🚨 New paper in @JAMAInternalMed!. As a geriatrician, I have a pretty good sense of "who goes where" -- when living situations are becoming unstable or unsafe because of medical and functional issues and moving to a facility might be better. But I never saw data on it. 🧵

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.".

What are the takeaways? . 1) It may be useful to think of potential residents as planners, avoiders, or accepters -- and what each wants in terms of information and resources may be distinct. Planners may want details, while avoiders may want to know more about their rights.

If you want to prepare, there is no central agency to help and no way to envision what this phase of life looks like. If you want to avoid, no one is transparent about your choices and risk and people take away your control. If you want to accept, you have to be lucky.

I came to see their stories as a back and forth between individual coping strategy (eg, prepare, avoid, or accept) and a long-term care entry system that flummoxes each coping strategy.

C. Some encouraged others learn how to accept it; they seemed the most grateful and happiest to be in the facility. "How do you come by people that are there when you need them? I don't know, are they gifts from heaven?…".

B. What did others hope their listeners could avoid? . 1) The restrictions, joylessness, and lack of stimulation in the facility. 2) The loss of autonomy, mostly through how others seemed to hide information and choices from them.

A. What were some unprepared for? . 1) Facilities were often not "as advertised" -- hence "investigate". 2) Care and information is fragmented -- hence "plan" to get all your care logistics to fit together. 3) Priorities changed -- hence "really think about what you want".

Things got interesting when we examined our transcripts for WHY residents gave this advice. Advice rarely came from good experiences. No one said "prepare" because preparation had helped them. They said "prepare" in response to all the things they couldn't prepare for.

We had 14 residents share their stories, for which I am so grateful. Advice fell into 3 camps: .- prepare (eg, investigate, plan, and really think about what you want) .- avoid (eg, stay away for as long as you can, don't trust other people) .- accept (eg, try not to plan).

I'm proud to announce our new paper! . Moving to a long-term care facility is a major late life decision. I know I've often benefitted from others' advice for my major life decisions. So I wondered: what advice is there for moving into an LTCF?.

RT @DavidCGrabowski: Expanding Medicare to cover the cost of long-term care at home would be a HUGE development. Great quote: “There isn’t….

Thanks to co-authors on this project: @matthew_growdon @anitachary @jdportz1 and lead author Karen de Sola Smith!.

The end result is hopefully a vision for how we might do a better job routinely thinking about the caregiving context of our older patients. Would this be useful to you?.

We highlighted the value of using design methods to really understand what information people want. More is not always better. Live feedback from potential users helps you home in on what to keep and what to cut.

We explored nuance around how information should be presented for the purpose of disposition planning in emergency departments. We found the analogy to a BPMH holds. Caregiver information is useful, but needs to be standardized, updated, and recognized.

Forgive the ugly font. This is what the VA medical record looks like, and making it look this way improved the feedback we got in focus groups.

We took inspiration from the "Best Possible Medication History" where you need to know what meds someone takes, when they take it, and what it's for. For caregivers, we wondered: who's helping, how often, and what do they help with? This is what we came up with.