Bits Blog: Facebook Unveils a New Search Tool

8:53 p.m. | Updated

MENLO PARK, Calif. — Facebook has spent eight years nudging its users to share everything they like and everything they do. Now, the company is betting it has enough data so that people can find whatever they want on Facebook. And on Tuesday, it unveiled a new tool to help them dig for it.

The tool, which the company calls graph search, is Facebook’s most ambitious stab at overturning the Web search business ruled by its chief rival, Google. It is also an effort to elbow aside other Web services designed to unearth specific kinds of information, like LinkedIn for jobs, Match for dates and Yelp for restaurants.

Facebook has spent over a year honing graph search, said Mark Zuckerberg, the company’s co-founder and chief executive, at an event here at Facebook’s headquarters introducing the new product. He said it would enable Facebook users to search their social network for people, places, photos and things that interest them.

That might include, Mr. Zuckerberg offered, Mexican restaurants in Palo Alto that his friends have “liked” on Facebook or checked into. It might be used to find a date, dentist or job, other Facebook executives said.

“Graph search,” Mr. Zuckerberg said, “is a completely new way to get information on Facebook.”

Graph search will be immediately available to a limited number of Facebook users — in the “thousands,” Mr. Zuckerberg said — and gradually extended to the rest.

Every Internet platform company has been interested in conquering search.

But Facebook search differs from other search services because of the mountain of social data the company has collected over the years. It knows which parks your friends like to take their children to, or which pubs they like to visit, and who among their network is single and lives nearby.

The company is betting that its users are more eager to hear their friends’ recommendations for a restaurant than advice from a professional food critic or from a stranger on Yelp.

Its search tool is based on the premise that the data within Facebook is enough and that its users will have little reason to venture outside its blue walled garden. What they cannot find inside the garden, its search partner, Bing, a Microsoft product, will help them find on the Web.

For now, the Facebook tool will mine its users’ pictures, likes and check-ins, but not their status updates. Graph search, Mr. Zuckerberg explained, is aimed at answering questions based on the data contained in your social network, not serving you a list of links to other Web sites.

Say, for example, you are searching for a grocery store in Manhattan. You would type that question into a box on your Facebook page and the results would show stores your friends liked or where they had checked in.

It remains unclear how users will react to having others mine the data they share on Facebook. Mr. Zuckerberg took pains to reassure users that what they post would be found only if they wanted it to be found. Before the new search tool is available to them, he said, users will see this message: “Please take some time to review who can see your stuff.” Facebook tweaked its privacy controls last December.

Mr. Zuckerberg said Tuesday that initially, photos posted on Instagram, which Facebook owns, would not be part of the database of photos that can be searched. Nor would he specify how soon graph search would be available to those who log in using the Facebook app on their cellphones.

The search tool is plainly designed with an eye toward profits. If done right, said Brian Blau, an analyst with Gartner, it could offer marketers a more precise signal of a Web user’s interests. “It’s going to lend itself to advertising or other revenue-generating products that better matches what people are looking for,” he said. “Advertisers are going to be able to better target what you’re interested in. It’s a much more meaningful search than keyword search.”

News of the new search tool offered a modest lift to Facebook shares, which rose 2.7 percent to a close at $30.10 Tuesday. Google remained stable, with a share price of nearly $725. Google retains two-thirds of the search market, and Facebook’s search tool by itself is not likely to affect Google’s business.

Still, introduction of graph search sharpens the divide between Facebook and Google.

“If Facebook can truly provide relevant answers based on mining data from the social graph, it has an advantage,” said Venkat N. Venkatraman, a business professor at Boston University.

Google has been scrambling for several years to collect social data and incorporate it into search results, as Web users increasingly turn to social networks to seek friends’ recommendations.

It introduced Google Plus, its Facebook rival, in 2011, and from the beginning said its main purpose was to use social information to improve and personalize all Google products, from search to maps to ads. Last year, Google began showing posts, photos, profiles and conversations from Google Plus in Google search results. A search for restaurants in Seattle, for instance, could show posts and photos shared by friends in addition to links from around the Web. Google declined to comment for this article.

