New paper in @JAMAInternalMed! In it, we use data to examine a commonly held belief about what moving into a nursing home or assisted living facility (also known as a long-term care facility; or LTCF) does to your social life. https://t.co/q7zVSdFSKa

Thank you also to @AlexSmithMD @geri_doc @cari_levy @ClaireAnkuda @IrenaCenzer and @AshwinKotwalMD for helping with the write-up and analysis of this work!

Thank you @NathanStall and @LonaMody for their generous editorial helping to interpret results:

These are averages -- of course. I do not mean to diminish the experience of those who have had terrible experiences with LTCFs, as I know this happens too. These results are also from 2011-2019 and may change alongside an evolving LTCF landscape.

...but here we show that in older adults, life outside of an LTCF in the months before entry was not conducive to community-building either, and that LTCFs are offering more life activities to an extent.

For policy, I think our results complicate Olmstead: https://t.co/rQBkXSWTkB. This Supreme Court case ruled individuals have the right to live in the community because: "confinement in an institution severely diminishes the everyday life activities of individuals"...

From a research standpoint, we also need to look at whether these activities are meaningful and if this improves quality of life -- though these can be hard to measure reliably given ~50% of residents have dementia.

Of course, we could do better; it would be good if more residents went out for enjoyment, if activity were culturally tailored, and if we resolved issues of segregation and inequitable access to high quality long-term care.

Taken together, I think this highlights how LTCFs are doing important but unglamorous work promoting activity among people going through a very difficult phase of life.

3) In exploratory analyses, men, nursing home entrants, and residents who were Black, Hispanic, and of other races/ethnicities were less likely to participate upon entry.

2) Upon entry, going out for enjoyment decreased (-14.1%). But participating in clubs (+15.6%) and attending religious services (+12.6%) increased. This suggests new LTCF residents are more likely to participate within their new community compared to their old one.

These are the findings. 1) Social participation drops for all activities before entry. So before people move, their social life is already starting to contract.

One question asked each year is about social life: Did you visit with others? Go out for fun? Attend religious services? Participate in clubs? Volunteer? This study analyzes the response for people who moved into a nursing home or assisted living, before and after entry.

We again turned to @NHATS_NSOC to help us answer this question. In this study, adults 65+ (or someone who knows them well) are interviewed each year. We found 606 older adults who moved into an LTCF between 2011 and 2019 and examined their interview responses.

So which is it? On average across the US, does moving into an LTCF mean the death of your social life? Or does moving actually increase how much you engage with others?

Most of us want to avoid an LTCF at all costs because we are afraid of them. But one-third of us will move into an LTCF in our lifetime. I've also met residents who -- having moved in and adjusted -- have nothing but good things to say about living in these communities.

Thank you also to @AGSJournal for publishing our work, to @dandohan for his mentorship, @landonjhaller for his help recruiting patients, and @geri_doc @Dan_Matlock @wjdeardorff @prepareforcare & James Harrison for helping me think through all we heard.

I am extremely grateful to the residents who were willing to talk with me. We will be printing copies of this manuscript and sharing it with them.

3) Meanwhile, there is much to improve about the long-term care system in terms of transparency and reduced fragmentation.

2) In-the-moment planning in hospitals and post-acute rehab is probably more useful than advance planning, as almost all moved after sudden events (cardiac arrest, CNS infection, falls): "It's a blindside." "You don't know what you miss until you aren't able to do it."