signifies the belief in the power of a mission-aligned core leadership team. There’s a number of folks on our team who have provided bedside care. We saw a gap in the market and a real need for a model where culture drives outcomes, where clinicians and our frontline teams feel seen and supported, and where families can receive care that feels professional and profoundly human.

Our team has about 100 years of collective experience under our belt, many who have delivered direct bedside care. That depth of perspective really shapes everything we do.

What is your current service region and breadth of services?

Our foundational service line is the community-based hospice care we currently provide in Chicago, Cleveland and Dallas. And we will be launching palliative care in our Chicago and Dallas within about the next two months.

When I think about the breadth of our service offerings, a lot of what sets us apart is our intention around having a really high-touch model. We actively work to figure out how we can reduce any administrative burdens on our clinicians and frontline team so that they can really be more present at the bedside.

It’s knowing firsthand what it felt like to see your patients and then have additional hours worth of charting to do. We’ve tried to be really intentional about the technology we select and the different systems in place to make sure we’re reducing burdens and drastically reducing the time spent documenting. It’s weaving in the component of technology to support the human side of what we do.

What led you to step into the CEO role at Cadre Hospice in October 2024? What are some of the hospice’s goals?

I started as a hospice nurse, and I’m deeply passionate about that. Our intent is to build something exceptional at Cadre. Intricate details are so important. We had to start where it really matters the most: with our people. If we believe that we want to deliver world class end-of-life care, we first have to be a world class employer. We look for the very best people and take great care of our people so that they can take great care of our patients. That’s the foundation.

Future goals for us are thoughtful expansion into high-needs markets. We are using data and leaning into cultural market intelligence to really tailor services around what that community needs. You can look at markets all over the country, and every single one has a unique element to it. It’s researching and figuring out from a data perspective and also culturally how we fine tune our services in each market.

We evaluate different markets based on a filter that runs about 15 metrics deep. There can be lots of elements of metropolitan areas that are underserved. So it’s learning whether this is a hospice- or palliative-rich or poor area. On top of that, we screen for open positions with conversation that is specific to the cultural needs in that market. We are creating a company almost like a resource library to really support a number of different cultural and religious observations. We do a lot of homework when it comes to hiring teams that bring a lot of diversity and rich knowledge to best serve a population.

Also, with our new palliative care line, we have been for a good period of time really building relationships with value-based care partnerships. It’s been with the goal of having some really early conversations to figure out what might be the biggest pain points for those large, at-risk providers. Because we can’t solve what we don’t know about the challenges.

It’s getting very curious and trying to help uncover a number of things, whether it’s driving earlier access or better outcomes. How do you do that is by working with the community of value-based and at-risk providers to filter out their patient populations and put triggers in place that help identify when patients are appropriate for palliative or hospice services. That becomes very valuable to improve patient engagement, earlier identification and receiving care in a timely manner. It’s a cost-saving side for the health systems to show there’s many opportunities that fall through the cracks.

What do you see as the largest challenges facing today’s hospice providers? How are you navigating through these challenges?

Workforce shortages and burnout are real, and it doesn’t matter what market you go into. At Cadre, we combat that by really investing heavily from a culture perspective, from coaching and ongoing leadership development.

We are fostering the emotional resilience side of our work, because the burnout doesn’t necessarily just come from a high caseload. Burnout comes from repeatedly caring for people who are passing away in their final chapter of life. That can be really emotionally taxing on our frontline. So we have to think about not only the shortage, but how we support and foster people once we bring them in.

We build this into our budget to have comfortable, safe space and room for people to physically, emotionally and psychologically decompress. It’s being able to refill your cup and continue with the mission that we’re doing in end-of-life care.

What are some of the important components to sustainability and thriving in the current hospice and palliative care landscapes?

We are working with boots on the ground to continuously educate our team members and ensure they understand front-to-back all of not only the regulations, but also what [accreditation organizations] are looking for. We weave in multiple elements of compliance when it comes to the regulatory landscape. We do mock surveys in every location.

It’s important for people to understand the dollar impact noncompliance can cause and the value of that mistake being absorbed. That is a really deep lesson and investment in educating our team of what happens when things go right and what could happen when things go wrong.

One of the biggest things to sustainability that I have seen in my experience is the lack of financial and operational literacy. That literacy among middle management, leadership and all staff is really important to everyone understanding the why behind our work. It’s taking onus on how their role influences or impacts financials and gives a higher sense of responsibility. The opportunity to look at the number can help drive the health of the business and help staff make really good decisions or avoid really bad decisions.

How do you define successful growth?

I think successful growth looks like expanding with your people, not ahead of them. It’s laying the pavers for continued growth and development of our people. That is the fabric of leading a company, consistently figuring out what’s fundamentally important to our people and taking the time to have conversations with them.

Successful growth looks like quality, culture and satisfaction from our patients and their loved ones that always remains uncompromised so that our communities trust us. If we can build that trust in our communities through end-of-life experiences, that changes the way people view hospice and Cadre. If we have a successfully growing company, our people thrive.

Growth is not just about numbers; it’s about alignment and integrity being woven into the fabric of your company.

How would you describe Cadre Hospice’s strategic growth strategy? How does Cadre Hospice fuel its strategic plans?

We’ve got one office in each of our three locations. And that will be rapidly growing. Our approach right now as a brand new company now is using a de novo model and planting flags in new markets.

Our strategy thus far is multitiered. We are planting offices in these really well-versed, identified markets and going through different filters of data to support our de novo strategy. We are creating those models from the ground up and ensuring we can replicate that DNA of compassion, leadership and excellence as we closely evaluate new markets.

It’s also evaluating are there any opportunities that come along and align with both our strategic and cultural priorities? Having had a lot of experiences in M&A, I’ve seen things that go right and things that go wrong. Those are lessons communicated to my team and built into what we look for in a partner that we would potentially acquire to make sure they’re a really good fit for future opportunities. It’s definitely on the organic side. There’s also always opportunities to buy additional assets if the foundation is built right.

Do you have plans to expand in the near future?

We will be launching next in Indianapolis, Minneapolis and Kansas City, Kansas, before the end of the year.

It’s having a hub-and-spoke model of how we expand reach across multiple markets. In our initial year thus far we are targeting six de novo sites. We will increase this as we look into 2026 and beyond. It’s continuing to build out that footprint and right now looking at a little bit more of a regional consolidation in the short term. Long term, we really look to be a national provider.

You’ve highlighted in social media the importance of leadership engagement with hospice and palliative care staff as well as organizational culture development. Can you elaborate on your approach to staff engagement and culture at Cadre Hospice? How do these approaches impact quality, staff satisfaction and retention?

If you’re boldly sharing what your organization’s vision is with people, they want to be a part of it and help breathe life into it. That makes people excited to get behind and help move whatever boulders out of the way.

People are our very first pillar, we are a very people-centric company. Engaging with team members allows me to get to know them and their onboarding experience right out of the gates paints a picture of whether or not someone will be with us for years to come. That investment shifts the conversation to relatability when we stay close to our team members. It shows the human side of our leadership and gives us authentic communication. When people are more engaged, they perform better and serve our patients deeper.

Communication, connection and culture are the three Cs in recruitment and retention. When you have the connection, the community is equally as important as how we lead and show up. The little things that are extra meaningful investments in our team and people. We really allow our teams to show up as their whole selves.