Home-like Environment Research Articles

Improving Maternity Care Where Home Births Are Still the Norm: Establishing Local Birthing Centers in Guatemala That Incorporate Traditional Midwives.

More than half of births among Indigenous women in Guatemala are still being attended at home by providers with no formal training. We describe the incorporation of comadronas (traditional midwives) into casas maternas (birthing centers) in the rural highlands of western Guatemala. Although there was initial resistance to the casa, comadronas and clients have become increasingly enthusiastic about them. The casas provide the opportunity for comadronas to continue the cultural traditions of prayers, massages, and other practices that honor the vital spiritual dimension of childbirth close to home in a home-like environment with extended family support while at the same time providing a safer childbirth experience in which complications can be detected by trained personnel at the casa, managed locally, or promptly referred to a higher-level facility. Given the growing acceptance of this innovation in an environment in which geographical, financial, and cultural barriers to deliveries at higher-level facilities lead most women to deliver at home, casas maternas represent a feasible option for reducing the high level of maternal mortality in Guatemala.This article provides an update on the growing utilization of casas and provides new insights into the role of comadronas as birthing team members and enthusiastic promotors of casas maternas as a preferable alternative to home births. Through the end of 2023, these casas maternas had cared for 4,322 women giving birth. No maternal deaths occurred at a casa, but 4 died after referral.The Ministry of Health of Guatemala has recently adopted this approach and has begun to implement it in other rural areas where home births still predominate. This approach deserves consideration as a viable and feasible option for reducing maternal mortality throughout the world where home births are still common, while at the same time providing women with respectful and culturally appropriate care.

Smartphone-based drug testing in the hands of patients with substance-use disorder-a usability study.

A clinical study was performed to test the usability of a smartphone eye-scanning app at a needle exchange facility to detect drug use to support therapy. The study recruited 24 subjects who visited the facility one to three times, making a total of 40 visits. During each visit the subjects underwent testing for non-convergence (NC), nystagmus (NY), and pupillary light reflex (PLR) using a smartphone-based eHealth system. The collected eye data were transformed into key features that represent eye characteristics. During each visit, a time-line follow-back interview on recent drug use and a usability questionnaire were completed. Technical usability of the smartphone eye-scanning app was good for PLR and NC, where key features were generated in 82%-91% of the cases. For NY, only 60% succeeded due to cognitive problems to follow instructions. In most cases, subjects were under the influence of drugs when participating in the tests, with an average of 2.4 different drugs ingested within the last 24 h. The key features from PLR could distinguish use of opioids from central stimulants. The usability questionnaire results indicate that 23 of the 24 subjects could perform the eye-scanning by themselves after a short training, even when under severe influence of drugs. The caregiver assessed that 20 out of the 24 challenging subjects could potentially perform these tests in an indoors, home-like environment. Smartphone-based eye-scanning is functional in a patient population with heavy drug use, also when under the influence of drugs. The use of central stimulants can be distinguished from the use of opioids.

Pilot Study Outcomes and Recommendations from Developing an Australian Residential Treatment for Eating Disorders

Individuals with eating disorders often face difficulty accessing sufficiently intensive, recovery-focused treatment. Residential treatment may fill a gap in the spectrum of care, offering 24-h support in a more home-like environment than a hospital and using a holistic approach including individual and group psychological therapy, meal support, and lived experience staff. As residential treatment has not previously been examined in Australia, the current study aimed to document the development, treatment components, and structure of this first Australian residential service for eating disorders and provide a pilot of its treatment outcomes. Preliminary outcomes are included from a sample of 19 individuals from the first six months of admissions, including eating disorder symptoms, eating disorder-related impairment, anxiety, and depression. Significant pre- to post-treatment improvement was found in total eating disorder psychopathology, dietary restraint, eating concerns, body mass index, eating disorder-related impairment, and depression, but not from pre-treatment to a six-month follow-up. Pilot outcomes were positive at end-of-treatment but require further clinical evaluation to examine follow-up effects. Clinical insights are discussed from the establishment of this new treatment service, including recommendations for clinicians involved in the current roll-out of residential programs across Australia.

Improving home-like environments in long-term care units: an exploratory mixed-method study

Although the number of older adults requiring care is rapidly increasing, nursing homes have long faced issues such as the absence of a home-like environment. This exploratory mixed-method study investigated how residents (n = 15) in a long-term care unit in South Korea perceive home-like features and privacy in their living spaces. The results indicated that most participants were satisfied with the homeliness and privacy of their environment, but some were unhappy with the level of privacy. Most participants had low scores on the Geriatric Depression Scale and the Pittsburgh Sleep Quality Index, indicating low levels of depression and sleep disorders. Sleep quality was affected by factors such as sensory environment, staff visits, and room temperature. Although participants appreciated social support and private rooms, they expressed a desire for larger rooms. Overall, this study provides preliminary insights into older adults’ views on their living spaces in long-term care with implications for improving their quality of life.

Nursing Home Characteristics and Resident Quality of Care Outcomes: A Scoping Review

Nursing Home Characteristics and Resident Quality of Care Outcomes: A Scoping Review

The impact of facility and staff characteristics on infection control of COVID-19: Perceptions of elder care home managers in Stockholm, Sweden.

