Volume 23, Number 4: April 2022
An architect’s rendering of the Grace House Akron project. Supplied by Grace House Akron. Used with permission.
From Here to a Glorious New There: A Roadmap to Develop Your New Facility
By Holly Klein, Cofounder and Executive Director, Grace House Akron; and
Dr. Steven “Skip” Radwany, Medical Director, Grace House Akron
We hope to describe below the roadmap for undertaking a major project as part of your hospice or palliative care program. Examples of such a project might include a new facility to house your team members who are working in the field visiting patients, a freestanding inpatient facility for hospice patients, or a new inpatient facility embedded within an existing hospital.
Most of you have already gained valuable experience in such efforts and may have much more to say. And many books have been written on each of the subheadings below. Nonetheless, our report offers a basic checklist to help you think, assess, and reassess as you proceed.
The two of us have worked together and independently on several major projects. For this article, we draw upon our most recent experience building a residence for homeless hospice patients, Grace House Akron (GHA), in Akron, Ohio. Akron is a medium-sized metropolitan area of about half a million people in the upper Midwest of the USA. Our leadership team for GHA is simultaneously developing a comprehensive handbook with templates, protocols, and guidance for other communities that hope to undertake such a project.
Define your community’s needs
Looking at your community, ask yourself if the need for your project is clear and convincing. Are there models outside of your community that inspire you to proceed?
For us, we identified a facility north of us in the larger city of Cleveland, Ohio, that was thriving and had tremendous community support. Its beds were always full of patients who had been in the most difficult and lonely situations prior to their admission. They were made to feel cared for, secure, and loved every day.
Define the project’s scope
Next, you need to define the scope and size of the project given your community’s needs.
It is best to draw upon more than one source when estimating the size and scope of the proposed project. Local demographic and health data within what you perceive as your catchment area can help you estimate the size of the population you will be serving. Where other communities near or far have comparable facilities or projects, compare your populations. If you will be working with local or regional referral sources, such as hospitals or hospices, ask them to estimate the number of patients they will refer. For both inpatient and outpatient services, you must also estimate a length of stay or duration of service in order to round out realistic projections.
We queried potential referral sources locally; we looked to the nearest facility in Cleveland, Ohio, to assess the ratio of beds to catchment area population; and, finally, we reached out to a small national network of such facilities for their data. These multiple sources helped us to predict a need for six beds, and an average length of stay of 20 to 30 days.
Define your mission & make a business plan
Mission and vision statements define your organization’s beliefs and values. While your organization's vision declares its broad aspirational goal, the mission statement describes the general means to achieve that goal. These should be formulated jointly by team members and revisited periodically as the local environment evolves, including economic, regulatory, and business changes. While communicating who you are and what you hope to achieve to your larger community, vision and mission statements also help to coalesce and align your team’s thinking. If you do not have a clear vision and mission, you have not really started your project.
GHA’s vision, “No one dies alone,” appears on all of its letterheads. GHA’s mission is to “provide a loving home for indigent, homeless, and abandoned individuals at the end of life. The home provides safe shelter, care with dignity and compassion, and a nurturing environment for individuals with terminal illnesses.” Thus, the mission operationalizes the vision.
Next, a business plan must be developed. It is an integral tool to map out a plan for a new venture. The business plan sets the foundation for the organization, assisting with progress to realize the mission and vision, to set goals, and to fundraise.
Communicate your message concisely
Let your passion for the project shine.
You must be able to communicate what your project is all about in 30 seconds or less. Longer, and you lose people’s attention unless they are already committed to your project. Your job is to distill your mission and vision in a way that immediately connects with people and engages them both intellectually and emotionally. Let your passion for the project shine through. Having clear, focused mission and vision statements help tremendously in this task.
This is GHA’s project description: Grace House Akron will provide housing and access to food, water, and a caregiver for hospice patients who have no home; who have no caregiver; who would otherwise face dying alone, perhaps on the streets or under a bridge. We will relieve suffering and become the family for these individuals, offering love and compassion to replace loneliness and isolation. We are obligated as a community to care for these persons, our future residents, as we would any member of our own families.”
Build an engaged board
Never take on a reluctant board member.
