Assessing Investments in Palliative Care
Challenge
An aging U.S. population is increasing the need for serious illness and end-of-life care.
As the U.S. population ages, more patients are exhibiting chronic conditions and medical and functional complexity, thus increasing the need for high-quality, person-centered care that supports their health and well-being. In 2015, the Institute of Medicine’s Dying in America report highlighted major challenges in serious illness care, including limited awareness of advance care planning, inadequate clinician training, insufficient policies and payment models, and structural barriers for marginalized communities.
In response to the article and growing needs in the United States, The John A. Hartford Foundation (JAHF) launched its Serious Illness & End of Life priority area in 2016. Since then, JAHF has awarded over $19 million in grants to 21 initiatives aimed at improving care for those living with serious illnesses and individuals approaching end of life. As JAHF nears 10 years of grantmaking in this priority area, it commissioned NORC to conduct an assessment to understand the impact of the priority area.
Solution
NORC conducted a mixed-methods assessment of the John A. Hartford Foundation’s Serious Illness & End of Life grants.
To assess the Serious Illness & End of Life priority area, NORC used a three-phase, mixed-methods approach between August 2024 and January 2025. We reviewed existing program documentation from all 21 grants to understand their scope, strategies, and outcomes. This review informed the development of an impact framework that identified five shared outcomes and program metrics across the priority area. The five shared outcomes identified are:
- Increasing access to services through sharing best practices
- Preparing the health care workforce through training
- Influencing public discourse through community engagement and messaging
- Informing public policy through research, recommendations, and technical assistance
- Increasing collaboration and partnerships through network building
The impact framework includes summary statistics demonstrating the collective reach and impact of the grants. We collected qualitative insights through surveys and interviews with 15 organizations, including grantees, subgrantees, co-funders, and JAHF staff. These perspectives provided nuances and individual experiences that complement the quantitative data.
Result
JAHF’s grantmaking helped shape the field of serious illness and end-of-life care.
The assessment found that JAHF’s grantmaking built and supported a robust, collaborative network of partners across health care, policy, communications, and philanthropy. Acting as a convener and catalyst, JAHF unified a traditionally fragmented field around shared goals and a common direction. Grantees identified JAHF’s long term commitment, mission alignment, flexibility, and active engagement as driving factors in advancing efforts in serious illness and end-of-life care.
The assessment identified findings across the five shared outcomes:
- More than 2,000 practitioners received direct technical assistance, and more than 150 resources were developed to increase access to care.
- Over 88,000 clinicians were trained in best practices and approaches to palliative care.
- More than 370,000 individuals were reached through engagement efforts, and learning was shared through thousands of presentations, webinars, conferences, podcasts, blogs, and articles.
- Policy was advanced in 14 states, and research was used to inform policy recommendations at the federal level.
- Nearly 200 organizations were brought together to advance efforts, including health systems, universities, funders, patient organizations, disease groups, community-based organizations, and policy groups.
