title: Exploring Environmental Variation in Residential Care Facilities for Older People.
abstract: OBJECTIVE
  The aim of this study was to explore variation in environmental quality in Swedish residential care facilities (RCFs) using the Swedish version of the Sheffield Care Environment Assessment Matrix (S-SCEAM).
  
  
  BACKGROUND
  Well-designed physical environments can positively impact on health and well-being among older persons with frail health living in RCFs and are essential for supporting person-centered care. However, the evidence base for informing the design of RCFs is weak, partly due to a lack of valid and reliable instruments that could provide important information on the environmental quality.
  
  
  METHODS
  Twenty RCFs were purposively sampled from several regions, varying in their building design, year of construction, size, and geographic location. The RCFs were assessed using S-SCEAM and the data were analyzed to examine variation in environmental quality between and within facilities.
  
  
  RESULTS
  There was substantial variation in the quality of the physical environment between and within RCFs, reflected in S-SCEAM scores related to specific facility locations and with regard to domains reflecting residents' needs. In general, private apartments and dining areas had high S-SCEAM scores, while gardens had lower scores. Scores on the safety domain were high in the majority of RCFs, whereas scores for cognitive support and privacy were relatively low.
  
  
  CONCLUSIONS
  Despite high building standard requirements, the substantial variations regarding environmental quality between and within RCFs indicate the potential for improvements to support the needs of older persons. We conclude that S-SCEAM is a sensitive and unique instrument representing a valuable contribution to evidence-based design that can support person-centered care.
authors.affiliation: 1 School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.|2 Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
authors.forename: Susanna
authors.initials: S
authors.lastname: Nordin
authors.affiliation: 1 School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
authors.forename: Kevin
authors.initials: K
authors.lastname: McKee
authors.affiliation: 3 Sahlgrenska Academy, Institute of Health and Care Sciences, Gothenburg University, Gothenburg, Sweden.|4 Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Helle
authors.initials: H
authors.lastname: Wijk
authors.affiliation: 1 School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.|2 Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.|5 School of Architecture, Chalmers University of Technology, Gothenburg, Sweden.
authors.forename: Marie
authors.initials: M
authors.lastname: Elf
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D004779:Environment Design; D006272:Health Facility Environment; D006707:Homes for the Aged; D006801:Humans; D008134:Long-Term Care; D013548:Sweden
keywords: assessment; long-term care facility; older people; person-centered care; physical environment