Lam Kenneth, Harrison James D, Haller Landon, Deardorff William J, Sudore Rebecca L, Covinsky Kenneth E, Matlock Dan D, Dohan Daniel
Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.
Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, California, USA.
J Am Geriatr Soc. 2025 May;73(5):1506-1516. doi: 10.1111/jgs.19405. Epub 2025 Mar 4.
The transition into a long-term care facility (LTCF) is difficult for older adults, prompting calls for clinicians to help guide and plan. Yet we know little about how those with lived experience of moving into an LTCF would advise others.
We conducted in-person semi-structured interviews with nursing home (NH) and assisted living (AL) residents within 6 months of moving into an urban non-profit continuing care retirement community in California between 2023 and 2024. Interviews were guided by theories of long-term care utilization and asked, "what advice would you give others considering an LTCF?" We thematically analyzed interviews using the constant comparative method.
We interviewed 8 NH and 6 AL residents. Mean participant age was 82 (range 73-90); 8 were female, 1 participant was Asian, 13 participants were White, and mean Montreal Cognitive Assessment was 19 (range 12-25). Residents talked about LTCF entry within a broader phase of life defined by dependence following sudden unexpected health crises. Advice reflected strategies for this phase of life and highlighted challenges outside of their control. Some residents advised preparation by visiting facilities and budgeting time and resources to plan but discovered care arrangements did not work out as promised; care was fragmented, and dependence caused them to re-evaluate what they wanted. Some advised avoidance as they disliked living in an LTCF but had little control over entry, leading to distrust of those making decisions for them. Others advised acceptance and believed luck or fate dictated how everything worked out in the end.
Unanticipated health crises catalyze entry into LTCFs. New residents advised others to prepare for, avoid, or accept LTCF entry, reflecting different strategies for approaching a unique phase of life and highlighting systemic problems that could be improved. Anticipatory guidance for LTCF transitions should acknowledge their sudden nature, these strategies, and the need for system reform.
对于老年人来说，过渡到长期护理机构（LTCF）是困难的，这促使人们呼吁临床医生提供帮助和规划指导。然而，我们对那些有进入长期护理机构亲身经历的人会如何建议他人知之甚少。
2023年至2024年期间，我们对加利福尼亚州一个城市非营利性持续照料退休社区内入住养老院（NH）和辅助生活设施（AL）的居民进行了面对面的半结构化访谈，访谈时间在他们入住后的6个月内。访谈以长期护理利用理论为指导，问题是“对于考虑入住长期护理机构的人，你会给出什么建议？”我们使用持续比较法对访谈进行了主题分析。
我们采访了8名养老院居民和6名辅助生活设施居民。参与者的平均年龄为82岁（范围73 - 90岁）；8人为女性，1名参与者为亚洲人，13名参与者为白人，蒙特利尔认知评估平均分为19分（范围12 - 25分）。居民们在由突发意外健康危机后的依赖所定义的更广泛生活阶段中谈论了进入长期护理机构的情况。建议反映了这个生活阶段的策略，并突出了他们无法控制的挑战。一些居民建议通过参观设施以及规划时间和资源来做准备，但发现护理安排并未如承诺的那样实现；护理是分散的，依赖使他们重新评估自己想要的东西。一些人建议避免入住，因为他们不喜欢住在长期护理机构，但对入住几乎没有控制权，这导致他们对为他们做决定的人产生不信任。其他人建议接受，并认为运气或命运决定了最终一切的结果。
意外的健康危机促使人们进入长期护理机构。新入住者建议他人为进入长期护理机构做好准备、避免或接受，这反映了应对独特生活阶段的不同策略，并突出了可以改进的系统性问题。对长期护理机构过渡的预期指导应承认其突发性、这些策略以及系统改革的必要性。