The kind of personal search that Facebook is promising is rife with potential privacy hazards, which Mr. Zuckerberg acknowledged repeatedly. “The search we wanted to build is privacy aware,” he maintained. “On Facebook, most of the things people share with you isn’t public.”

The American Civil Liberties Union immediately posted a warning, reminding Facebook users to review their privacy settings. It pointed out that advertisers who, until now, could target only certain categories of people anonymously — “users under 35 who live in Texas,” for instance — could now find specific users under 35 who live in Texas, if their privacy settings allowed them to be found. It cautioned that “controlling your personal data means controlling not only who can see your information but how it can be found and what can be done with it.”

But Facebook pointed out that even though a business owner could personally search for specific personal data, a brand page could not. Detailed searching of Facebook data for the sake of sending promotional messages would violate the site’s internal policies.

The search team was led by two former Google engineers, Lars Rasmussen and Tom Stocky. As they explained in a blog post on the Facebook Engineering Department page, graph search solves a problem of Facebook’s own making: it has collected so much information.

“As people shared more and more content, we saw that we needed to give them better ways to explore and enjoy those stories and memories,” they wrote.

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Facebook's Bold, Compelling and Scary Engine of Discovery: The Inside Story of Graph Search

Beast had a birthday last week. The First Dog of social networking — live-in companion to Mark Zuckerberg and his bride, Priscilla Chan — turned two. The proud owners baked a cake for the Hungarian sheepdog and decided to throw an impromptu party. Naturally, when it came time to compile the guest list, the couple turned to Facebook, the $67 billion dollar company that Zuckerberg founded in his dorm room nine years ago.

To date, sorting through your Facebook friends can be a frustrating task. Although the site has a search bar, there has been no easy way to quickly cull contacts based on specific criteria. But Zuckerberg was testing a major new feature that Facebook would announce on Jan. 15 — one that promises to transform its user experience, threaten its competitors, and torment privacy activists. It’s called Graph Search, and it will eventually allow a billion people to dive into the vast trove of stored information about them and their network of friends. In Zuckerberg’s case, it allowed him to type “Friends of Priscilla and me who live around Palo Alto” and promptly receive a list of potential celebrants. “We invited five people over who were obvious dog lovers,” he says.

For years now, Facebook watchers have wondered when the company would unleash the potential of its underpowered search bar. (Nobody has feared this day more than Google, which suddenly faces a competitor able to index tons of data that Google’s own search engine can’t access.) They have also wondered how a Facebook search product might work. Now we know. Graph Search is fundamentally different from web search. Instead of a Google-like effort to help users find answers from a stitched-together corpus of all the world’s information, Facebook is helping them tap its vast, monolithic database to make better use of their “social graph,” the term Zuckerberg uses to describe the network of one’s relationships with friends, acquaintances, favorite celebrities, and preferred brands.

In the weeks leading up to the launch, Facebook executives were still trying to come up with a name for the new product. They were hoping to stay away from the word search, to distinguish it from web search. (Only a few days before the launch, one Facebook executive slipped and referred to it as “browse.”) But after hours of contortionism, they relented; nothing topped Graph Search. “It’s descriptive — it’s search,” Zuckerberg says. “And the graph is a big thing.” The idea is that Facebook’s new offering will be able to extract meaning from the social graph in much the same way that Google’s original search unearthed the hidden treasures of the web. “People use search engines to answer questions,” Zuckerberg says. “But we can answer a set of questions that no one else can really answer. All those other services are indexing primarily public information, and stuff in Facebook isn’t out there in the world — it’s stuff that people share. There’s no real way to cut through the contents of what people are sharing, to fulfill big human needs about discovery, to find people you wouldn’t otherwise be connected with. And we thought we should do something about that. We’re the only service in the world that can do that.”

