In many cultures, the subjects of death and dying are not discussed openly until they must be. The reluctance to prepare for death often leaves families and caregivers making critical end-of-life decisions when they are strained and feel depleted. Often, the result is that individuals die alone and in unfamiliar institutional settings. These circumstances can result in deaths that do not encompass desirable mental preparations or the comfort and reconciliation of loved ones.
Hawaii's Kōkua Mau Coalition (KMC) goal is to create a system of community support so that individuals can die in the place of their choice, relatively free of pain, and cared for according to their wishes. The Coalition was formed in 1999, as a result of the governor's Blue Ribbon Panel on Living and Dying with Dignity. As of 2001, the coalition consists of 265 organizations and individuals that assist four lead organizations. This is the first state-launched coalition in the nation that targets improved end-of-life care.
The coalition organizations consist of government, university and nonprofit corporations and organizations. These organizations have banded together to support a public awareness campaign entitled, "Women Caregivers: the key to end-of-life decision-making." The campaign targets women ages 45 and above as potential caregivers. A series of practical workshops, The Complete Life Course, are administered in churches and temples. These focus on those over 60 years-old, to foster a motivation for end-of-life preparation and advocate for Hawaii's Hospice Organization.
As of December 2001, Hospice has reported a 20 percent increase in admissions since the inception of KMC. Hospice has reported that much of this increase is due to family and self-referrals, which indicates that media and workshops are being well received. The result is that Hospice is transitioning from a "movement" to a mainstream option. Many medical programs in Hawaii have also begun end-of-life studies programs, often requiring students to commit to hospice training and volunteer for one semester.
The KMC has woven its coalition with information initiatives to produce an enhanced environment for the early discussion and planning of final decisions. The program has effectively begun to serve Hawaii's entire society since everyone will inevitably have the opportunity to take advantage of its advancements and services.