A new hospice provider has emerged in Oregon and is seeing strong staff and patient satisfaction. Solterra Hospice’s success has come from integrating a retention strategy that prioritizes mental health and employee-driven innovation.
Solterra Hospice launched late last autumn and has a geographic service region that spans a 60-mile radius around Salem, Oregon. The hospice began serving patients in November 2024 after receiving regulatory approval, and later became Medicare- and Medicaid-certified in May.
The organization’s sustainability approach places interdisciplinary care teams at the forefront of growth and service development, according to Christie Rivelli, hospice nurse practitioner and administrator of Solterra Hospice .
“We have experienced hospice team members, and we’re trying to give anyone who has the interest and passion for hospice a place to grow,” Rivelli told Hospice News. “We have slowly been bringing on our clinical team, many of whom we have worked with for years, creating a new, safe space for them to be able to do the beautiful work that I believe hospice is meant to be. It turns out, when you have a model that values your care team, it’s not so hard to find great staff. Sustainability seems to be the easiest part of our plan.”
Putting staff in the driver’s seat
Solterra Hospice’s average daily census hovers around 25 patients. The organization’s 18 hospice interdisciplinary care professionals have served a total of nearly 60 patients since its launch.
Leaders of family- and locally-owned Solterra Hospice include John Vaughn, co-owner and Rivelli’s husband, as well as Dr. Chris Eilersen, hospice medical director, and his wife and co-owner Linda Eilersen. Rivelli and Dr. Eilersen worked for a large hospice provider for nearly a decade before forming a program with their spouses.
Solterra Hospice was developed in large part due to a growing need for a program that focuses on staff well-being alongside patient care, Rivelli indicated.
The hospice provides community-based care wherever a patient calls home. In addition to hospice, the organization has a dementia care program, Solterra Sunset. Designed by the hospice’s staff, the program is designed to provide nursing and health care visits to patients with dementia-related conditions during “sundowning” time frames in the evening, when physical and emotional symptoms often worsen and need higher levels of attention.
The organization offers speech, massage, occupational and physical therapy, as well as bereavement. Solterra Hospice also operates a We Honor Veterans program and a “bridge” program, which provides informational visits and monthly check-ins for terminally ill individuals and their families seeking additional support.
Solterra Hospice’s approach to growth and service diversification is fueled by insight from its employees, Rivelli said.
The organization’s recruitment strategy has centered around hiring hospice professionals with several years of experience in the field. Its chaplains, nurses, physicians and social workers each bring decades of not only bedside experience, but also innovative ideas in terms of what services could help improve person-centered care and quality, Rivelli said.
“We are lucky to have a group of people so driven to provide care,” she said. “Having experienced hospice nurses, social workers and chaplains [who] all have ideas that are amazing – they have been helping to drive processes like our veterans, dementia and bridges programs. A lot of our program ideas and other things come from quarterly vision and feedback meetings with all of our team.”
Future goals for Solterra Hospice include expanding its facility-based service reach. The hospice was recently approached by a large long-term care facility referral partner to establish a seven-patient unit at its campus. Currently in development and construction stages, the hospice unit will allow for greater care collaboration, coordination and transitions of care, Rivelli indicated.
The hospice is also exploring the potential to expand its bereavement program and explore heart failure services, she added.
Fostering supportive innovation
Consistent staff engagement and transparent communication are key to understanding the significant barriers that can hinder strong retention, Rivelli.
Each of Solterra Hospice’s quarterly organization-wide meetings engage all staff and include open conversations about its programs, operations, challenges and financial situations. Employees are invited and encouraged to weigh in and provide thoughtful feedback. This strategy has resulted in a more dedicated and invested hospice workforce, as well as more person-centered care approaches, she stated.
“The sustainability piece here is [in part] our meetings. It’s where we have an opportunity for staff to hold us accountable and make sure we’re following that guiding light of why we’re all here,” Rivelli told Hospice News. “It’s making sure that as we’re moving forward we’re not taking anything for granted, and that the vision of the whole team and input is being put in motion as well. It’s trying to get a lot of opportunities for them to weigh in on the future. We remove role-specific constraints and work as a whole team, so it’s being really transparent with them, even about the financial numbers.”
Focusing on wellness and well-being are strong suits in a hospice’s recruitment and retention models, according to Rivelli.
Burnout and compassion fatigue have served as significant challenges amid widespread staffing shortages in the hospice space and across the care continuum. The COVID-19 pandemic exacerbated these labor issues, with some hospices seeing long-term impacts on retention due to rising demand and limited workforce resources.
Operating with fewer resources can take a heavy emotional toll on hospice clinicians, Rivelli said. Having a balanced clinical capacity can make or break a hospice’s sustainability trajectory, she indicated.
In some larger hospices, nurses take on 30 patients in their clinical rotations, with chaplains and social workers seeing upwards of 70 cases. This stressful caseload volume prioritizes productivity and profit over people and results in high turnover, Rivelli said.
Burnout issues were a significant driver in Solterra Hospice’s founding, she stated.
“The biggest item that we are committed to is keeping nursing caseloads at 10 or less, with chaplains and social workers staying at caseloads of 30 or less,” Rivelli said. “We want to provide a space that allows for some down time in the day, it’s so important with hospice care. There can be a lot of emotion and some days can feel pretty heavy, so we want to allow time between visits to decompress a bit. With low case loads, we see satisfaction surveys shift, retention shift and a team that focuses on patients first and leadership that focuses on our team. That all flows forward.”
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