The physical environment impacts outcomes among residents, their family, and staff in three main areas: (a) resident quality of life, (b) resident safety, and (c) staff stress. Several studies show that different aspects of the physical environment—such as the unit layout, supportive features and finishes, reduced noise, as well as access to outdoor spaces—may be linked to better outcomes, including improved sleep, better orientation and wayfinding, reduced aggression and disruptive behavior, increased social interaction, and increased overall satisfaction and well-being.

Further, a growing body of research suggests that the environment should not only support functional abilities, but also provide opportunities for residents to be physically active and healthy. The environment can increase safety among residents by removing barriers to ambulation and performance of critical tasks and by preventing infections and unsafe behaviors such as exiting.

Studies also show that if supports for work (such as ceiling lifts) are incorporated within a long-term care setting, it results in greater satisfaction, morale, and fewer work-related injuries. Design enhancements, such as a homelike ambience, are also linked to higher satisfaction among nurses.

This report presents findings from more than 250 articles published in peer-reviewed journals that assess the relationship between physical environmental factors and resident and staff outcomes in different types of long-term care settings—skilled-nursing facilities, assisted-living settings, special-care units, and independent-living facilities. Some of the findings are relevant primarily to one type of setting, while others have wider applicability to different types of long-term care settings.