Margaret P. Calkins

Professional environmental assessment procedure for special care units for elders with dementing illness and its relationship to the therapeutic environment screening schedule.

The Professional Environmental Assessment Procedure (PEAP) was developed as a global quality-assessment measure for use by trained professionals in special care units for older people in dementia units of nursing homes. The PEAP consists of nine ratings whose relationship to another assessment device, the Therapeutic Environment Screening Schedule (TESS), is reported. Although designed to be multidimensional, the PEAP as tested in 43 special care units seems to reflect primarily a single evaluative dimension. It correlates highly with the TESS and may be used either separately or in combination with the TESS.

The physical and social environment of the person with Alzheimer's disease

The papers by Lawton and Charness & Holley present two different but complementary views about our current state of knowledge about environments for people with Alzheimer’s disease, and suggest distinct approaches for advancing our knowledge base in this area. This paper has three specific aims: it will review some of the common themes found in the papers by Lawton, Charness & Holley; it will provide more concrete examples of links between research and design; and it will present a more systemic conceptualization of the physical and social environments which may serve as a foundation for future research on care settings for individuals with dementia.

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 Alzheimers disease and related dementias.

Effect of Increased Time Spent Outdoors on Individuals with Dementia Residing in Nursing Homes

SUMMARY There is growing evidence that exposure to bright light may improve circadian rhythms in individuals with dementia residing in shared residential settings. The vast majority of this research uses electric bright light boxes. However, the outdoor environment not only provides exposure to bright light but to natural elements which have been shown to have a restorative effect across a broad range of situations. Previous research that sought to explore the impact of time spent outdoors on sleep and/or agitation in individuals with dementia was hampered by low time spent outdoors. This project, conducted in three nursing homes (n = 17), used actigraphy, validated proxy measures of sleep and agitation and direct observation to explore the impact of increased time outdoors on sleep and agitation. The repeated measures design assessed residents with dementia under four conditions: winter/no activity, winter/inside activity, summer/no activity and summer/outside activity. Results suggest that increased time spent outdoors resulted in a modest improvement in sleep, and mixed or immeasurable impact on agitation.

Impacts of a therapeutic environment for dementia care

This study explores the association ofphysical environments with the behaviors and care ofpeople with dementia. In order to have a comparative understanding, environmental settings of a traditional nursing facility and an innovative dementia care unit on the same campus were selected. Behavioral observations were done on 12 residents before and after their move ftrom the traditional facility to the dementia care unit. Resident and staffusage and behaviors in the shared spaces were systematically recorded and analyzed Findings include increased use ofthe activity spaces, increased social interaction among the residents, and more interactive than assistive behavior between the staff and residents

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).

Influences on perceived function of a nursing home resident.

UNLABELLED This article describes a typical, yet fictionalized woman with Alzheimers 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 Organizations 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. LEARNING OUTCOMES 1. The reader will be able to identify the four main constructs of the ICF classification system. 2. The reader will be able to identify three environmental factors that may influence the functioning of a person with Alzheimers disease. 3. The reader will be able to discuss at least four interventions that can be implemented by a speech-language pathologist to improve a nursing home residents participation in daily activities.

Powell Lawton's Contributions to Long-Term Care Settings

Abstract The design of long-term care facilities has changed radically over the past three decades, due in large part to the pioneering work of Powell Lawton. His early conceptualizations of key principles for people with dementia-orientation, negotiability, personalization, social interaction and safety-were considered somewhat radical when first applied in the Weiss Institute. Now, several decades later, many of the design implications of these principles have been empirically validated, and are pervasive and considered standard practice in long-term care design. This paper traces the history of long-term care design over the past three decades, clearly demonstrating the influence of Powell Lawtons work.

Therapeutic kitchens for residents with dementia

Long-term care facilities are increasingly incorporating some sort of kitchen, often referred to as a therapeutic kitchen, for resident, staff, and family use through remodeling efforts or new construction. A study, consisting of five site visits and a questionnaire mailed to 631 facilities providing dementia care, was conducted to identify physical features that are typically included in therapeutic kitchen design and to explore how these features support daily use in relation to activities programming and food service systems. Findings indicate that universal design features should be incorporated to a greater extent and certain features are more common, reinforce homelike imagery, or enhance safety. Results also suggest that a higher number of residents participate in more recreational activities, such as baking, than they do in household chores, such as meal set-up, and therapeutic kitchens are not always linked to food service systems.

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.g., take medications), or the reverse of not letting them do what they want (e.g., eat a regular diet). The current article discusses a process that helps care communities follow the regulations about education and offering choices while honoring resident preferences and documenting the process for surveyors. [Journal of Gerontological Nursing, 42(8), 12-17.].