Three studies highlight how design can shape the patient experience in long-term care facilities.

Image from the American Hospital Association

It is well established that the physical environment impacts our health. The relationship between the environment and health is especially critical when it comes to where we live. For those living in long-term care, buildings and outdoor spaces are the literal foundation for health, health care and home. The Center for Health Design’s Knowledge Repository includes several studies on design for long-term care. Three recent articles focusing on residents are highlighted here.

When we think of long-term care, we usually think of environments for aging, but there are people of all ages living with cognitive impairment who may require care for extended periods, sometimes for their entire lives. A literature review by Roos and colleagues indicates that the published research on long-term care design for those with intellectual disabilities requiring 24/7 care is sparse. From what they were able to find, the research points to the exciting potential of design to facilitate better quality of life by providing community social settings, “home-likeness” and variety. 

While we do have more research specific to dementia-friendly environments, we have less evidence to guide supportive garden design. A new study by Motealleh and colleagues looks at how a garden might help to alleviate the agitation and apathy experienced by many people with dementia. The researchers measured agitation, engagement and apathy of residents who spent time in the long-term care facility garden over the course of four weeks. 

While the results of the quantitative measure showed no change in agitation for participants spending time in the garden, there was a reduction in apathy and increase in engagement. And findings from interviews did show an impact on agitation, with comments from residents such as, “When I’m in the garden all my cares go away. All my worries go away. I’m very much at home.” 

Many studies in long-term care environments focus on the importance of providing a sense of control, social support or positive distractions, but a new study by Bae and Asojo appears to be the first to look at these outcomes together under Roger S. Ulrich’s “theory of supportive design.” The basic idea behind the theory is that if the health care environment fosters a sense of control, provides access to social support and offers access to positive distractions, users will be less stressed. 

Researchers interviewed residents in long-term care facilities about what they liked. They found that nearly half of the residents’ responses were about perceived control (e.g., ability to personalize their space). Next, nearly a third of responses had to do with positive distraction (including window and views). Only a tenth of responses focused on social support (e.g., space for visitors).

As the research on long-term care environments continues to grow, the findings serve as a reminder that we are not designing places just for extended health care, but for extended living. These buildings are homes. 

To read more on how design can impact the experience of residents in long-term care, as well as many other topics related to health care design, visit The Center for Health Design’s Knowledge Repository.

Research used for this column

The following citations from The Center for Health Design’s Knowledge Repository of health care design resources were used by the author when writing this column:

  • J. Roos, et al., “Unlimited Surrounding: A Scoping Review on the Impact of the Built Environment on Health, Behavior, and Quality of Life of Individuals with Intellectual Disabilities in Long-Term Care,” HERD: Health Environments Research & Design Journal, 2022, in press.
  • P. Motealleh, et al., “The Impact of a Dementia-Friendly Garden Design on People with Dementia in a Residential Aged Care Facility: A Case Study,” HERD: Health Environments Research & Design Journal, vol. 15, no. 2 (2022): 196–218.
  • S. Bae and A. O. Asojo, “Interior Environments in Long-Term Care Units from the Theory of Supportive Design,” HERD: Health Environments Research & Design Journal, vol. 15, no. 2 (2022): 233–47.

About this column

“Design Discoveries” highlights research from The Center for Health Design’s Knowledge Repository, a user-friendly library of health care design resources. This research effort is supported by the American Society for Health Care Engineering, the American Institute of Architects, the Academy of Architecture for Health Foundation and the Facility Guidelines Institute. It can be accessed at