The result is surprisingly compelling. The mark of a transformative product is that it gets you to do more of something that you wouldn’t think to do on your own. Thanks to Graph Search, people will almost certainly use Facebook in entirely new ways: to seek out dates, recruit for job openings, find buddies to go out with on short notice, and look for new restaurants and other businesses. Most strikingly, it expands Facebook’s core mission — not just obsessively connecting users with people they already know, but becoming a vehicle of discovery.

Zuckerberg says that this is in fact a return to the company’s roots. “When I first made Facebook, we actually offered some functionality that was like this but only for your college,” he says. “Facebook then was arguably as much for meeting new people around you and exploring your community as it was for keeping in touch with the people you already knew. But it was such a hard problem to do it for more than a few thousand people at a time. We transitioned from connecting with whoever you wanted to primarily staying with people you already knew. But Graph Search is like the grown-up version of that discovery aspect. Exploring your community is a core human need, and this is the first big step we’re taking in that direction.”

The first of many steps, that is. Graph Search will be improved based on how people actually use it. So Facebook plans a slow introduction, limiting the initial rollout to a small number of users. Zuckerberg’s expectation is that by the time it becomes available to millions it will be considerably improved.

For example, he thinks he can make it easier to find invitees for a canine birthday party. “We don’t have the ‘who has dogs’ field yet,” Zuckerberg says.

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Poet Sharon Olds wins T.S. Eliot award

LONDON (Reuters) – American poet Sharon Olds won the T.S. Eliot Prize for Poetry on Monday for “Stag’s Leap”, a critically acclaimed collection that traces the end of her marriage 15 years ago.

The annual award, celebrating its 20th anniversary, goes to what a panel of poets decides is the best collection of verse published in the United Kingdom and Ireland each year, and is considered to be one of the world’s top poetry prizes.

Stag’s Leap, published in Britain by Jonathan Cape, was chosen from a record 131 submissions and a shortlist of 10.

“From over 130 collections, we were particularly impressed by the strong presence of women on the list and were unanimous in awarding the 2012 T.S. Eliot Prize to Sharon Olds‘ Stag’s Leap,” said Carol Ann Duffy, chair of the judges.

Duffy, also Britain’s poet laureate since 2009, called the work “a tremendous book of grace and gallantry which crowns the career of a world-class poet.”

Olds wins a cheque for 15,000 pounds ($ 24,000) for the prize, which is administered by the Poetry Book Society and supported by the estate of leading 20th century poet T.S. Eliot whose works include “The Waste Land”.

When her marriage ended, Olds, now 70, promised her children she would not write about the divorce for 10 years. In fact, it took her 15 years to get around to publishing a collection which some critics said was her best yet.

“Olds, who has always had a gift for describing intimacy, has, in a sense, had these poems thrown at her by life and allowed them to take root: they are stunning – the best of a formidable career,” wrote Kate Kellaway in The Observer.

The critic added that the collection was surprisingly kind considering its subject matter.

In “Unspeakable”, from Stag’s Leap, Olds writes:

“He shows no anger,/I show no anger but in flashes of humor/all is courtesy and horror. And after/the first minute, when I say, Is this about/her, and he says, No, it’s about/you, we do not speak of her.”

Olds was born in San Francisco in 1942 and her first collection of poems, “Satan Says” (1980), received the inaugural San Francisco Poetry Center Award.

She went on to win a string of other prizes and currently teaches creative writing at New York University.

(Reporting by Mike Collett-White, editing by Paul Casciato)

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Well: Turning to the Web for a Medical Diagnosis

Thirty-five percent of American adults said they have used the Internet to diagnose a medical condition for themselves or someone else, according to a new Pew Research Center study. Women are more likely than men to turn to the Internet for diagnoses. Other groups more likely to do so are younger people, white adults, people with college degrees and those who live in households with income above $75,000.