Many factors can impact the success of your project, but the single most important factor in determining your success will be the board members you are able to enlist.
Each board member must be completely engaged by your vision and understand and support the mission. Never take on a reluctant board member. You should seek cultural diversity representative of the community you will serve. The talents of your board members must also be diverse, most coming from outside your own skill set. Consider people from the building trades, the financial industry, accounting, communications, information technology, law, human resources, fund development, etc. This assumes that you already have some from the medical field who are interested and should be involved. But a board must offer broad additional expertise and connections with foundations, government, churches, businesses, and other community organizations.
GHA’s board includes a banker, two attorneys, two accountants, a health insurer, a medical supply executive, two builders, a pastor, an educator, a human resources representative, a marketing representative, two local hospice executives, and a physician. Board members need to be able to demand the best from you and your team. They must also be willing to respectfully disagree with you and with one another in order for your project to be viable. Engagement of the board and a relationship built on respect and open communication is vital for the success of the organization.
Define your financial needs
When undertaking a building project, whether small or large, you should estimate both capital needs plus at least two years of operating expenses. Define and predict your sources of revenue in order to draw some realistic boundaries around what you think you need. It is better to overestimate costs and underestimate revenue at the start. If the costs and budgets exceed what you think you can consistently earn and/or raise, then be willing to revise your plans. For any building or space, architectural help may be needed early on to help craft a realistic budget.
It is better to overestimate costs and underestimate revenue at the start.
GHA had to reduce the square footage of its project by 20% in order to have a more achievable financial goal.
For any charitable undertaking that will depend on fundraising, think early and often about what services and products you might be able to secure as “in-kind” donations. Many companies and services might be as enthusiastic as you are about your project, including the architects and designers. You won’t know unless you ask: don’t wait for the launch of the formal capital campaign to pose the question.
Fund your project
No money, no mission. Fundraising is not an easy task but it is essential, even if the thought of asking people for money makes you cringe.
Fundraising for your project should be focused on “friendraising,” or engaging long-term supporters of your project. Start with your board: your board must all donate and be part of the fundraising effort. However, there are several reasons why a capital campaign deserves its own leadership team. First, the committee connections need to be different and focused on potential large donors. Without those large donors or funders, major projects rarely succeed. Second, they need to give their all to the fundraising effort, while your board needs to continue to focus on overall management of the organization and its project. Finally, their skill set needs to be different, with a greater focus on communications, government funding, and the donor community.
Every campaign has a quiet phase followed by a public phase.
The quiet phase involves approaching major donors and funders; its success will determine whether or not you can proceed. For any large project, 80% of your funding will need to come from large donors or public sources. After their commitment, these sources will require continuous communication, including updates. ALL donors deserve such communication, but some large donors may hope to build a personal ongoing relationship with the project that will be sustained over time.
The public phase is necessary to recruit everyone who might want to help the project while also raising broader public awareness. Smaller donors and volunteers are critically important for a multitude of efforts, be it patient care, administration, or future fundraising events. And they may surprise you some day with a meaningful connection to other funding sources or an unexpected donation of their own.
This distinction between small and large donors and funders may seem demeaning to those of us in health care, who know that all of our patients deserve the best we can give. However, it does serve an important purpose in planning your project.
Set & adjust your timeline
At some point in your project, you must develop a calendar of how you hope the rollout proceeds. A loose, general timeline should start very early in the planning, such as: “We hope to have this up and running in four years.”
Be ready to alter the calendar as reality hits you in the face.
At the GHA, we began somewhere in that range, but are now at six years. One cannot anticipate all barriers. We thought fundraising would be the challenge and it was not; finding the parcel of land to build on took an extra two years! So be ready to alter the calendar as reality hits you in the face.
As your project proceeds, the calendar will have to become more specific. It should include: recruiting and training staff, completing policies and procedures, initiating contracts with suppliers, firming relationships with referral sources, scheduling inspections, and achieving benchmarks with your builders.
This article represents a very general introduction to project development for a nonprofit palliative care program. We provided our own emphases based on our own successes and challenges. We hope that you can use this to pat yourself on the back for a job well done, or to better anticipate future needs.
To learn more about Grace House Akron visit the IAHPC Global Directory of Palliative Care Institutions and Organizations.