Lois J. Cutler

Post-Occupancy Evaluation of a Transformed Nursing Home: The First Four Green House® Settings

To study how well the physical environments of four Green Houses® served the residents, staff, and visitors and to develop recommendations for similar small-house nursing home projects. Longitudinal post-occupancy evaluation of four houses using mixed-methods, including behavioral mapping, checklist ratings of individual bedrooms and bathrooms, place-centered time scans, environmental tracers, and questionnaires and interviews. The small residential environments achieved the desired functional results for residents and staff. Some components of the environment proved problematic, especially bathroom designs, lighting and fixtures, and storage spaces. Certain areas of the buildings were under utilized, particularly a den. Space was used differently in the two houses dedicated to residents with dementia compared to the other two houses. In the latter, residents tended to use their own rooms for a variety of activities, including visits, and often kept their doors closed, whereas in the former the central hearth area was used more frequently. The physical design of the Green Houses was associated with desired behavior and outcomes in residents and staff. Post-occupancy evaluation methods were useful to elicit detailed information about environmental performance and suggest modifications for the next iteration of Green Houses.

As great as all outdoors: A study of outdoor spaces as a neglected resource for nursing home residents

Abstract Purpose. Previously, most information on outdoor amenities in nursing homes and the use of outdoor space by nursing home residents has been anecdotal. Using data collected from the Center for Medicare and Medicaid Services (CMS) study on Quality of Life (QOL), this paper describes the availability of outdoor amenities in 40 nursing homes and the residents perception of their use of that space. Design and Methods. Resident data were collected from nineteen hundred and eighty-eight residents in 131 nursing units in 40 nursing homes located in 5 states on a broad array of topics including how often they get outdoors and if that amount was as much as they want, too much, or not enough. For each of those nineteen hundred and eighty-eight residents, staff was questioned on how often the resident participated in planned outdoor activities. Environmental data were collected using theoretically-derived observational tools that were developed to observe in detail the physical environments experienced by those nineteen hundred and eighty-eight nursing home residents at three nested levels: their rooms (112 items), the nursing unit (140 items); and the facility as a whole (134 items). These analyses focus on the presence or absence of items specific to outdoor space at the unit and facility level. Results. Descriptive statistics showed great variation in outdoor amenities and access to those amenities across facilities. The majority, 55.7% (n = 73), of the environments of the 131 units had no items featured on the outdoor amenities index. Of the residents who are physically able to go outdoors, thirty two percent do so less than once a month. Implications. Only recently have the effects of the outdoor environment on well being been systematically studied. This resident-specific data collection on the availability of outdoor amenities and research at the resident level permits hierarchical analysis to examine the effects of outdoor space on resident quality of life.

Re-Imagining Long-Term Services and Supports: Towards Livable Environments, Service Capacity, and Enhanced Community Integration, Choice, and Quality of Life for Seniors

In the half century since enactment of the 1965 Great Society programs, accomplishments were gradually made to improve access to and quality of long-term services and supports (LTSS), including: mitigation of financial and care abuses in nursing facilities (NFs); substantial rebalancing of LTSS towards consumer-preferred home-and-community-based services (HCBS); increasing flexible consumer-centered HCBS including payment to family caregivers; and more assisted-living and housing options for seniors with heavy care needs. A unified planning and advocacy agenda across age and disability type and greater consumer transparency fueled progress. Nonetheless, LTSS is a broken system; persistent problems interfere with substantial and necessary change. These include; over-emphasis on safety for LTSS consumers; inattention to physical environments in all settings; regulatory and professional rigidity; and poor communication and information. Our recommendations are aimed at builders and designers, LTSS professionals, regulators, and educators/trainers; the last may be crucial in forging new consensus and over-coming entrenched beliefs. Policy recommendations include relatively narrow steps-for example, requiring single occupancy in all NFs and assisted living settings financed with public dollars-to broad reworking of the prerequisites for livable age-friendly (and dementia-friendly) communities and for a capable, flexible LTSS workforce.

Developing a Typology of Nursing Home Environments

Abstract Nursing homes are complex environments with large numbers of features that may impact resident quality of life. Multivariate analysis of the effects of individual features is difficult because many features are potentially confounded with one another. We used cluster analysis to identify four types of resident room environments and four types of unit/facility environments. The data were collected using a new environmental assessment instrument in 1,988 resident rooms in 131 units in 40 nursing homes in 5 states. We lay out a series of testable hypotheses about the impact of specific environmental features on resident quality of life as an agenda for future research.