Differences in dementia services and settings across place types and regions.

People with dementia have complex and unique social, environmental, and communication needs arising from impaired cognition. One response to dissatisfaction with the medical model of care in nursing homes has been the creation of more homelike and social options for care in the community. These options include community-based residential facilities and a variety of more independent senior dwellings. Staying in residential settings longer may be associated with benefits, including decreased financial burden and improved quality of life. However, with the boundaries between these place types often less than clearly drawn, it has become increasingly difficult to anticipate the specific services and environmental features provided by each. It is also difficult to effectively match facilities to the specific needs of older persons with dementia. Even social workers responsible for placements, especially in urban areas, may not be able to visit all local residential options. To better understand these new venues for dementia care, this study explored the range of services and settings available to people with dementia in three different place types in five Wisconsin counties: nursing homes, community-based residential facilities, and independent senior housing.

Environmental gerontology at the beginning of the new millennium: reflections on its historical, empirical, and theoretical development.

Over the past four decades the environmental context of aging has come to play an important role in gerontological theory, research, and practice. Environmental gerontology (EG)--focused on the description, explanation, and modification or optimization of the relation between elderly persons and their sociospatial surroundings--has emerged as a subfield in its own right. The aim of this article is to reflect on the historical, empirical, and theoretical development of recent EG, following Parmelee and Lawton's diagnosis from 1990 that there is a need to move the field beyond its current languishing state. From a historical perspective, EG has clearly played an important and successful role within the gerontology enterprise in terms of explicit consideration of the sociophysical environment in theory and research. A literature analysis of empirical studies supports the view that research has continued on a substantial quantitative level during the 1990s. Findings of these research studies address the whole diversity of classic EG research questions, but mostly in the sense of replication and extension. In terms of theoretical discussion, our analysis leads to the insight that EG may be described as a field high in conceptual aspiration ("world views"), but low with regard to making research and application-productive use of its theoretical achievements.

The Therapeutic Environment Screening Survey for Nursing Homes (TESS-NH): an observational instrument for assessing the physical environment of institutional settings for persons with dementia.

OBJECTIVE: To develop an observational instrument that describes the ability of physical environments of institutional settings to address therapeutic goals for persons with dementia. METHODS: A National Institute on Aging workgroup identified and subsequently revised items that evaluated exit control, maintenance, cleanliness, safety, orientation/cueing, privacy, unit autonomy, outdoor access, lighting, noise, visual/tactile stimulation, space/seating, and familiarity/homelikeness. The final instrument contains 84 discrete items and one global rating. A summary scale, the Special Care Unit Environmental Quality Scale (SCUEQS), consists of 18 items. Lighting items were validated using portable light meters. Concurrent criterion validation compared SCUEQS scores with the Professional Environmental Assessment Protocol (PEAP). RESULTS: Interrater kappa statistics for 74% of items were above.60. For another 10% of items, kappas could not be calculated due to empty cells, but interrater agreement was above 80%. The SCUEQS demonstrated an interrater reliability of.93, a test--retest reliability of.88, and an internal consistency of.81--.83. Light meter ratings correlated significantly with the Therapeutic Environment Screening Survey for Nursing Homes (TESS-NH) lighting items (r =.29--.38, p =.01--.04), and the SCUEQS correlated significantly with global PEAP ratings (r =.52, p <.01). DISCUSSION: The TESS-NH efficiently assesses discrete elements of the physical environment and has strong reliability and validity. The SCUEQS provides a quantitative measure of environmental quality in institutional settings.