Community-State Partnerships to Improve End-of-Life Care

An RWJF National Program

From 1997 to 2003, the Robert Wood Johnson Foundation (RWJF) funded a $11.25 million national program called Community-State Partnerships to Improve End-of-Life Care. The program supports the work of state-based commissions and task forces to identify and implement changes in policy and practice to improve care for terminally ill patients and their families.

Groups that received funding formed state and local coalitions with other organizations interested in working on end-of-life care policies, and secured matching funding equal to one-third of their RWJF grant. A total of 24 applicants received grants.

In furthering statewide projects, site staffs worked with hospitals and nursing homes to improve the care of dying patients. Seven sites (California, Hawaii, Kansas, Kentucky, Michigan, North Carolina and Rhode Island) provided some form of training for hospital staffs and administrators in addressing the needs of dying patients and improving the quality of their treatment. Sites in Rhode Island, California and North Carolina similarly educated administrators and staff at nursing homes.

Site staff also worked with project partners to provide or improve education about palliative care to professionals in training and practice. The audiences for this professional education fell into two groups: the academic community including students and faculty; and the practicing professional community who require continuing education.

In conjunction with project partners, site staff worked to increase demand for and access to quality end-of-life care. Staff held community meetings, focus groups and developed materials for health professionals and the general public to educate and excite them about the need for better care at the end of people's lives, such as palliative care and advance care planning.

Project partners distributed educational materials (which sometimes included advance directives such as living wills and medical power of attorney forms) to patients and others, and helped in efforts to simplify state law regarding advance care planning. Project directors realized that not only the general public but also health care professionals are often confused about the purpose of and process for advance care planning.

Finally, project staff aided those in public policy to encourage physicians to prescribe needed pain medication. Participants in statewide projects helped educate legislators about the importance of requiring professional education on pain control.