The study, released by Pew’s Internet and American Life Project on Tuesday, points out that Americans have always tried to answer their health questions at home, but that the Internet has expanded the options for research. Previous surveys have asked questions about online diagnoses, but the Pew study was the first to focus on the topic with a nationally representative sample, said Susannah Fox, an associate director at Pew Internet. Surveyors interviewed 3,014 American adults by telephone, from August to September 2012.

Of the one in three Americans who used the Internet for a diagnosis, about a third said they did not go to a doctor to get a professional medical opinion, while 41 percent said a doctor confirmed their diagnosis. Eighteen percent said a doctor did not agree with their diagnosis. As far as where people start when researching health conditions online, 77 percent said they started at a search engine like Google, Bing or Yahoo, while 13 percent said they began at a site that specializes in health information.

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DealBook: JPMorgan Board Votes to Release 'London Whale' Report

The board of JPMorgan Chase voted Tuesday to release an internal report detailing the bad bet — and related management missteps — that cost the nation’s largest bank more than $6 billion, according to several people familiar with the matter.

Since announcing the trading losses in May, JPMorgan Chase has worked to move beyond the fiasco, shuffling senior management, clawing back millions of dollars in compensation from senior executives and commissioning the internal investigation. The report, which exceeds 50 pages, is the result of the investigation, led by Mike Cavanagh, JPMorgan’s former chief financial officer.

The losses stemmed from a bungled derivatives bet made by the bank’s Chief Investment Office, which was a little-known unit with offices in London and New York. An aggressive group of traders in London built a large position that distorted the credit market and has prompted $6.2 billion in losses.

Some within the bank were wary of releasing the report, which takes aim at lax supervision and risk controls, according to the people who insisted on anonymity because the discussions were not public. One concern was that plaintiff lawyers might seize on the report, the people said.

But Jamie Dimon, the bank’s chief executive, argued that the report should be released. The report is expected to be critical of Douglas Braunstein, formerly the bank’s chief financial officer, for failing to strictly monitor the activities of the traders in London.

Ahead of JPMorgan’s earnings announcement on Wednesday, the board met to discuss whether to make the report public. Also on the agenda is whether to reduce the bonuses of Mr. Dimon and Mr. Braunstein. Mr. Dimon, these people said, could have his annual payout cut by as much as 20 percent.

Among the six largest banks in the United States, Mr. Dimon was the highest-paid chief executive, taking home $23.1 million in 2011. That year, his total pay package was made up of stock and option awards along with a $4.5 million cash bonus.

A spokesman for JPMorgan Chase did not immediately return calls for comment.

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An Anaheim woman demands respect for her neighborhood

Yesenia Rojas, vibrant in her purple shawl, sang with a voice so powerful it rose above the rest of the procession as they shuffled down the damp Anaheim sidewalk.

"Era mexicana. Era mexicana," they sang with a statue of Our Lady of Guadalupe hoisted high, candlelight and street lamps illuminating their way. "Madrecita de los mexicanos."

The singsong serenade lauds the patroness, the mother of all Mexicans.

On this drizzly evening, Rojas led the group down Anna Drive, where she and her family have made their home.

In a city often defined by Disneyland and elegant sports venues, this street of working-class Latino immigrants has become an avatar of a lesser-known, voiceless Anaheim, one riddled with poverty and gangs.

When police shot and killed a 25-year-old alleged gang member who lived on Anna Drive, it stoked what had been a growing fire in the city. It was the latest in a spate of police shootings last year, which inflamed anger with law enforcement into a larger sense of resentment over ethnic and class fissures that divide Orange County's largest city.

Unrest — amplified by Occupy-connected protesters from outside the city — gripped Anaheim for days after the July shooting, followed by weeks of heated City Council meetings.

The wave of protesters demanding change has washed away, but Rojas has emerged in its wake. The 35-year-old mother of six, with short, wavy dark hair and a small frame that belies her force of will, has taken it upon herself to become the voice of Anna Drive.

