How 2025 Forever Changed Health Care Giving

By Heather Wiley Starankovic, CFRE

As we reflect on year 2025, the philanthropic landscape—particularly within health care—presents both significant opportunities and pressing challenges. Charitable giving reached historic highs, with Americans contributing an estimated $592.5 billion. However, along with  this record generosity came a revealing trend: fewer donors are giving more. The donor pool is narrowing even as giving totals rise. This shift requires urgent attention. It is not simply a statistic; it is a signal that strategies rooted in institutional loyalty and broad appeals may no longer be enough. For health care philanthropy professionals, this is the moment to rethink engagement models from the ground up.

The donor pool is narrowing even as giving totals rise. This shift requires urgent attention.

Within health systems, this trend was especially apparent. Donor motivations in 2025 were influenced by immediacy, transparency and a growing desire for cause-aligned giving. We have seen that donors under the age of 50—particularly Gen X and Millennials—are a growing and driving force in the sector. Their giving is proactive and impact-oriented. They are not waiting for a gala invitation or an end-of-year campaign. They want to fund causes they believe in now, see where their money goes and hear stories about the people their gifts touch. Unlike their predecessors, these donors are less influenced by institutional reputation and more by personal alignment with the cause. While gratitude still plays a role, loyalty is earned through relevance and results. This has changed the donor story. Most recently, we have seen younger donors supporting health care causes such as mental health, pediatric care or cancer research over general building funds. The implication is clear: health institutions must build cases for support around mission, not just infrastructure. Technology has enabled this shift. Mobile-first giving platforms, instant impact videos and social media campaigns made giving both accessible and personal. Donors expect seamless digital experiences—efficient, intuitive and responsive. They want giving to be as easy as online shopping. But while technology enhanced efficiency, it was never a substitute for authentic human connection. It is a best practice to use tech-amplified relationship-building—freeing time for gift officers to engage more deeply, listen more attentively and steward more intentionally. Major gifts still dominated in 2025. The nation’s ultra wealthy continued to give generously—and strategically. These donors, many of them new to philanthropy, are often values-driven and data-minded. They give through vehicles like donor-advised funds and expect evidence of impact, influence in outcomes and alignment with their broader legacy goals. However, it is not just about the size of their gifts—it is the strength of their networks. Each transformational donor can open doors to dozens of peers with similar capacity. That is why ongoing cultivation, thought partnership and tailored engagement are essential. At the other end of the spectrum, mid-level donors—those contributing between $1,000 and $25,000 annually—proved to be an under-leveraged asset. In many organizations, these donors receive mass communications but no personal outreach. In 2025, this gap translated to missed opportunities. From experience, we see modest investments in mid-level stewardship—like thank-you calls, tailored invitations and impact updates—led to significant increases in retention and gift size. These donors are future major donors. Ignoring them risks shrinking the pipeline just when we need it most. Ultimately, retention remains the core challenge. Across the nonprofit sector, we often struggle with a small percentage of first-time donors making a second gift. This statistic is alarming, especially given how much energy and cost go into donor acquisition. The window for meaningful follow-up is short—days, not months. Donors who do not hear back, do not hear a story or do not feel seen will not return. This makes stewardship less of a “nice-to-have” and more of a mission-critical system.

Across the nonprofit sector, we often struggle with a small percentage of first-time donors making a second gift.

Five Strategic Shifts from 2025

1. Donor loyalty is now mission-dependent. Generic appeals based on history or legacy are no longer enough. Impact and alignment drive giving decisions.

2. Major donors want partnership, not just recognition. Strategic, long-term engagement beats event-based outreach.

3. Mid-level donors need real stewardship. They are too important to remain in the shadows of major campaigns.

4. Digital is expected, but not sufficient. It must be paired with personalized, human connection.

5. Retention begins at the first thank-you. Stewardship must be designed for immediacy, authenticity and continuity.
   

2025 did not just change philanthropy—it clarified what matters most to donors: authenticity, relevance and relationships. It is a wake-up call to recalibrate for the future. And it is an invitation to meet donors where they are, with the mission they care about and the impact they are ready to make.

Accordant Perspectives_How 2025 Changed Giving.pdf

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About the Author:

Heather Wiley Starankovic, CFRE, CAP, is a Principal Consultant with Accordant. She can be reached at Heather@AccordantHealth.com or through LinkedIn.