Transcript Plenary 4 - IUPUIScholarWorks Repository

Palliative care:
Now what?
Diane E. Meier, MD, FACP
Director, Center to Advance Palliative Care
Mount Sinai School of Medicine
New York, New York
Chicago
11.04.06
www.capc.org
Sources of support for
palliative care: Diversify
• Hospital dollars for cost avoidance, and
quality, accreditation goals
• MD and NP Billing: Clinical revenues
• Medical education dollars
• Grants, industry
• Charitable foundations in your community
• Philanthropy
www.capc.org
2004 Contributions: $248.52 Billion
By Source of Contribution
Bequests
$16.02 (7.8%)
Corporations
$10.86 (5.3%)
Foundations
$24.50 (12.0%)
Individuals
$152.07 (75.0%)
www.capc.org
SOURCE: Giving USA/AAFRC Trust for Philanthropy
Why it’s necessary
• Clinical income typically inadequate to
support core team operations
• Grants are for specific (usually research)
purposes
• Hospital support unreliable
• Medical school support ditto
• Pharmaceutical dollars: perception of and
actual conflict of interest
www.capc.org
Advantages of Philanthropy
Dollars
• Can be applied wherever needed
• Builds reputation and support in the
community
• Less likely to create appearance of conflict of
interest
• Available in most communities
• Available to academics and non academics
alike
• Pays for what nobody else wants to pay for
www.capc.org
Why People Give Money
• You ask them
• They have money to give away
• They want to make a difference
• To say thank you
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They are creating a living legacy
It helps them grieve
It gives them a way to relieve tension
Out of fear
www.capc.org
Philanthropy and Palliative Care
• Everybody gets it, everybody cares about
it, everybody has a powerful story.
• Genuine desire to contribute to improving
the experience for others.
• Your need is real and easy to justify.
• Families and patients are grateful and
want to express it in real terms.
www.capc.org
Approaches
• If somebody asks you how they can help,
tell them.
• When somebody wants to know why you
work so hard, tell them.
• Ask for support. “I hope we can count
on you to help us build this important
program.”
www.capc.org
What Influences People to Give
• You do. People give to people, not
causes.
• Relationships are all.
• The program’s leader is usually the best
advocate (because the most motivated)
and the one who best legitimizes the
donor’s interest.
www.capc.org
It’s all about relationships
Location is to real
estate as relationship
is to philanthropy.
www.capc.org
Making contact
• After an offer or an indication of interest:
“Now that we’ve spoken a little bit, I hope you’ll think seriously about
supporting our program. Can I call you in a couple of weeks to follow up on
our conversation and perhaps get your answer?”
• Make the call when you said you would. If you
set up a time to call, call at that time, on time.
Respect people’s time. They’re busy too. If
you’re working on a large gift, several contacts
are likely to be necessary. Let the person speak
and ask you questions. Then,
• Ask for money. “Would you consider a gift of $100,000 to
support a nurse coordinator position?”
www.capc.org
Fear of asking
You actually have to ask. If
you don’t ask they won’t
give.
www.capc.org
How to think about it
• Your cause is good.
• You are not asking for yourself (even though it
feels like it).
• You and the donor are united in your common
concern about care of the seriously ill and dying.
This is an opportunity to really make a
difference in a lot of people’s lives.
• Establish your credibility. Show seriousness of
purpose, be firm, positive, self confident. Don’t
be cowed!
www.capc.org
The Case For Palliative Care
• All people deserve relief from suffering at
every stage of life
• Palliative care supports the patient and
the family
• Palliative care is the gold standard way to
approach care of persons with advanced
illness
www.capc.org
From Prospect to Donor:
Making the Case
• Mention the many ways a gift can be
made (check, stock, pledge, bequest,
trust, etc.)
• Mention other donors
• Summarize importance of gift
• Share your personal beliefs
www.capc.org
Asking for a Gift From Individuals:
The Solicitation
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Conduct solicitation in comfortable setting
Decide on best solicitor(s)
Frame and focus your introduction
Discuss benefits and the vision of a gift
Ask the prospect for a gift of $X
Wait for a response -- Do not speak again
Agree on next steps before concluding
www.capc.org
No previous expression of
interest, a sample approach
• Call and tell the secretary who you are and that you
need to speak to Mr. Jones for 3 minutes. You’ll get
through.
• Tell Mr. Jones that Mr. Smith suggested he might be
interested in your program and you’d like to tell him
about it to see if you can engage his support. Ask if you
can make an appointment to see him. Show up on
time. Send materials in advance.
