Jack 

Low-income older adults with serious illnesses often avoid advance care planning (ACP) due to mistrust of healthcare institutions. The mistrust is rooted in systemic issues such as high staff turnover and poor staffing ratios. Traditional ACP visits are short and paperwork-focused, leaving no room for the relationship-building needed to discuss end-of-life care. “Someone To Talk To” is a community health worker (CHW) facilitated ACP intervention for residents of Medicaid-funded assisted living (AL) facilities, a population palliative care has largely failed to reach. Unlike conventional models, this program prioritizes building trust with residents before addressing documents. The study investigates whether a resident-driven, CHW-facilitated ACP model can feasibly engage older adults in Medicaid-supported assisted living. Trained CHWs conduct three one-hour visits per resident using the PREPARE decision aid and SMART goal-setting to guide conversations. Feasibility is assessed using the Bowen criteria alongside pre/post measure of ACP engagement, medical mistrust, symptom burden, perceived stress, and more. The program met feasibility thresholds across domains. Both residents and CHWs rate it well: a mean feasibility score of 83%, with satisfaction and worth-of-time both at 92%. Symptom burden dropped from a mean symptoms total of 32%, and feelings of being heard improved. Medical mistrust fell 15%. ACP engagement and palliative care knowledge stagnated. However, findings show a trust-based, resident-driven model can work in Medicaid-funded assisted living settings and create outcomes that shorter, more clinical approaches have not. Next steps include writing a paper, a grant, and implementing the study in more residences.