Dying is a topic we often avoid discussing—whether in regard to our own deaths or the passing of those we love. But it is a shared human experience, and one that none of us can avoid. Yet, patients, families, and healthcare providers alike struggle with having conversations and making decisions around death and dying. The Jewish Healthcare Foundation (JHF), as part of its commitment to supporting issues around aging, embarked on an initiative to change the narrative around death and dying.
Launched in late 2007, Closure brought together a group of about 30 community leaders to share collective experiences, expertise, and passion to develop and implement an agenda to advance end-of-life care. Closure participants understood first-hand the importance of quality end-of-life care, what works and what is “broken” and how institutions and individuals need to change.
In five sessions, participants outlined specific, pragmatic actions to improve end-of-life planning, decision making, and care. Members represented a wide range of perspectives as adult day care workers, clergy, family caregivers, financial planners, home care, hospice and long-term care, lawyers, physicians and other medical professionals, social workers and other social service providers. They represented a natural network to community stakeholders who can directly improve end-of-life care.
Closure was designed to be a learning, community-organizing, and planning forum for meaningful change to empower consumers and healthcare professionals with easy-to-access, simple-to-understand information and resources to make informed decisions around the end of life. It also sought to champion policy and reimbursement changes that facilitate end-of-life discussions between patients and their healthcare providers, improve availability of palliative care service, increase access to high-quality end-of-life care, and change the default settings of the healthcare system to account for patients’ wishes and values.
Closure participants’ recommendations would increase appropriate use of hospice and palliative care, decrease unnecessary healthcare expenditures and ICU admittance at end-of-life, and help patients proactively plan for and manage end-of- life experiences.
Resources developed through the initiative included the website closure.org, featuring an array of online learning materials; in-person presentations and discussions; Closure 101, a curriculum of educational lessons dealing with an array of complex end-of-life issues including important questions to ask your doctor, advance care planning, and the Medicare Hospice Benefit; collateral materials; and legislative and policy initiatives.
Expanding on the Closure initiative, in 2011, JHF partnered with local Public Broadcasting Service (PBS) station WQED-TV to produce The Last Chapter, a one-hour documentary exploring the numerous medical, legal, cultural, spiritual, and ethical implications surrounding end-of-life care.
Closure received coverage in local and national news outlets, including the Pittsburgh Post-Gazette, Health Affairs, and The Washington Post.
Learnings from the Closure initiative continue to inform JHF’s serious illness and end-of-life programming, including the Death and Dying Fellowship and Death and Dying Series for Healthcare Professionals, as well as a JHF-led Osher @ CMU course offered annually.