At the time of this article’s publication (2018), there was an estimated population of two million elderly patients living in nursing homes. The authors suggest that approaches for optimizing the designs of nursing homes are unclear and relatively unexplored, resulting in negative connotations towards nursing homes among residents and the public alike. More specifically, many previously proposed assessments of nursing homes did not focus on the appraisal of individual patient rooms or care spaces for patients living with dementia. The assessments also relied heavily on subjective ratings while conflating observed patient behaviors with descriptions of physical environments. The authors suggest that creating new nursing home assessment tools could improve assessments overall and help improve facilities in the future.
To describe the development of a set of environmental checklists used for observing and assessing the quality of nursing home environments that provide care to patients living with dementia.
The authors conducted both a literature review and a series of discussions with relevant stakeholders to develop new “environmental checklists” that could assist with the assessment of physical environments designed for the care of patients living with dementia. The validity of each checklist item was gauged by four environmental design experts. The result was a 112-item checklist for individual patient rooms; a 140-item checklist for nursing stations, corridors, shower rooms, dining areas, and outdoor spaces; and a 134-item “facility-wide” checklist that encompassed all spaces not covered in the aforementioned lists. The checklists were then tested over one year in eight different nursing homes located in different geographical regions within the U.S. All patients observed in the included nursing homes were above 65 years of age and were living with dementia.
After testing all three checklists in the field and gathering additional feedback from other professionals using the checklists, the authors state that the new checklists were found to be reliable and helpful in the assessment of nursing homes treating dementia patients. Certain subjective judgments, such as how “well maintained” a given area was, resulted in slightly lower levels of reliability. Use of the new checklists revealed wide varieties in quality at all levels of observation, further highlighting the need for these assessments and future actions to better equip facilities for dementia patient care specifically.
The authors note that additional research is needed to further establish the reliability of these checklists between different reviewers and institutions, especially with regard to more subjective checklist items. Since checklist items were initially designed and reviewed by a relatively small team of professionals, consumer perspectives were not directly incorporated.