Environmental audit scoring evaluation: evolution of an evidence-based environmental assessment tool to support person-centered care.

Long-term care settings are at the center of strongly debated approaches to policies that shape the delivery of care and operational practices. There is advocacy for transformational change within these settings to support a person-centered approach to care delivery, but it is difficult and multifaceted involving everything from changing the level of staffing and care models to developing appropriate metrics to assess an individual's quality of life. The physical environment is a key component for accomplishing the organizational and operational goals related to person-centered care, but providers and their design teams need the appropriate tools to guide evidence-based decision-making.

The Assessment of Long-Term Care Environments for Wayfinding Design.

Objectives: The purpose of this article is to compare three different methods to assess the complexity of a long-term care (LTC) environment for wayfinding before and after an environmental design intervention. The methods include space syntax (SS), the Wayfinding Checklist (WC), and the Tool to Assess Wayfinding Complexity (TAWC).

Background: Wayfinding is important to maintain older adults' independent functioning.

The Environmental Audit Screening Evaluation: Establishing Reliability and Validity of an Evidence-Based Design Tool.

Background And Objectives: Current assessment tools for long-term care environments have limited generalizability or ability to be linked to specific quality outcomes. To discriminate between different care models, tools are needed to assess important elements of the environmental design. The goal of this project was to systematically evaluate the reliability and validity of the Environmental Audit Screening Evaluation (EASE) tool to better enable the identification of best models in long-term care design to maintain quality of life for persons with dementia and their caregivers.

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

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.

Effect of Ambient Bright Light on Behavioral and Psychological Symptoms in People With Dementia: A Systematic Review.

Background And Objectives: Behavioral and psychological symptoms of dementia (BPSD) commonly occur in persons living with dementia. Bright light (BL) interventions have shown some positive impact on BPSD. Ambient lighting is a more efficient approach to delivering BL with better compliance and less staff workload than individual-based lighting interventions.

Advancing Research on Care Needs and Supportive Approaches for Persons With Dementia: Recommendations and Rationale.

The first National Research Summit on Care, Services, and Supports for Persons with Dementia and Their Caregivers was held on October 16-17, 2017, at the National Institutes of Health. In this paper, participants from the Summit Session on Research on Care Needs and Supportive Approaches for Persons with Dementia summarize the state of the science, identify gaps in knowledge, and offer recommendations to improve science and practice in long-term care. Recommendations cover 4 areas focused on persons living with dementia: (1) symptoms (behavioral and psychological symptoms of dementia, function, cognition, and sleep); (2) dementia care settings (physical and social environments, home, and residential care); (3) living with dementia (living well with dementia, living alone with dementia, and living with dementia and intellectual and developmental disabilities); and (4) technology as a cross-cutting theme.

From Research to Application: Supportive and Therapeutic Environments for People Living With Dementia.

The evidence about the role the designed and built environment plays in supporting individuals living with dementia has been steadily mounting for almost 40 years. Beginning with the work of M. Powell Lawton at the Weiss Pavilion at the Philadelphia Geriatric Center, there are now dozens of researchers who are exploring how the environment can be either supportive and therapeutic, indeed even serving as a prosthetic for various changes in cognition, or be a barrier to independent functioning and high quality of life.

Beyond ADA Accessibility Requirements: Meeting Seniors' Needs for Toilet Transfers.

Purpose: To identify the optimal spatial and dimensional requirements of grab bars that support independent and assisted transfers by older adults and their care providers.

Background: Although research has demonstrated that toilet grab bars based on the Americans with Disabilities Act (ADA) Accessibility Standards do not meet the needs of older adults, the specific dimensional requirements for alternative configurations are unknown.

Methods: A two-phased study with older adults and care providers in residential facilities was conducted to determine the optimal requirements for grab bars.

Honoring Individual Choice in Long-Term Residential Communities When It Involves Risk: A Person-Centered Approach.

Nursing homes that are working on adopting person-centered care (PCC) practices express concerns about giving residents the freedom to make their own decisions and the accompanying risks. This challenge is especially true for those who are at the beginning of the PCC change process. Although the Centers for Medicare and Medicaid Services regulations are clear that residents have the right to a dignified existence and self-determination, and that the facility must protect and promote their rights, examples abound of care communities coercing, cajoling, or requiring residents to do things they do not want to do (e.

Development and evaluation of the environment and communication assessment toolkit with speech-language pathologists.

Communication dysfunction that results from dementia can be exacerbated by environmental barriers such as inadequate lighting, noisy conditions, poor or absent environmental cues, and visual clutter. Speech-language pathologists (SLPs) should address these environmental barriers as part of a comprehensive treatment plan for clients with dementia. The Environment and Communication Assessment Toolkit for Dementia Care (ECAT) was evaluated by SLPs to determine: (1) changes in awareness of environmental factors prior to and after training; (2) impact of the ECAT on practice as measured by changes in the number of environmental modifications recommended and made prior to and after training; (3) utility of the information as measured by the helpfulness, amount of new information, and usefulness of the ECAT; and (4) usability of the ECAT materials based on ease of use.

Evidence-based long term care design.

Research on the impact of the built environment in long-term care settings continues to grow. This article focuses on work conducted and published since 2000, when an earlier review on research on dementia and design was published. The vast majority of research that addressed neurological conditions in residents in long-term care settings (assisted living and nursing homes) relates to Alzheimer's disease and related dementias.

Exploring the cost and value of private versus shared bedrooms in nursing homes.

Purpose: There is debate about the relative merits and costs of private versus shared bedrooms in nursing homes, particularly in light of the current efforts at creating both cost-efficient and person-centered care facilities. The purpose of this project was to explore the extent to which there is evidence-based information that supports the merits of three different bedroom configurations: traditional shared, enhanced shared, and private.

Design And Methods: We developed a framework of four broad domains that were related to the different bedroom configurations: psychosocial, clinical, operational, and construction or building factors.

Measuring physical and social environments in nursing homes for people with middle- to late-stage dementia.

Objectives: To evaluate measures of dementia care environments by comparing a special care facility (SCF) with traditional institutional facilities (TIFs).

Design: A cross-sectional comparative study of nursing home environments conducted as part of a longitudinal study on quality of life for residents with dementia.

Setting: Twenty-four traditional nursing homes and one special care facility.

Influences on perceived function of a nursing home resident.

Unlabelled: This article describes a typical, yet fictionalized woman with Alzheimer's disease during her first week at a nursing home. Readers are challenged to ask themselves in what areas of difficulty a speech-language pathologist may or may not be able to contribute to the success of this resident. The authors use the World Health Organization's International Classification of Functioning, Disability, and Health [International Classification of Functioning, Disability, and Health, 2001, Geneva, Switzerland] as the framework for assessments and the resident-centered interventions for this case study.

The Therapeutic Environment Screening Survey for Nursing Homes (TESS-NH): an observational instrument for assessing the physical environment of institutional settings for persons with dementia.

Objective: To develop an observational instrument that describes the ability of physical environments of institutional settings to address therapeutic goals for persons with dementia.

Methods: A National Institute on Aging workgroup identified and subsequently revised items that evaluated exit control, maintenance, cleanliness, safety, orientation/cueing, privacy, unit autonomy, outdoor access, lighting, noise, visual/tactile stimulation, space/seating, and familiarity/homelikeness. The final instrument contains 84 discrete items and one global rating.