Her family lives in a one-bedroom apartment just yards from where Manuel Diaz was shot that summer day. Rojas' 14-year-old daughter saw Diaz's body and has been traumatized since. Her mother can't let that go.

"I thought about leaving, and so did my husband, because of the children," she said. "But I said no. Because, first of all, we don't need to fear anyone, not even the police. The biggest thing right now is to stay on our feet and make things happen as a community. If we all leave, things won't change. They'll keep trampling us and humiliating us."

Rojas has a vision for her community that would seem bold if her wishes weren't so simple: She imagines playgrounds and community centers and political representation. But most of all, she sees respect for Anna Drive.

She balances two jobs, but she makes time for her community. She bends the ears of politicians. She organizes rallies encouraging her neighbors to register to vote and head to the polls. She plans events that she hopes will draw together a community that has grown accustomed to seeing itself as the backdrop of news cameras trying to highlight the city's ills.

And on this night, dozens gathered to pray a rosario in the tight courtyard outside her apartment, where the statue of the Virgin rested on an altar of roses and carnations.

As sirens echoed in the distance, the crowd stayed late into the night. They sang, they danced, they sipped cinnamon-spiced coffee.

And they prayed, petitioning the Virgin Mother for peace and for guidance.

"This is the community," Rojas said. "These are the people of Anna Drive."

::

Anna Drive, a collection of squat, modest apartment buildings, horseshoes off of a busy thoroughfare. On any given day, it pulses with life: children whipping down the sidewalk on scooters and skateboards, older boys tussling with one another and nanas and tatas watching it all unfold from chairs in their frontyards.

The street is clogged with cars and the vending truck that always seems to be parked along the same slice of curb, hawking snacks, produce and spices to the families who live on this stretch of tidy apartments and small, fenced-in lawns.

Rojas came to Anna Drive about a year ago, moving her family into the tight but comfortable apartment, its walls lined with family photographs. She was born in the Mexican state of Guanajuato, but she has lived much of her life in the flatlands of Anaheim. Her mother has lived in the same apartment, just a few blocks away, for decades.

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CAD Designer Transforms <em>Halo</em> Chief Into Bobble Heads

Master Chief from the Halo series is one of the most fearsome computer-generated characters of all time, as well as a popular product license for everything from action figures to desk toys. When Funko licensed characters from the iconic Xbox franchise to make bobble heads, they recruited CAD/3-D printer artist Khurram Alavi to handle the mini-makeover.

Alavi grew up on a steady diet of animated shows and videogames from the ’80s and ’90s and dreamed of becoming a comic book artist. After earning a design degree in Pakistan, he joined a local animation firm where he discovered ZBrush, a powerful CAD package developed for the entertainment industry. “The world of 3-D just opened up to me,” says Alavi. “It was as if I was sketching, but with actual clay. I started using the software and began entering online contests. I won a few and managed to get some gigs with Marvel- and Sega-based characters.”

He went on to model characters from Star Wars and completed projects for Valve Software, but the Halo bobble head project proved to be more difficult to manage than an evil mutant or fearsome Street Fighter because it had to be cute. “Trust me when I say this — cute and small is not as simple as you may think,” says Alavi. “In fact, it is very challenging as the simplified forms and curvature need to be perfect in every way. I’ve spent days on the simplest of designs just to get the curves right.”

The character and a rough idea for a pose are all Alavi had to work with. “Funko sends over rough ideas for the pose and that’s about it.” says Alavi. “It’s my job to translate it and make it work in 3-D.” Funko also provided the original 3-D models used in Halo 4, but they were of limited use because of the differing requirements in videogames and design for manufacturing. “I could barely use those models as they were made for the game, but they did help speed up with sculpting process.” he says. “I was able to nail the costume elements and details very quickly.”

The model had to capture Masture Chief’s unique look, but was also required to be manufacturable at a low cost, which required great artistry from Alavi. “When you bring more than 40 individual costume elements into the mix, it gets far more complicated,” he says. “Then to make sure that the parts are thick and detailed enough and will be produced properly is another challenge within itself.”

