Health Care Philanthropy and the Intergenerational Transfer of Wealth
- Cindy Reynolds, CFRE
- May 21
- 5 min read
…it is important to respect generational differences while making no assumptions that these generalities will predict individual family dynamics.
Over the next two decades, a total of $84.4 trillion will be transferred through inheritance—$72.6 trillion in assets will be transferred to traditional heirs, while $11.9 trillion will be donated directly to charities.¹ This transfer is quite top-heavy: only 1.5% of all households will transfer 42% of the inheritance, or $35.8 trillion, from high-net-worth (HNW) and ultra-high-net-worth (UHNW) households.
This represents a massive, ongoing shift of wealth—almost too big to comprehend, and the amount already designated to go to charity is mind-boggling. $11.9 trillion will benefit many types of charitable endeavors, including donor advised funds, private foundations, direct bequests and trust remainders—ideally, your hospital or health system will be among the organizations your most passionate supporters choose to include. But support at the time of death isn’t your only opportunity—there are meaningful ways to engage and inspire giving during your donors’ lifetimes as well.
Health care philanthropy, specifically giving to hospital and health systems, has traditionally been the province of mid-to-late-life donors. While Giving USA data shows that younger donors are also active in health-related giving, their contributions tend to support disease associations and national charities through walks, runs, galas and viral campaigns like the Ice Bucket Challenge.
Meaningful gifts most often result from a significant life experience—and serious medical care skews older. You may see this reflected in the age distribution of your board members and among your highest impact donors. As these deeply engaged leaders move through their seventies, eighties and beyond, how will you maintain their loyalty while simultaneously encouraging enthusiasm from the next generation of inheritors?
Those of us in the philanthropy trenches are not alone with our anxiety about the inevitable shift in financial power to a rising generation we have yet to engage. Financial services firms are well-resourced, motivated and a great source for research on HNW & UHNW households. To survive, they must stay relevant to younger clients, and they have poured significant resources into preparing for this generational transition. So, what have they discovered?
It’s All About Relationships
Hopefully, the results will be reassuring, since relationships are already the bedrock of philanthropy. The same relationship-building principles that make you successful with your current donors can be extended to their spouses, next-generation inheritors and future generations. At the same time, engaging the “I’m not quite there yet” family members with a compelling case for health care philanthropy will also attract other new donors as they approach their legacy years.
Before crafting a plan for engaging intergenerational donor families, it is helpful to understand who this will involve. The sooner you engage both spouses, the more likely your organization will remain a top philanthropic priority. Widows and widowers are not necessarily predictable—without an established relationship, you will not know whether they feel compelled to continue their late spouse’s legacy, give in memory of the loved one or refocus their own personal priorities. The best way to maintain a philanthropic priority is to ask both spouses what they value most and to regularly communicate the impact of their giving.
The best way to remain a philanthropic priority is to ask both spouses what they most value and to regularly communicate the impact of their giving.
In general, each generation approaches philanthropy differently due to a confluence of many factors. The advantage is having access through the elder generation, if they are willing to be the conduit for a family-wide engagement strategy, and if you both are open to a flexible scenario.
Just as your board and clinical allies use their relationship capital to open doors, advocate and influence on your behalf, so can your existing donors weave their spouses, children and grandchildren into their philanthropic decision-making. This process will often include their financial advisors as well. In fact, 94% of donor advised funds have documented succession plans—an indication that financial advisors and sponsor organizations have realized the importance of engaging the successors in these endeavors with their clients.²
While your first-generation donors may assume that their spouses, children and grandchildren will support the same charitable endeavors they hold so dear, this is often not the case—and this can be an unpleasant surprise for all concerned unless you are prepared to normalize and manage the emotional repercussions. Younger generations may be more open to funding community health or social drivers of health outcomes, while older donors may consider it “mission creep.”
Fortunately, most health organizations have a wide enough variety of projects to engage all generations. Younger family members can find meaningful ways to support causes that align with their own values while also honoring the legacy of their parents or grandparents.
Older Generations May:
Like and trust institutions
Give to hospitals
Support religion, education and health
Write checks, give stocks or other appreciated assets
Younger Generations May:
Trust social media
Give to help individuals
Support social causes
Support health charity walks and other similar events
Give digitally
Aging into Major Giving
A 2024 study by EverTrue analyzing university donors found that the average age at which individuals make a first gift of $50,000 or more to their university has steadily increased over the past 15 years—from age 59 to age 66. Three quarters of these donors had given previously at lower levels, but for 27%, the major gift over $50,000 was their first gift to the institution.³
The intergenerational transfer of wealth may be a key factor in increasing the age of the first major gift, because North American lifespans—and thus the age of inheritance—is also increasing.
So, how might we keep our older donors engaged while also encouraging them to involve their next-generation family members? According to research by Bank of America, older generations do not think younger generations are ready to carry on their legacy of philanthropy. Younger generations, not surprisingly, disagree. They expect to do things differently than their elders, and they believe they will be more effective with their philanthropy.⁴
The Bottom Line
As you step into these family relationships, it is important to respect generational differences while making no assumptions that these generalities will predict individual family dynamics. The most impactful role for the philanthropy professional in these situations is to facilitate the intergenerational conversations and to help each family member see how their individual aspirations for impact can be achieved, honored and celebrated.
Ultimately, engaging younger generations who are set to become your next wave of donors is all about the ask: not asking for the gift but asking the questions that lead to deeper engagement and understanding of what is important to each participant.
¹ Cerulli and Associates, 2022
About the Author: Cindy Reynolds, FAHP, CFRE is a Principal Consultant with Accordant. She specializes in strategic planning, board engagement and philanthropy operations. She can be reached at Cindy@AccordantHealth.com or through LinkedIn.
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