Engaging life in two Irish nursing home units for people with dementia: Quantitative comparisons before and after implementing household environments

Abstract

Objectives: This study compares the Social Engagement and Interactive Occupation of residents with dementia in two Irish nursing homes, before and after conversion to a household model environment. The changes were an open plan design and a functioning unit kitchen, supported by a homemaker role and operational policies which reduced task-based work in favour of person-centred care offering choice.

Method: A snapshot observation method was used to obtain quantitative data of resident activity using the Assessment Tool for Occupation and Social Engagement (ATOSE). Residents were assessed for four hours, on seven different weekdays, over a six-week period both pre- and post-renovation. The exception to this was the assessment of the traditional model unit (TMU) for Nursing Home 1 which was reduced to four days due to the early start of the building work.

Results: The results were consistent for both nursing homes and data were aggregated. Residents spent more time in the communal living spaces and were more likely to be active and engaged in the household model units (HMUs) compared to the TMUs. Using the independent t-test, these changes were found to be highly significant (p < 0.001).

Conclusion: Creating an HMU increased the Interactive Occupation and Social Engagement of residents in the communal areas of the two nursing homes. The physical environment change, in conjunction with supportive staff procedures and organizational initiatives, improved the well-being of residents with dementia. The outcomes must be viewed in context with financial implications.

Keywords:

• building conversion
• household model
• Interactive Occupation
• post-occupancy assessment
• Social Engagement

Acknowledgements

The authors acknowledge both the time and the assistance given to the principal researcher by the staff and management of Moorehall Lodge, Ardee, County Louth, Ireland and Castleross Nursing and Convalescent Centre, Carrickmacross, County Monaghan, Ireland. Their commitment to exploring the possibility of improving quality of life for their residents and undertaking the relevant renovations and culture change were the genesis of this study. The authors acknowledge the openness of the residents to the research and the commitment of the staff and visitors to the observational study. The authors gratefully acknowledge the assistance given by Dympna Manley in contributing to the development of the ATOSE, and the inter-rater assistance of both Dympna Manley and Michelle Fitzpatrick; and the assistance given by the reviewers in improving the quality of this article.