Might as well have my rant. Do not EVER on my acute take record the words "lives with family" in the medical record. You might as well have written that they like cheese or house music. @acutemedicine https://twitter.com/jfdwolff/status/1342939151688212480

I know the implication: "Lives with family" is the opposite of "lives alone" and hypothetically makes it easier to provide support if someone is discharged from hospital. Not quite good enough though.

What if the "family" they live with is in fact someone for whom they are the main carer, and this person won't be able to provide any support after discharge? This person's care may become destabilised by admission of their main carer. Enquire and explore!

One of my first bosses in the UK, the geriatrician Dr N.K. Offonry, used to ask his older patients "do you care for your spouse or do they care for you?" This was a starting point for conversations about this.

Better ways of finding out: "Who is at home with you?" Humans and other species... Sometimes it turns out that patients refuse admissions because of concerns about a pet at home. (Asking the pets' names is optional.) https://www.nejm.org/doi/full/10.1056/nejmp1806388

Asking about mobility is also important. Unfortunately the recording of exercise tolerance is generally quite poor (and should be explored in detail).

Don't take shortcuts. A lot of people who are "bedbound" are actually able to transfer to a chair with support/equipment.

Some details about the property are useful. Are there stairs? If so, are there toileting facilities on all floors? Important to know prior to prescribing diuretics etc.

Very often it is the social history that determines the course of the admission. It allows the identification of frailty: not all people people without major comorbidities are automatically physiologically robust. Estimate the clinical frailty scale if possible.

When taking a collateral history from a relative or carer, it should really be as comprehensive as possible. This is especially important in the current climate where relatives are unable to visit and not able to fill in details during a chat on the ward.