Since the downturn in 2008, we at the Hartford Foundation have had the incredibly frustrating experience of not having money for new grant programs amid what seems like a smorgasbord of opportunities to make an incredible impact on the health of older Americans.
We of course had faith in what we funded back in 2008, so we have been mostly working to pay our prior commitments and build grantee and our capacity for sustainability and impact. I am really proud of this work: the painful but necessary process of rightsizing our commitments and managing our cash flow, the furious efforts to draw in other funding and build grantee capacity, and the vigorous attempts to be sure that every drop of value from our grantees’ work is included in health reform and workforce considerations. The latter drives our communications efforts, such as the blog itself.
But now, in the absence of any major market changes, by 2013 we will have fulfilled our commitments and will be looking at about $100,000,000 to spend through new grants in the five years 2013-2017. To do this really, really well, we need all the help we can get. I want to use this post as an open invitation for our grantees, stakeholders, peers, and older persons themselves to offer suggestions about how we can make the biggest difference in the lives of older adults. We continue to believe that health professionals (physicians, nurses, and social workers) and service delivery models are important, but we should go back to first principles and think about the actual challenges faced by older adults. As stewards of the Foundation’s money, holding it in trust for the benefit of society, we are obliged to think carefully about how the money can be best put to use to help the most people.
Now, one of the truths about philanthropy is that it is easy to give away money in ways that are socially approved and plausibly related to real change, but that do not actually have any game-changing impact on the real lives of beneficiaries. For example, with this money we could endow 50 health professions school chairs in geriatrics and gerontology. They could all have the Foundation’s name on them, and they would no doubt be filled with excellent people who would do excellent work. However, how exactly is that idea linked to our mission of improving the health of older adults? How much improvement in the health of the population we care about would spending that $100 million on chairs achieve over those five years, the subsequent five years, etc.? Or, we could use that money to pay for in-home long-term care services for a year each for 2,000 people (assuming an average cost of $50,000 each). But, at the end of those five years the money would be gone and those needs would remain. Would we have missed our chance to make more fundamental change?
These two examples represent extreme cases of upstream (chairs) or downstream (direct service provision) giving, and neither is on the menu for us. Nevertheless, they represent the kinds of issues we need to think through as we plan for our return to giving.
I’ve laid out the steps in our strategic planning process with our board of trustees. Here’s how we expect to work through the issues over the next nine months:
December 2011:
1. Understand the nature of the problem; i.e., what do we mean when we think about “aging and health?”
2. Look at the current and emerging forces that seem likely to impinge on this vision (e.g., health care information technology, consumerism, payment reform).March 2012:
3. Opportunities: Growing out of 1 and 2, we should be able to work out what kind of grantmaking seems most likely to address the needs as we understand them in the current environment. Examples from our current work include faculty development, curricular innovation, and developing and testing service innovations.
June 2012:
4. Means and Resources: How do we need to be staffed to do this work, what should our measurable goals be, and how should we allocate funds among opportunities for the most impact? For example, we currently target most of our funds to education: about 36% in medicine, 24% in nursing, and 20% in social work. The other 20% goes to our integrating and improving services portfolio.
The first step, then is to discuss the nature of the problem of health and aging and the broad societal forces that seem likely to be relevant. What do you think? At this stage we are not looking for ideas for particular projects, but rather a definition of the problem and the macro forces that might impinge on it. I think many disagreements about strategy stem from different understandings of the nature of the problem at hand. Later, in 2012 and 2013, we will need specific grants, but right now we need definitions.
P.S. I know that commenting publicly can be difficult for many grantees and people, but posting comments here is most helpful to us; we could really benefit from discussion among our audience as well as just with us. You are always welcome to post a comment anonymously (just leave the e-mail and website fields blank). However, if you are too uncomfortable, you can also e-mail directly.