Residential Long-Term Care and the Built Environment: Balancing Quality of Life and Infection Control

OBJECTIVES

This article explores expert insights into residential long-term care (RLTC), specifically regarding the built environment, its impact on infection control (IC) measures and on resident, staff, and family member quality of life.

DESIGN

The interviews discussed in this report form part of a larger mixed methods research design, examining the planning, design, and operation of RLTC. Specifically, this report discusses findings from one aspect of this research, a series of semistructured interviews.

SETTING AND PARTICIPANTS

Interviews were conducted online through video conferencing platform Zoom. The project's steering committee were asked to suggest key organizations involved in IC and RLTC provision and policy, with 23 representatives (17 organizations) being invited to interview. Where representatives were unable to participate, they suggested alternate representatives.

METHODS

The research team conducted 20 interviews with key representatives or "experts" from different aspects of RLTC provision, policy, and IC. A thematic analysis was employed to analyze and generate key themes.

RESULTS

For brevity, the codes that had been mentioned by >5 interviewees, specific to the built environment, IC and quality of life were prioritized, resulting in 16 prioritized themes grouped according to spatial scale.

CONCLUSIONS AND IMPLICATIONS

This research demonstrates the growing awareness of the built environment as a critical partner in the RLTC health and social care model, as well as illustrating the need for a holistic design approach across all key spatial scales to support the health and well-being of older people in RLTC. Further research is needed on various aspects of RLTC, including the impact of care models and setting size on IC, quality of life, and cost implications. RLTC policy needs a more integrated approach to planning and design, specifically around RLTC location. This research suggests that RLTC providers look to evidence-based, inclusive design guidelines to inform the design and retrofit of RLTC. Additionally, the operation and management of space should be considered by providers.

RETHINKING NURSING HOME ARCHITECTURE AND DESIGN IN THE LIGHT OF THE COVID-19 PANDEMIC

Introduction

The huge death rate in nursing homes during the COVID-19 pandemic raised serious questions as to whether the built environment of nursing homes was a factor in this very high mortality, as well as a factor in quality of life.

Method

We embarked on a wide-ranging study involving a review of Irish policy, stakeholder engagement, Irish case studies, literature review, and international case studies to understand the key issues that influence the planning, design, and operation of nursing home settings settings, and to identify how these shape care models and the physical environment.

Results

The project generated the following key themes: a) including the voices of residents, family and staff in co-creation of design and research; b) integrating nursing homes with the overall housing spectrum; c) linking nursing homes with ageing in place policy; d) further research on optimal design; e) understanding resident diversity; f) greater inclusion of Universal Design principles; g) designing for resilience; and h) Convergence between infection control and quality of life Discussion: Our Research Findings have been developed to identify major current issues related to the built environment and its role in creating a balance between quality of life and COVID-19 infection control in Irish and international nursing home settings. These findings are relevant for a wide range of stakeholders and will be disseminated across a number of channels to continue this conversation and help to continue the evolution of nursing home design.

212 BUILT ENVIRONMENT OF NURSING HOMES AND INFECTION CONTROL AND PANDEMIC PREPAREDNESS

Background

The disproportionately high death rate of nursing home (NH) residents from COVID-19 in many countries, including Ireland, has focussed attention on infection prevention and control, including the built environment, in nursing homes. This has been a poorly researched topic to date, and we undertook a systematic review of evidence for architectural design measures which support infection control and pandemic preparedness.

Methods

Databases were screened for keywords related to NHs, built environment, infection prevention and control, and COVID-19; relevant papers were uploaded onto Covidence and screened for relevance. Data extracted from included articles was tabulated under 8 specific aspects of the built environment.

Results

Of 17 papers included in the final analysis, four studies found that larger nursing homes carried an increased risk of COVID-19 infection. Crowding in NHs was also a risk factor for infection, with a high crowding index associated with COVID-19 infection in five studies. Green House care homes, which are based on small clusters of domestic dwellings, fared better than traditional NHs. Two papers found an association between the location of NHs and the risk of COVID-19 infection, with urban NHs and those in areas of high prevalence being more at risk. Two papers identified internal fittings as a target for infection prevention and control. Seven papers highlighted the role of adequate ventilation in NHs in the prevention of spread of COVID-19. Only one paper described easy access to the outdoors as beneficial to infection control.

Conclusion

Residents of NHs are amongst the most vulnerable to COVID-19 infection. When designing and building NHs, the role of the built environment in controlling the spread of the virus should not be underestimated.

This research supported by Science Foundation Ireland.

Understanding the knowledge and engagement of facilities management with dementia-friendly design in Irish hospitals: an exploratory study

Purpose

This exploratory study stems from research conducted between 2015–2018 focussing on dementia-friendly design (DFD) in hospitals (Grey T. et al. 2018). Specifically, this study focusses on facilities management (FM) staff in Irish hospitals to gain a preliminary understanding of the level of knowledge and engagement of FM in the implementation of dementia-friendly hospital (DFH) design.

Design/methodology/approach

A mixed-methods approach based on a series of ad hoc semi-structured interviews, and an online survey. The aims were, namely, assess the extent of FM engagement in hospital works; measure the level of awareness regarding DFD; and identify facilitators and barriers to DFD in hospital settings. Participants (74) comprised FM staff in 35 Irish acute care hospitals. The research findings are based on thematic analysis of ad hoc semi-structured interviews (participants, n = 4) and survey responses (participants, n = 13).

Findings

While FM staff reported to possess important knowledge for building DFH, they also mentioned a lack of engagement of FM in design processes and hospital works.

Practical implications

The research has gained insight into the role of FM in promoting a dementia-friendly approach. Lack of or poor engagement of FM in design processes and hospital works means not fully tapping into rich expertise that would be invaluable in the development, implementation and maintenance of DFH. Universal design is a key driver for facilitating their engagement in the design, implementation and maintenance of DFH environments.

Originality/value

This is the first study exploring the role of FM in supporting a DFD approach in acute care hospitals.

Dementia Friendly Hospital Design: Key Issues for Patients and Accompanying Persons in an Irish Acute Care Public Hospital

OBJECTIVES

Research was conducted to investigate the impact of the hospital environment on older people including patients with dementia and their accompanying persons (APs). The article presents key research findings in the case study hospital.

BACKGROUND

For many patients, the hospital is challenging due to the busy, unfamiliar, and stressful nature of the environment. For a person with dementia, the hospital experience can be exacerbated by cognitive impairment and behavioral or psychological symptoms and can therefore prove to be a frightening, distressing, and disorientating place.

METHOD

The findings are based on a stakeholder engagement process where the research team spent approximately 150 hr observing within the hospital, administered 95 questionnaires to patients and/or APs, and conducted 12 structured interviews with patients and APs. A thematic analysis was employed to analyze and generate key themes emerging from the process.

RESULTS

Themes were grouped into overarching issues and design issues across spatial scales.

CONCLUSION

This research confirms the negative impact of the acute hospital setting on older people with cognitive impairments including dementia and delirium. The multiple perspectives captured in this study, including most importantly people with dementia, ensure that stakeholder needs can be used to inform the design of the hospital environment. The research points to the value of understanding the lived experience of the person with dementia and APs. The voices of patients, particularly persons with dementia and their APs, are a crucial element in helping hospitals to fulfill their role as caregiving and healing facilities.