title: Measuring physical and social environments in nursing homes for people with middle- to late-stage dementia.
abstract: OBJECTIVE
  To evaluate measures of dementia care environments by comparing a special care facility (SCF) with traditional institutional facilities (TIFs).
  
  
  METHODS
  A cross-sectional comparative study of nursing home environments conducted as part of a longitudinal study on quality of life for residents with dementia.
  
  
  METHODS
  Twenty-four traditional nursing homes and one special care facility.
  
  
  METHODS
  One SCF with six distinct environments, 24 TIFs with 45 distinct environments, and 88 family members.
  
  
  METHODS
  Therapeutic Environment Screening Scale-2+ (TESS-2+); Special Care Unit Environmental Quality Scale (SCUEQS), a subset of the TESS-2+ items; Composite Above Average Quality Score (CAAQS), a composite score of all items on the TESS-2+; and Models of Care Instrument (MOCI).
  
  
  RESULTS
  The SCUEQS did not detect a significant difference between the SCF and the TIFs (30.0 vs 27.2, P = .28). The CAAQS detected a significant difference between the SCF and the TIFs, whereby the SCF environments were rated as having above-average quality in 71.4% of the domains, compared with 57.3% for the TIF environments (95% confidence interval (CI) for difference = 2.6-25.6%, P = .02). Using the MOCI, SCF families were 1.8 times as likely to rate the SCF as a home or resort versus a hospital as TIF families rating TIFs (95% CI for odds ratio = 1.5-2.1, P < .001).
  
  
  CONCLUSIONS
  The TESS-2+ CAAQS differentiated between physical environments better than the more established SCUQES. The MOCI distinguished between environments using a more holistic approach to measurement. The availability of environmental measures that are able to discriminate between specialized and traditional long-term care settings will facilitate future outcome-based research.
authors.affiliation: Department of Community Health Sciences, University of Calgary, Calgary, Canada. sslaught@ucalgary.ca
authors.forename: Susan
authors.initials: S
authors.lastname: Slaughter
authors.forename: Margaret
authors.initials: M
authors.lastname: Calkins
authors.forename: Michael
authors.initials: M
authors.lastname: Eliasziw
authors.forename: Marlene
authors.initials: M
authors.lastname: Reimer
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D003704:Dementia / Q000628:therapy*; D005160:Facility Design and Construction; D019538:Health Care Surveys; D006272:Health Facility Environment; D006801:Humans; D009735:Nursing Homes / Q000458:organization & administration*; D011785:Quality Assurance, Health Care; D012931:Social Environment