In order to test his models, Alavi turned to 3-D printers and worked with a firm in Hong Kong called Ownage Manufacturing, which specializes in 3-D printing complex ZBrush models. “The approval process is usually very painful, with a lot of back and forth between myself and the licensor,” says Alavi. “They want their designs to be as accurate to the source material as possible, and rightly so. A one-week job can go up to two months sometimes in the collectibles business.”

Fortunately for Alavi, working in pixels has huge benefits over modeling with plasticine clay. “The digital sculpt is very fast in this respect as we can make changes very on the fly and takes less time when compared to making changes to a physical real world sculpture.”

CAD software and 3-D printers have essentially become a “reset” button for the real world.

Photos: Khurram Alavi

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Justin Timberlake releases ‘Suit & Tie,’ first single in 5 years

LOS ANGELES (Reuters) – Pop star Justin Timberlake unveiled on Sunday his first single in more than five years, “Suit & Tie,” featuring rapper Jay Z and producer Timbaland and said a new album would be released later in 2013.

Timberlake, 31 and newly married to actress Jessica Biel, had teased his fans last week with a cryptic tweet saying “I think I am ready” and linking to a video showing him walk into a studio.

Timberlake, a six-time Grammy winner and former member of boy band N’Sync, took a break from music after his 2006 album “Futuresex/Lovesounds” and worked as an actor in movies such as “The Social Network.”

He said in an open letter on his website that the new album is titled “The 20/20 Experience” but gave no further details.

(Reporting by Piya Sinha-Roy; Editing by Jon Boyle)

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The New Old Age Blog: What You Need to Bring Your Loved One Home to Die

Most of us, when asked about how and where we want to die, answer simply “at home.” Making that happen is not always as simple as it sounds. After a post in November, “Turning a Home into a Hospital,” some readers of this blog left comments asking what equipment they needed on hand and what other steps they needed to take to make that last wish a reality.

To even begin to answer that, you have to consider two things – not simply the patient’s situation, but the caregiver’s, too, said Dr. R. Sean Morrison, director of the National Palliative Care Research Center at the Mount Sinai School of Medicine in New York.

“What I see that prevents people from being able to stay at home [to die] is not their medical needs but the needs of their caregiver — can the caregiver really help, are there resources to help, or is that person going to be overwhelmed?” Dr. Morrison said.

There is professional help available. But before we get to that, here are what specialists say are the most common kinds of equipment and preparations you may need – though, of course, every person’s medical and emotional condition is different, as is every person’s home.

1. Make room for the bed.
One of the trickiest parts of bringing the patient home is realizing that the bedroom may not be the best place to put the bed, especially if it’s located up even a few stairs. “A lot of people put the patient in a family room where there is more space, or the dining room if it’s closer to a bathroom,” said Dr. Stacie K. Levine, a geriatrician and palliative care physician at the University of Chicago. Or you might consider a room closer to the kitchen – the center of life and activity for most families.

2. Don’t forget curtains for privacy.
You can still provide privacy for whichever room you decide to turn into the bedroom by putting up a temporary curtain using a spring pressure curtain rod in the doorway. Especially in the patient’s already vulnerable state, a little privacy can go a long way toward preserving dignity.

3. Get tools that keep them moving.
Walkers, four-point canes and slim wheelchairs all help the patient to get out of bed and take part in daily life (and are covered by Medicare). To get the house ready for this new equipment, Dr. Levine cautioned, you will have to remove slippery throw rugs, as well as chairs and other furniture that can get in the way. (See this earlier post and this post for more details on reducing fall hazards at home.)

Changing door handles from knobs to levers can make moving from room to room easier on the patient feeling weak or suffering from painful arthritis.

4. Fix their favorite chairs.
Many patients find that they are just too weak to get up from what used to be their favorite chair. You can buy risers or foam cushions to put on the seats — or replace a side chair with an armchair — to give them extra leverage and allow them to stay in their old spots comfortably.

