The purpose of the literature review was to create a framework for evaluating key environmental design features that impact resident safety in various residential care settings - skilled nursing facilities, assisted living, and memory-care facilities. The review focused on the existing empirical research studies about the relationships between environmental design and safety outcomes in residential care settings. After a process of searching, sorting, and screening over 100 publications, a total of 55 research articles were identified and classified into six major outcome categories. A framework was then created to present the environmental features impacting each outcome category, key research findings, strength of evidence, and the relevant reference information as well as evidence-based design recommendations.
The existing body of research evidence indicates that various environmental features significantly impact safety outcomes in six categories:
- Resident falls
- Resident elopement/unsafe exiting
- Sleep disorders
- Aggressions/disruptive behaviors
- Medical errors, and
- Healthcare-associated infections
Several environmental features are especially important because each of them influences multiple resident safety outcomes:
- Room occupancy (single-bed rooms)
- Lighting (high lighting levels, sunlight)
- Outdoor nature/wander garden
- Acoustics (noise reduction, music, nature sounds)
- Ambience (soothing environment, positive distractions).
The literature review also identified several gaps in knowledge base that need more research. Rigorous research is needed to verify whether evidence from other similar healthcare settings including other residential care settings is also applicable in specific residential care settings and to address specific problems found in residential care.