Trajectories of At-Homeness and Health in Usual Care and Small House Nursing Homes

Abstract

Long-term care providers across the United States are building innovative environments called "Green House" or small-house nursing homes that weave humanistic person-centered philosophies into clinical care, organizational policies, and built environments. To compare and contrast trajectories of at-homeness and health over time between residents remaining in a usual care nursing home (ucNH) and residents moving from that home to a small house (SmH). Mixed methods longitudinal design with 4 waves of data collection: before the move and 1, 3, and 6 months after the move (or equivalent for nonmovers). Prior to the move, individuals who decided to relocate to the SmH had more depressive symptoms and lower levels of at-homeness (measured by the Experience of Home [EOH] Scale). Most participants who chose to stay in the ucNH reported high baseline levels of at-homeness and maintained this over the next 6 months. All EOH scores in the SmH group increased after the move. Individuals who moved to the SmH also had greater less functional dependence over time. Qualitative findings highlight variables that contributed to at-homeness in both groups. This study demonstrates that a "one size fits all" approach may not be best because at-homeness is an individualized construct. Complex relationships emerged between perceived self-care ability, functional performance, and SmH nursing homes. Mixed methods enable deeper understanding of therapeutic environments and inform the development and testing of tailored interventions.