Space Exploration: How Nursing Homes Utilize Space to Improve Person-Centered Care

Newly constructed buildings often incorporate the latest design trends to better support resident wellness, leaving older buildings apparently limited in their ability to do this. However, the results of a recent study revealed interesting ways that existing nursing homes can make their environment more efficient.

Specifically, researchers investigated how staff utilization of their environment can improve person-centered care. Participating nursing homes had all adopted the Promoting Excellent Alternatives in Kansas Nursing Homes (PEAK 2.0) pay-for-service program, which promotes person-centered care through resident choice, staff empowerment, home environment, and meaningful life. Five sites had recently implemented the program, while the other five had achieved a high level of proficiency with the program. Researchers documented environmental features and staff interactions through observations and interviews, and staff work areas, or distinct sections of the facility where 30 or fewer residents live, were mapped out for each site.

One of the primary differences between sites was that in recent-adopting sites, staff tended to float throughout the entire facility, being responsible for residents in every work area. Advanced sites, on the other hand, tended to assign staff to a specific work area and only using floaters when necessary. This meant staff in recent-adopting sites were responsible for an average area of 17,550 square feet, whereas staff in advanced sites were responsible for a much more manageable area of around 7,150 square feet.

There were also notable differences in environmental attributes. For example, advanced sites were more likely to have designated dining and social areas within each staff work area, while in recent-adopting sites, these areas were limited to more centralized locations. Environmental affordances such as these can be beneficial for resident autonomy, as residents would be less dependent on staff to take them to a nearby location.

While the overall physical layout, number of staff present, and amenities offered were similar for both the recent-adopters and advanced nursing homes, optimal utilization of the environment made all the difference in person-centered care. Staff can be more effective when responsible for a smaller work area, and resident independence is enhanced by having easier access to amenities.



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Kaup ML, Poey JL, Corneilson L, and Doll G. Environmental attributes of person-centered care. Journal of Housing for the Elderly (2019);

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