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Funders across the nation have helped to launch and support community-centered approaches to address a wide range of issues.

For patients and their loved ones, no care decisions are more profound than those made near the end of life.

That was the conclusion of the expert panel that wrote the landmark 2014 report, Dying in America, for the former Institute of Medicine (now known as the National Academies of Sciences, Engineering, and Medicine). Sadly, the care people want at the end of life is far too often not the care they receive. This disconnect represents one of the most serious gaps in our health care system.

In recent years, grantmakers have been working to close that breach. Here are some examples of the important work they have been advancing:

Across the country, there are many innovative programs that have demonstrated their ability to improve the care of older adults facing serious illness and end of life. But they have lacked the ability to scale their models to the level needed to transform the health care system. A $3.5 million, three-year grant from The John A. Hartford Foundation is helping six innovative national models to create a shared vision for collective action, and identify practical steps to accelerate national scaling of their efforts—increasing access to more than 300,000 older people—through the development of a coordinated strategy aimed at sustained national impact. The University of Washington’s Cambia Palliative Care Center of Excellence is the coordinating center for the grant.

Advance care planning is a crucial step toward making sure our wishes regarding the care we want during serious illness or end of life are respected and followed. Yet, a quarter of older Medicare beneficiaries have not documented their advance care planning wishes, according to a study by researchers at the University of California, San Francisco (UCSF). To make the planning process less intimidating and more user-friendly, a team of UCSF researchers developed PREPARE For Your Care. The website is designed to take users through a brief, easy to understand, five-step process that doesn’t rely on clinician input for someone to note their medical care preferences. After completing the process, people have a unique, printable document they can share with their family and clinicians. The Gordon and Betty Moore Foundation awarded a $650,000, three-year grant to PREPARE to help it build on its initial work with California’s advance directive and expand to provide easy-to-read, culturally appropriate, evidenced-based advance directives for all U.S. states.

The Conversation Project is a national public health campaign dedicated to helping people talk about their wishes for end of life care. In Buffalo, NY, the Health Foundation for Western & Central New York awarded grants totaling $40,000 to help Erie County Medical Center deepen its work with its local Conversation Project, a community-based collaborative and integrated organizational model of advance care planning in a high-risk Buffalo community.

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