A 2009 survey confirmed the experiences of many end-of-life advocates: Most Californians said they would prefer to die at home, but only 32% of deaths occurred at home that year. A large percentage of survey respondents said it was important to put their end-of-life care wishes in writing, yet only 23% said they had done so.
To address this continuing challenge in California, regional coalitions -- which included hospitals, skilled nursing facilities, emergency medical service providers, hospices, nursing homes, senior centers, and consumer groups -- formed in the late 1990s and early 2000s to promote advance care planning through a community-based approach. Advance care planning is a process to help patients consider options and to establish their wishes about future care in legal documents that take effect when those patients lose the capacity to make decisions for themselves. These coalitions readily embraced the Physician Orders for Life-Sustaining Treatment (POLST) process when it was first introduced to California in 2007.
To better understand successful community engagement strategies for advance care planning, the California HealthCare Foundation (CHCF) interviewed 10 coalition members in four California communities: Inland Empire, Sacramento, Santa Cruz County, and Sonoma County. This paper describes the experiences and lessons learned from these coalitions in implementing successful advance care planning and POLST initiatives.