Indoor environment acceptability in the Continuing Care Retirement Community setting

Includes a sample letter and questionnaires.Department: Architecture

Validation of the Environmental Audit Scoring Evaluation (Ease) Tool for LTC Households

This poster will share the results from a research initiative funded by the National Institutes of Health to assess the validity of the Environmental Audit Scoring Evaluation (EASE) tool in its ability to distinguish between different types of skilled care models based on the environmental and operational practices that can be observed and documented. The EASE tool was compared against three existing tools; PEAP, TESS-NH, and EAT-HC. Twenty-eight living areas in nursing homes across the state of Kansas identified as a traditional, household, or hybrid model were observed. The scores of the EASE were compared against the scores of three existing tools in order to evaluate its construct validity. The EAT-HC was most closely related to the EASE, with an R-value of 0.8817. The PEAP and the TESS-NH were less correlated to the EASE, with R-values of 0.8175 and 0.7097, respectively. Results found that the EASE was able to distinguish between traditional and homelike settings, though it could not identify hybrid models with a high degree of certainty. The analysis of variance between homelike and traditional homes was significant at 0.016, while the variance between homelike and hybrid and between hybrid and traditional were not significant. Inter-rater reliability of the EASE was consistently high (.96 and above). The outcomes demonstrated the EASE tool was able to assess the homelike characteristics of the environment of nursing homes better than or equally as well as previously validated tools

The significance of the door in nursing homes: a symbol of control in the domestic sphere

This article explores how public/private contradictions can be enacted in the space of the nursing home through the use of architectural features that signal transition and passage, most specifically the door. To explore these relationships, two alternative forms of the institutionalized skilled care setting will be described. The first represents the state of the most common form of nursing home, the institution that has been patterned after a hospital; the second represents an emerging place type in long-term care called a "household," patterned after the domestic home. The divergent spatial experiences of these settings will be expressed through the role of the door and the supporting transitional features that are architecturally determined and will compare and contrast the dramatic changes that can occur in the ideological communication of these domains. Their use, their language, and therefore their meaning within the spaces are suggested through the patterns of behavior they support

Regulating “Culture Change” in Long-term Care

As an institutional type, nursing homes can be most closely linked to the hospitals created during the Industrial era of our nation’s history, and have adopted similar approaches to providing clinical care. While often physically and cognitively frail the needs of nursing home residents are more complex than simply needing medical treatment. These individuals often become permanent residents of these facilities and require a setting that recognizes them as individuals. As America ages, projections point to an increasing use of nursing homes in the next ten to twenty years. Therefore, nursing homes will become an increasingly important place-type in our country. Since 1997, groups increasingly called for more patient-centered approaches. In the field of long-term care, this is often referred to as “culture change.” The goal of culture change is to create a system of “interdependency” that enhances the quality of life for residents as well as the quality of the work environment for staff. This approach focuses on the capacity of residents and their abilities to participate fully in the lives and the decision about their daily routines and care. This type of care requires rethinking the way that residents interact with care professionals as well as the built environment. Finding a fit between these new approaches and existing regulatory requirements is daunting. Nursing homes derive a majority of their resources from federal dollars, and eligibility is contingent upon meeting federal regulatory policies. The existing regulatory statutes may be too clinically focused to provide for the necessary flexibility that is required in a person-centered care approach. Some argue that “negative attributes of nursing home culture are reinforced by governmental regulation and payment mechanisms, as part of a mutually-reinforcing and mutually-symbiotic relationship between government and the nursing home industry (Vladeck, 2003, p. 3).” This paper will focus on understanding of the existing regulatory framework and the implications and contradictions of the new interpretive guidelines that are intended to advance the quality of life in long-term care settings. It will conclude with recommended actions to increase the efforts to ensure that long-term care regulations make quality of life a top priority

Establishing acoustical standards within environments for the aging: What should we be building?

Currently one in twenty-five people are at retirement age; in the near future, this figure will jump to one in eight (Weinstein, 2000, p. 10). This demographic curve represents the cohort commonly referred to as “baby-boomers,” who will retire as an influential, active, and expectant body of individuals (Levin, 2002; Peck, 2003; The Growth of America’s Older Population, 2000). Despite anticipating this growing older population, acoustical standards are not being considered in even most award-winning long term care (LTC) facilities, where an estimated one in three residents have some form of hearing impairment (Dugan, 2003, p. 22; Healthcare Design, 2002; Healthcare Design 2003). These unique acoustical issues include understanding hearing within the aging process, application of existing acoustical standards and research to health care facilities, and discussing what should be built to maintain a high quality of life for residents in LTC environments

Evaluation of environmental assessment tools for settings for individuals living with dementia

Abstract Introduction The overarching goal of research on physical settings for individuals living with dementia is to identify associations between designed features within the built environment and outcomes of interest. Over the past three decades numerous environmental assessment tools have been developed in several countries, responding to a changing set of care industry values that increasingly prioritize a holistic, quality‐of‐life–driven person‐centered care (PCC) model over a biomedical approach to long‐term care (LTC) provision. This article reviews the diversity, constructs, strengths, and limitations of existing environmental assessment tools and identifies gaps for future tool development. Methods A systematic literature search was conducted using four databases (Medline, CINAHL, PsycInfo, and Avery Index) and terms related to health‐care environments and assessment tools. Results A total of 13 environmental assessment tools for people living with dementia within shared residential settings were identified. Evaluation of the environmental assessment tools includes a synthesis of published data for each tool's reliability, validity, ease of use, interpretability, strengths and weaknesses, as well as a comparison of various tool characteristics including date of development, country of origin, applicable care setting(s), number and variety of measures and underlying constructs, format, and descriptive versus evaluative content. Discussion While the shift to person‐centered values encompasses all aspects of care and care settings, the majority of person‐centered definitions exclude the important role of the designed, physical environment. However, this review of environmental assessment tools clearly demonstrates that newer tools are embracing the full array of PCC values. In the United States, this is shown in the shift from tools designed to assess segregated dementia care settings to tools that integrate the needs and preferences both of individuals living with and without dementia. Next‐generation tools need to specifically address the household model of design. Highlights The overarching goal of research on physical settings for individuals living with dementia is to identify associations between designed features within the built environment and outcomes of interest. A systematic literature search identified a total of 13 environmental assessment tools for people living with dementia within shared residential settings; these tools were then described and evaluated based on reliability, validity, ease of use, interpretability, strengths, and weaknesses. This review of environmental assessment tools clearly demonstrates that newer tools are embracing the full array of person‐centered care values