Evaluating quality of life in residential care buildings

One result of a policy in the UK of providing support for older people to remain in their own homes has been an increase in frailty in the residents of care homes, many of whom suffer from dementia. The importance of enabling these residents to enjoy a good quality of life is recognized. Results from two research projects show that the physical environment can affect a person's quality of life, but it is one of a number of interrelated factors. Design in Caring Environments (DICE) and INDEPENDENT, both funded by the EPSRC EQUAL programme, use different methods to examine the impact of design on quality of life. The tools and methods developed are discussed, as are the implications of the findings for policy and practice. The Sheffield Care Environment Assessment Matrix (SCEAM) is a method for recording the characteristics and use of a care home building. The effects of the building on well-being can be unpicked by a multilevel analysis of building data against measures of quality of life. Used in a study of care homes in Sheffield, UK, it gave some significant results: in homes where the safety of residents had high priority, the scope for pleasurable activities tended to be low; activity appeared to have a beneficial impact on well-being; people in larger homes tended to have a poorer quality of life; staff satisfaction and retention increased with the amount of training and tended to be high in more personalized settings; and most homes under-used the facilities available. INDEPENDENT developed technologies to enhance well-being based on a 'wish list' of favourite activities derived from consultations with users. The policy and practice implications of these findings are discussed.