Financing a Palliative Care Program

1. Financing a Palliative Care Program AAHPM January 19, 2005 New Orleans Diane E. Meier, MD Professor, Departments of Geriatrics and Medicine Mount Sinai School of Medicine Director, Center to Advance Palliative Care in Hospitals and Health Systems a Robert Wood Johnson Foundation - Mount Sinai School of Medicine initiative 102504

2. Sources of support for palliative care • Hospital dollars for cost avoidance, and quality, accreditation goals • Clinical revenues- MD and NP billing instructions in The Guide and on www.capc.org • Medical education dollars • Grants, industry • Charitable foundations in your community • Philanthropy

3. 2002 Contributions: $203.45 BillionBy Source of Contribution Corporations $10.86 (5.3%) Bequests $16.02 (7.8%) Foundations $24.50 (12.0%) Individuals $152.07 (75.0%) SOURCE: Giving USA/AAFRC Trust for Philanthropy

4. Why it’s necessary • Clinical income typically inadequate to support core operations • Grants are for specific (usually research) purposes • Hospital support unreliable • Medical school support ditto • Pharmaceutical dollars: perception of and actual conflict of interest

5. Advantages of Philanthropy Dollars • Can be applied wherever needed • 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

6. Why People Give Money • You ask them • They have money to give away • They want to make a difference • They are creating a living legacy • It helps them grieve • It gives them a way to relieve tension • Out of desire for a reliable connection to you • To say thank you

7. 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.

8. 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.”

9. What Influences People to Give • You do. People give to people, not causes. • The program’s leader is usually the best advocate (because the most motivated) and the one who best legitimizes the donor’s interest.

10. It’s all about relationships Location is to real estate as relationship is to philanthropy.

11. 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 $1 million to endow a nurse coordinator position?”

12. Fear of asking You actually have to ask. If you don’t ask they won’t give.

13. 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!

14. No previous expression of interest • 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. Say what you need. Ask if you can follow up with a phone call and secure a time to do that.

15. 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

16. 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 • Multidisciplinary case is a strong approach

17. Asking for a Gift From Individuals: The Solicitation • 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 to consider of a gift of $X • Wait for a response -- Do not speak again • Agree on next steps before concluding

18. Asking for a Gift From Individuals: Donor Responses • Tell us more about the project • Who else is supporting this • The timing is bad • That’s a lot of money • We’re not as wealthy as your other donors • I’m not sure I want to support this project • I need to check with my advisors

19. Intellectual Barriers to Success • 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

20. Personal Barriers to Success • 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

21. From Prospect to Donor:Stewardship • Stay connected • Say “thank you” seven times • Provide annual report on accomplishments • Second-time donors are easier • Stewardship reports become proposals

22. 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.

23. 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.

24. 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

25. Working With the Development Office: Their Role • Providing research • Talking to prospects with you • Writing proposals • Strategizing on the best approach • Writing letters • Writing stewardship reports • Creating brochures and information packets

26. Endowment • The good news: perpetuity, sustainability, security. Your program will be there after you’re not. • The bad news: You get 3-5% of the principal. • Therefore, aim high. A $20 million endowment = $1 million per year core operating budget.

27. Spending money to make money: the back end • Some people hire their own full time or free-lance development staff. Return on investment > 4:1. • Research 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

28. Establishing key priorities • Establish a menu of options with a range of price tags • Endowment: faculty, research, fellowships, patient care, education • Identify other naming opportunities: capitol space/real estate/ identify well-trafficked spots • Create list of immediate needs with prices, range from 25,000 to 5 million

29. Collateral materials • Follow up letter • Annual appeal letter • Brochure • Testimonials • Supporting materials (publications, news articles, video, awards) • List of giving options- the menu

30. High level support • Honorary chair • Trustees • Advisory Board • Executive committee of the advisory board

31. Summary • Fundraising is a big business • 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

32. Diversify • Hospital dollars (the cost avoidance argument) • Clinical income • Philanthropy/endowment • Medical school dollars • Local foundation grants

33. Foundation sources • Local foundations support local talent • Once funded, (nearly) always funded • Commitment to strengthening the community • Identify local foundations with health/aging/family/access focus • Build relationships over time • The Community Trust

34. Fortune favors the prepared mind Good luck!