5. Experiment with earphones.
You may need several models to fit into the TV, radio and iPods or tape players so those who are losing their hearing can still enjoy their entertainment, whenever they choose, without disturbing the rest of the household.

6. Make the existing bathroom safer.
“You’ll need to install grab bars or benches inside the tub,” Dr. Levine said. (Note: Tub benches, costing about $30 to $40, are one of the few things Medicare does not cover, according to Janet Wulf, a home care registered nurse with Gilchrist Hospice Care in Baltimore, the largest hospice organization in Maryland. Convertible commodes with arms that fit over the existing toilet – and solid foam risers that fit on the toilet seat — make sitting and getting up easier.

“Sometimes we suggest changing the shower head to install a hand-held shower head so that they can still participate in bathing themselves,” Dr. Levine advised. Putting down nonskid bathmats with a rubber underside also helps prevent slipping. (Find other bathroom and household safety tips in an earlier post on fall prevention.)

7. Good lighting is critical.
Nighttime trips to the bathroom or even moving down poorly lit corridors on an overcast day can pose serious falling hazards for those whose eyes and minds may be declining. Night lights with light sensors in every room and hallway of the house are an energy-and-cost-efficient way to keep pathways lit and safe.

8. Bedside commodes are a delicate matter.
People resist bedside commodes, said Dr. Morrison. It’s not only the lack of privacy, but it makes them feel like invalids. Dr. Morrison said he stresses with patients that it’s safer than slipping and falling on the way to the bathroom. And it can be done discreetly. “I say, ‘We can put it there at night and move it in the morning.’”

What if they still balk, as many do? Dr. Morrison had this useful reminder: “Our parents are adults and they are allowed to make bad decisions.”

9. Make breathing easier.
If the patient experiences breathlessness, common for those with heart and lung disease, Dr. Morrison said, oxygen equipment can ease the discomfort and the anxiety that gasping for breath can trigger. The caregiver needs to practice not only operating the machines, but getting the long, plastic oxygen tubing out of the way as the patient moves around the house.

10. Are pain pumps or intravenous drips for pain helpful?
In most cases, they are not necessary. “We can control pain orally with medication that comes in highly concentrated form, so even if patients can’t swallow, they can have pain control,” Dr. Levine said. Or the patient can get a steady baseline of pain medication by wearing a skin patch, or a nurse can administer a shot (through the skin, not the muscle, which would itself be painful).

Occasionally, for those with long-standing pain issues who require unusually high doses of medication, an intravenous drip can deliver a steady supply, which can be controlled by the patient with a button (within limits) or by a nurse or caregiver.

In even more rare cases, for patients with the highest pain-control needs, an intrathecal pain pump can be inserted into the intrathecal space around the spine area, “much like an epidural used in childbirth,” Dr. Levine said, and added that “It is an invasive procedure and requires a lot of monitoring.” So it is most commonly used as a solution for chronic pain over many years – and rarely recommended for those with less than a few months to live.

11. Should you order a hospital bed?
The idea of bringing this piece of equipment home sparks some of the most emotional disputes, among patients and caregivers alike.

“It’s a big deal to give up sleeping with a lifetime partner and the warmth and comfort of sleeping together,” Ms. Wulf said.

It is also the one piece of equipment that clearly turns the home into a hospital. Small wonder so many resist, as the blogger who wrote the “Turning Home into a Hospital” post admitted.

“And there is the issue of where are you going to put it?” said Ms. Wulf, as the hospital bed is not only an extra bed in the home, but it is slightly longer than a regular twin bed.

But if your loved one is having trouble getting in and out of a regular bed, and your back is being strained as you help, the hospital bed, which lowers, can make that process safer and easier for both of you. (It is covered by Medicare.) Similarly, being able to raise the hospital bed can make assisting with dressing, changing adult diapers and making up the bed a lot easier.