• Be business-like, polite, brief, and leave on time at the
end of the appointment. Introduce your cause and let
them tell their story. ASK (Say what you need). Do not
speak until Mr. Jones does. Ask if you can follow up with
a meeting in a week and secure a time to do that.
www.capc.org
Intellectual Barriers to Success
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Not making the case clearly
Not showing need
Asking for too much or too little
Not having done the right research
Not showing or defining success
Not having engaged prospect during
cultivation
• Not timing solicitation properly
www.capc.org
Personal Barriers to Success
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Seeing fundraising in a negative light
Fearing rejection
Feeling inadequate to receive support
Feeling uncomfortable with wealthy
people
• Not having/projecting positive self image
• Not feeling part of success
www.capc.org
Stewardship
• Keep in touch by mail, by phone, and in
person. It’s you they’re giving to. Try to
engage your donors as advocates, ask if
they’d like to join your board, ask for their
help in securing the financial sustainability
of the program by helping you to make
other contacts with people who might be
concerned about this issue.
www.capc.org
The Development Office
• The good news: They’re professionals
at this. They know people. They have
infrastructure (help with proposal writing,
research on potential contributors,
stewardship).
• The bad news: They have a lot of
competing obligations.
www.capc.org
Working With the Development
Office: Our Role
• Provide background information on
prospect
• Present specific request for help
• Use lay language
• Be prepared to negotiate among
competing requests
• Be the squeaky wheel
www.capc.org
Working With the Development Office:
Their Role
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Providing research
Talking to prospects with you
Writing proposals
Strategizing on the best approach
Writing letters
Writing stewardship reports
Creating brochures and information packets
www.capc.org
Endowment
• The good news: perpetuity, sustainability,
security. Your program will be there after
you’re not.
• The bad news: You get 5% of the
principal.
• Therefore, aim high. A $20 million
endowment = $1 million per year core
operating budget.
www.capc.org
Spending money to make money:
the back end
• Some people hire their own full time or freelance development staff. Return on investment
> 4:1.
• Research and cultivate potential contributors
• Establish a database of grateful patients and
their families, past donors, conference
attendees, friends, family foundations,
corporations, community foundations
• Record all contacts, track status, follow-up
• Assure stewardship
www.capc.org
Collateral Materials
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Follow up letters
Annual appeal letter
Brochure-Newsletter
Testimonials
Supporting materials (publications, news
articles, video, awards)
• List of giving options- the menu
www.capc.org
High Level Support
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Honorary chair
Trustees
Advisory Board
Executive committee of the advisory
board
www.capc.org
Summary
• Fundraising is a big business
• All successful not-for-profits have figured
this out
• Most money is generated from individuals
• Relationships are key
• Being positive and personally committed
is the real secret
• Use the development office to your
advantage
www.capc.org
Diversify
• Hospital dollars (the cost avoidance
argument)
• Clinical income
• Philanthropy/endowment
• Medical school dollars
• Foundation grants
www.capc.org
Foundation Sources
• Local foundations support local talent
• Once funded, future funding easier
• Commitment to strengthening the
community
• Identify local foundations with
health/aging/family/access focus
• Build relationships over time
• The Community Trust
www.capc.org
Fortune favors the
prepared mind.
Good luck!
www.capc.org
www.capc.org
Take-home principles
Define palliative care using National Consensus
Project language:
Palliative care expands traditional disease-model medical treatments
to include the goals of: enhancing quality of life for patient and
family, optimizing function, helping with decision-making and
providing opportunities for personal growth. As such, it can
be delivered concurrently with life-prolonging care or
as the main focus of care.
Align messages- with the mission and concerns of key decision-makers and
other audiences
Measure- both for quality and to justify your existence
Finance with a diversified portfolio- There is funding for this type
of care.
Many ways to get there so start somewhere: Examples
presented not intended to cover every setting. Borrow what fits, leave what doesn’t.
An imperfect program is much better than no program. Build and grow from there.
www.capc.org
More Take-Home Messages
• Identify and overcome barriers
• Get educated about the clinical aspects of
palliative care
• Don’t waste time re-inventing the wheeluse CAPC resources.
www.capc.org
Common barriers to getting started
(in addition to money)
• “I don’t know enough about palliative
care.”
• “There’s no one here with the necessary
training.”
• “I don’t have time.”
• “Our doctors will never refer.”
• “We just keep having meetings but
never seem to actually get started.”
www.capc.org
“I don’t know enough about
palliative care.”
• Get training (EPEC, ELNEC, DELeTCC, AAHPMHPNA, Harvard advanced courses)
• Subscribe to the J of Palliative Medicine. Get
the Oxford Textbook of Palliative Medicine
• Do a clinical site visit (list of places accepting
visitors is on the website)
• Take a year off and do a fellowship (AAHPM
website) or an APN (HPNA website) degree
program
www.capc.org
Education is Not Optional
Training opportunities
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ELNEC
www.aacn.nche.edu/elnec
EPEC
www.epec.net
EPERC
www.eperc.mcw.edu
AAHPM
www.aahpm.org
Harvard
www.hms.harvard.edu/cdi/pallcare/
Fellowship training www.aahpm.org
APN palliative care training programs,
ANCC certification
www.hpna.org www.nursingworld.org
• MD Certification: ABHPM
www.abhpm.org
• Clinical site visiting programs: www.capc.org/palliative-careprofessional-development/Training/index_html#clinical
• Web resources
www.palliativedrugs.com
www.growthhouse.org
www.capc.org
www.stoppain.org
“I don’t have time.”
