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Using Donor Feedback and Best Practices in Donor Retention to Improve Declining Renewal Rates at Bailey-Boushay House

Nicole ReeseFebruary 28, 2014

AbstractThis project explored how, based on best practices in donor retention and donor relations, Bailey-Boushay House can improve or reverse its declining renewal rates. Through an examination of literature on the topic, reports of giving trends in the area and by administering a postal survey to current and lapsed donors, the current stewardship and solicitation strategies of Bailey-Boushay House are analyzed for their effectiveness and efficiency. Based on findings of the survey and trends in the literature, recommendations are given as to how Bailey-Boushay House can optimize stewardship and donor relations to increase donor retention rates. IntroductionSince the economic recession of 2008, nonprofit organizations have struggled with the challenge of maintaining donation levels and donor retention rates. In the Pacific Northwest, between 2008 and 2010 (removing donations made by the Bill and Melinda Gates Foundation which rose by 15% during this time) there was an overall funding decrease of 23.5% to charitable organizations (Lewis, 2012). The funding sources that were most heavily impacted were foundation grants, corporate donations, and major giving. The decline of giving in other areas placed an increased importance on the role of annual fund donations for many organizations (LPR Publications, 2009). Generating the lions share of annual fund revenues, the decline in retention rates for direct mail has been an area of focus for many organizations (Flannery & Harris, 2011). As donation amounts and donor retention rates are decreasing, the demand for human and social services, like those provided by Bailey-Boushay house, are on the rise. Without an active new donor recruitment strategy, the best option to expand declining revenue is to reacquire lapsed donors (Lewis-Lodhi, 2013). The question is how this feat can be accomplished. By adopting best practice in stewardship, relationship fundraising, and donor retention models, Bailey-Boushay House can close the gap in funding deficit, but it is important that these models be adopted in a strategic way that meet the needs, wants, desires, and expectations of the Bailey-Boushay House donor base while still being fiscally efficient. By surveying both lapsed and new donors, and reviewing the literature containing industry best-practices, a comprehensive and tactical strategy has been developed to improve or reverse Bailey-Boushay Houses declining annual fund donor retention rates. Background/History Washington State saw its first reported AIDS case in 1982 (Wood, 2009); by 1987 the number of reported AIDS cases in the state had jumped to 847 in Seattle alone. By the end of the decade there were 4,117 cumulative HIV/AIDS cases, with a combined incidence rate of 19.24 new cases per 100,000 people, and the AIDS mortality rate in the city had reached 9.24 deaths per 100,000 people (Reese, Clark, & Leonard, 2008). While not much was known about the disease at this time, it was known that is was deadly, spreading quickly, and putting strain on the citys health care systems. Starting in 1985, the incidence rate for new AIDS cases in Washington State had been higher than the incidence rate for new HIV cases by an average of 3.97 per 100,000 people annually; some years had a discrepancy as high as 16.08 more new AIDS cases per 100,000 people over new HIV cases (Reese, Clark, & Leonard, 2008). The practical application of these statistics meant that of the new HIV/AIDS cases in Washington State, the majority of people were being diagnosed after the disease had progressed to full blown AIDS, reducing the patients prognosis and increasing the difficulty and complexity of care. With standard hospitals and nursing care facilities ill-equipped, unable, or unwilling to help HIV/AIDS patients with disease management or end of life care, the majority of people with HIV/AIDS were ending up in local emergency rooms (Shapiro, HIV's New Normal, 2013). The lack of knowledge about the disease generated a great deal of fear in the medical and healthcare community; misinformation about the disease, and the stigma that surrounded people who had contracted it caused many doctors, nurses, and nursing care facility workers to be unwilling to help patients with HIV/AIDS. In the late 1980s, it was not uncommon to find AIDS patients on stretchers, in hospitals hallways, who had passed away waiting for care that was never coming (Shapiro, The New Face of AIDS, 2006). It was clear that something needed to be done to provide dignified end of life care for the people living with AIDS in Seattle. The seeds for Bailey-Boushay House were planted in 1987, when the clinic director for Seattles Pike Place Market Clinic and the AIDS Housing Alliance of Washington (now known as Building Changes) came together