Also, because the head and foot of the hospital bed can be adjusted separately, it can make patients (especially those with heart and lung disease who need propping up to prevent fluid from accumulating in the lungs and legs) more comfortable than they would be lying flat or propped up with an assortment of pillows.

For those with dementia, who forget to change position, or with cancer and other ailments that leave them too weak to move around, the hospital bed — with an air compression mattress — will do the job for them. It can prevent bedsores, which, according to Dr. Levine, “can start very soon in somebody who isn’t turned and repositioned every three hours” all day and night.

12. Consider hospice.
Equipment aside, one of the biggest resources that a caregiver can call upon in these last stages, in addition to backup care from family, friends and home health aides, is hospice — as we’ve talked about in this blog many times. I can tell you from my family’s recent experience that hospice is like sending in a team of loving aunts – only they’re far more patient (no family baggage) and way more competent.

A good hospice team not only helps the caregiver figure out a plan for care but arranges for Medicare approval and payment. What many don’t know is that hospice even covers “respite care” for the caregiver – paying for up to five days of room and board for the patient in a nearby medical facility (or nursing home) so the caregiver can take a break – even to go on vacation, according to Lori Mulligan, senior director of development marketing and community services at Gilchrist Hospice Care, the largest hospice care organization in Maryland.

But as this blog has written many times before, too many people wait until the very end to call hospice. The median time in hospice is about 19 days, and more than a third of patients wait until the last week, according to the 2012 report tracking hospices nationwide from the National Hospice and Palliative Care Organization.

Why don’t they take advantage of the six months of extra help at home that they are eligible for under Medicare once a prognosis is made?

First, “clinicians are not great at prognosis” until the very end, said Dr. Levine. And the patient and family aren’t always ready to hear it.

“When people think of hospice, they think, ‘Oh, my mom will be lying in bed all the time,’” Dr. Levine said. Or they worry that calling in hospice may actually hasten death. Instead, Dr. Levine has found just the opposite.

“I have been doing this for over a decade and I find my patients who choose hospice sooner at home may live a little longer,” said Dr. Levine. When you shift the focus from a full-court press on cure (hospitals’ goals) to providing comfort (hospice credo), patients can stop using all their energy to fight the pain, so they are more likely to have the energy to “eat and walk and do all the things they like to do that keep us alive,” Dr. Levine added.

How do you know when it’s time?

Dr. Levine advises: Ask yourself if you would be surprised if the person you’re caring for would die within six months. And ask the patient about his or her goals. If he or she feels that all the treatment options have been exhausted but the disease is still progressing, and the patient is tired, doesn’t want to go back into the hospital, and just wants the comfort of their own bed — then it may be time to go home.

One more thing to bear in mind if you decide to call hospice: size matters.

“The larger the hospice, usually the more services for the patient and caregiver,” said Dr. Morrison, referring to a 2011 study in Medical Care journal supporting the bigger-is-better rule of thumb. “Ask for their daily patient census – several hundred patients per day is a good size,” Dr. Morrison added.

Remember, the point of all this is to make both the patient and the caregiver as comfortable as possible in those final days.

For most of us that can mean, “There’s no place like home.”

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F.D.A. Warns St. Jude Medical

St. Jude Medical, a maker of medical devices, said Monday that it had received a warning letter from federal regulators concerning manufacturing issues at its Sylmar, Calif., plant, where it makes cardiac rhythm management products.

In a regulatory filing, St. Jude said the Food and Drug Administration had noted in the letter that it would not approve certain new product applications until the quality system violations were corrected.

The letter does not identify any specific concerns about the performance of the company’s Riata ST Optim or Durata leads or any other St. Jude Medical product, the company said.

St. Jude said it would continue manufacturing and shipping products from the Sylmar plant, and that customer orders were not expected to be affected while it works to resolve the F.D.A.'s concerns.

In October, the company disclosed that it might receive such a letter from the F.D.A.

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