• Think about what you really want to do with
the rest of your professional life. The highest
priorities should get the time.
• Rotating core team of docs and nurses- take
turns.
• Recruit help from outside- call leaders of APN
programs, contact fellowship training
programs.
• Retrain or cross-train existing interested staffhospitalists, oncologists, geriatricians, retiring
MD leaders, APNs.
www.capc.org
“Our doctors will never refer.”
• Identify and empower opinion leaders, MD + RN
champions
• Start slow, lead through competence, availability,
word gets out
• Focus energy on the low hanging fruit, not the
curmudgeons
• Critical mass>rising demand
• Audience-specific marketing, survey docs on their
needs, referring MD is the client
• Patience, persistence, eyes on the prize
www.capc.org
“We just keep on having meetings but
never seem to get started.”
Visit a Palliative Care Leadership Center
Hands-on training and tools to jump-start
your program:
“The program made all the difference. Because of what
our hospital staff learned, our palliative care program
now has more patients, a larger budget, and much more
legitimacy through out the hospital. It really helped to
have a leader in the field behind our efforts.”
Erin Rhatigan, RN, HPNC
Community Hospital Monterey Peninsula
www.capc.org
Advice to local champions:
Just do it!
“Remember, it’s better to beg
forgiveness than to ask permission…
When you begin you just start doing it.”
www.capc.org
von Gunten J Pal Med 2000;3:115-122.
CAPC Resourcesno reinvention of the wheel
• National seminars
• Palliative Care Leadership Centers
• Publications: The Case; The
Guide
• Website
www.capc.org
Palliative Care Leadership Centers
• Hands on training and tools to fast -track
your palliative care program
• Six exemplary palliative care programs
serve as visiting and training sites for
new program leaders: at 2 yrs. post
visit, 60% success rate.
• Visits scheduling through 2007.
• Information and registration on
www.capc.org
www.capc.org
www.capc.org
• The CAPC Impact Calculator
• Register for the Palliative Care Leadership Center training
• Full text of national meeting presentations and appendices,
downloadable PowerPoint
• CAPC publications in PDF format
• Spread sheet financial templates, cost avoidance analyses
• Needs assessment tools and forms
• Standardized progress notes, billing cards, orders, care pathways
• Position descriptions, staffing models
• Program models
• Marketing tools, brochures
• Billing strategies
• Alternate funding sources via philanthropy, foundations
• Case studies
Call or email us if you can’t find something.
www.capc.org
CAPC Projects: Palliative Care
Guidelines
National Consensus Project on Quality
Palliative Care: Essential Elements
and Best Practices Guidelines
downloadable or ordered @
www.nationalconsensusproject.org
National Quality Forum Framework for
Hospice and Palliative Care- 2006
www.qualityforum.org
www.capc.org
Is all of this having any impact?
• 2004: >1102 hospital based palliative care
programs in the U.S.
increase since 2000
(2006 AHA annual survey),
74%
• 2004: 70% of COTH-member teaching
hospitals report a palliative care
program (2006 AHA annual survey)
• 2006- 2146 MDs now ABHPM-certified
in palliative medicine.
www.capc.org
Our healthcare system is
wealthy…
• In the skill and commitment of its
professionals
• In the privilege and rewards of the work
• In the strength and capacities and
gratitude of patients, families, and
communities
www.capc.org
Evaluations
• Tell us what else you need
• Tell us what we could be doing differently
• We really want your feedback so we can
help you start and sustain your palliative
care program
www.capc.org
Thank you
www.capc.org
Foundations: $25-100,000
Know your local foundations in your community.
Build relationship.
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Local private foundations: The Community Trust
Grantmatch: www.grantmatch.org
The Foundation Center: www.fdncenter.org
Philanthropy news network online
Grantmakers in Health: www.gih.org
Grantmakers in Aging:
www.giaging.org/links.htm
• Medweb: www.medweb.emory.edu
www.capc.org
Foundations, cont’d.
• The Foundation Center: Grants for hospitals,
medical care, and medical research
• FunderSearch: Corporate funders that support
hospitals, medical centers and clinics. Corporate
Giving Watch 2000;19:17.
• Hospice Foundation of America:
www.hospicefoundation.org
www.capc.org
Foundation sources
• Regional Associations of Grantmakers:
http://www.givingforum.org/
• http://foundationcenter.org/
www.capc.org