for a grant from the Robert Wood Johnson Foundation. The idea was to open a skilled nursing facility that specialized in providing compassionate hospice care for people dying from AIDS, and to provide outpatient care for the chronically homeless living with HIV. When developing the concept for Bailey-Boushay House, the King County Commissioners office stated it would not allow a skilled nursing facility to be opened and operated without support and oversight from one of the citys major hospitals or medical centers. Initially, the Nuns of Providence had agreed to operate the facility; the caveat in this agreement was Bailey-Boushay House would not be able to hand out condoms to clients. Given that this was to be an HIV/AIDS care facility, the board decided that they could not allow this regulation to be enforced. Just at ground breaking was occurring for the facility; Bailey-Boushay House was left without a major area hospital to support it. The board for Bailey-Boushay House reached out to all the major area hospitals for support. The primary concern from medical centers like Swedish, The Polyclinic, and University of Washington Medical Center was the operating cost of Bailey-Boushay House. Because the outpatients were low to no income, and because many of the inpatients receiving end of life care did not have insurance, the facility would have to be run as a nonprofit, and would more than likely be operating at a deficit for the foreseeable future. All but one of the medical centers in the greater Seattle area voiced their compassion for the cause, but ultimately declined the request to operate and assist Bailey-Boushay House. When Virginia Mason Medical Center agreed to support and oversee the operations of Bailey-Boushay House, it is an understatement to say that the boards of Bailey-Boushay, the Pike Place Market Clinic, and the AIDS Housing Alliance were shocked. At the time, Virginia Mason Medical Center was not known as a place for HIV/AIDS care, and the community outreach aspects of the hospital were just starting to be developed. When asked by a local reporter as to why they chose to take on the relationship with Bailey-Boushay House, the board president at the time state, We decided it was just the right thing to do (Shapiro, The New Face of AIDS, 2006). When Bailey-Boushay House opened its doors in 1992, it was the nations first facility designed to help people living with HIV/AIDS. During its first few years of operation, it was not uncommon for Bailey-Boushay House to lose one or more of its inpatient clients a week to AIDS. The outpatient program could see upwards of 300 clients a day come through its doors. The outpatient clients at Bailey-Boushay House in addition to living with HIV/AIDS are also low-to-no income, chronically homeless, and often dealing with substance abuse and mental illness; because of the additional challenges the outpatient clients face, when Highly Active Antiretroviral Therapy (HAART) was introduced in 1996, the nursing staff at Bailey-Boushay House began the medication management program. The medication management program dictated that for their first six months at the facility, a clients medication would be kept at Bailey-Boushay House and administered by its nurses. This insured that clients would have to come to the facility, so the nursing staff could track compliance rates. In addition, nurses taught the patients how to take their medication properly. The medication management program also kept clients safe. According to the Executive director at Bailey-Boushay House, many outpatient clients at the time voiced their concern that others would try assault them and try to steal their medication at night on the streets or in area homeless shelters. After six months, if a client is operating with a 95% compliance rate or higher, they are allowed to take a few days worth of their medication with them when they leave Bailey-Boushay House, however the vast majority of clients opt to keep their medication at Bailey-Boushay House. The introduction of HAART and subsequent antiretroviral (ARV) therapies changed HIV from being a death sentence to being a manageable chronic disease if drug therapies were adhered to with 100% compliance. Between 1995 and 1998, the mortality rate from AIDS in Washington State dropped from 12.25 deaths per 100,000 people to 2.99 deaths per 100,000 people (Reese, Clark, & Leonard, 2008). The key to HAART and ARVs being effecting, however, is the compliance with the medication regiment. If patients are not methodical about taking ARVs, they develop resistance to the drugs, and the disease will progress as if the patient had never been on a drug therapy regime (Shapiro, HIV's New Normal, 2013). There are several combinations of ARVs, or AIDS cocktails, that a patient can try, but not all patients respond to all cocktails, making compliance with medication regimes even more critical for a patients prognosis. 80% of HIV/AIDS patients have only a 60% compliance