To examine the perceptions of managers of elder care homes on the impact of facility and staff characteristics on infection control of COVID-19. Case study. Six purposively sampled care home managers in the city of Stockholm were interviewed. Through content analysis, three categories and nine subcategories were identified. According to the interviewed care home managers, a home-like environment that allows for isolation of residents and possibilities for staff to get changed and store personal protective equipment outside each resident's room was considered ideal. Experienced employees were reported as invaluable when facing an infectious outbreak. A mix of permanent and temporary staff was considered essential although some thought that temporary staff who work in multiple care homes might negatively influence the spread of infection. Language barriers among staff were considered an obstacle when trying to disseminate information.

A Place to Feel at Home? An Exploratory Study of the Perceived Living Environment in Home-Like Groups, Family-Style Group Homes, and Traditional Residential Youth Care

ABSTRACT Traditionally, residential youth care (RYC) in the Netherlands has been characterized by short-term placements, groups with relatively large numbers of youth (8–12), often located on a campus with several RYC units. Recently, alternative RYC settings have been developed to create a home-like environment and promote stability. These alternative settings are characterized by long-term care, smaller groups (typically 6), and placements within the community. Examples of alternative RYC settings are home-like groups and family-style group homes (with live-in professionals). We aimed to gain insight into the perceived living environment in different RYC settings from the perspectives of 26 youth, 14 parents, and 35 professionals. Quantitative data were collected using q-methodology. To deal with the small sample size, we used a triangulation of techniques: the Mokken scale, Mann-Whitney, and by-person factor analyses to explore differences in perceived living environments between RYC settings. We found that participants in home-like groups experienced significantly more sensitivity from professionals than did participants in traditional RYC. Participants in alternative RYC tended to emphasize sensitivity, while participants in traditional RYC tended to emphasize factual conditions. Alternative RYC may provide more opportunities than traditional RYC for youth to experience an environment with sensitive professionals and a positive group atmosphere.

Counter-professionalisation in collective childcare: The case of communities of care in Barcelona

Post-industrial transformations have significantly reshaped how young children are cared for outside the family home. Among other factors, the labour market participation of young mothers and a concomitant wish for intensive mothering have led to more diversified childcare solutions for the under-threes. Collective childcare projects (CCPs) promote approaches that are based on a home-like care environment and are run by educators and parents who have usually not trained in formal institutions but who become professionals in informal communities. Applying a discursive approach, this article asks: what characterises professionalism in CCPs? What type of professionalisation is being pursued? We analyse the case of Barcelona, using 45 interviews with association representatives, policymakers, campaigners, educators and parents. Our findings show the important role played by communities of care in defining professionalism and in consolidating a counter-professionalisation ethos, while evidencing their reluctance to pursue formal professionalisation.

Perceived barriers and facilitators to infection prevention and control in Dutch residential care facilities for people with intellectual and developmental disabilities: a cross-sectional study

BackgroundAdequate implementation of infection prevention and control (IPC) in residential care facilities (RCFs) for people with intellectual and developmental disabilities (IDDs) is crucial to safeguarding this vulnerable population. Studies in this field are scarce. This study aimed to identify perceived barriers to and facilitators of IPC among professionals working in these settings, along with recommendations to improve IPC, to inform the development of targeted interventions.MethodsWe administered an online questionnaire to 319 professionals from 16 Dutch RCFs for people with IDDs (March 2021-March 2022). Perceived multilevel barriers and facilitators (guideline, client, interpersonal, organisational, care sector, and policy level) were measured on a 5-point Likert scale (totally disagree-totally agree). Recommendations were assessed using a 5-point Likert scale (not at all helpful-extremely helpful), supplemented by an open-ended question. Barriers, facilitators, and recommendations were analysed by descriptive statistics. Open answers to recommendations were analysed through thematic coding.ResultsBarriers to IPC implementation included the client group (e.g., lack of hygiene awareness) (63%), competing values between IPC and the home-like environment (42%), high work pressure (39%), and the overwhelming quantity of IPC guidelines/protocols (33%). Facilitators included perceived social support on IPC between professionals and from supervisors (90% and 80%, respectively), procedural clarity of IPC guidelines/protocols (83%), and the sense of urgency for IPC in the organisation (74%). Main recommendations included the implementation of clear IPC policies and regulations (86%), the development of a practical IPC guideline (84%), and the introduction of structural IPC education and training programmes (for new staff members) (85%). Professionals also emphasised the need for IPC improvement efforts to be tailored to the local care context, and to involve clients and their relatives.ConclusionsTo improve IPC in disability care settings, multifaceted strategies should be adopted. Initial efforts should involve clients (and relatives), develop a practical and context-specific IPC guideline, encourage social support among colleagues through interprofessional coaching, reduce workload, and foster an IPC culture including shared responsibility within the organisation.

Quality of life in assisted living facilities for seniors: A descriptive exploratory study.

Promoting individuals' health across different life spans has always been key to a holistic nursing practice. Seniors are a diverse population who go through many physical and mental changes as they age. During the last decade, assisted living facilities (ALFs) have dramatically increased in numbers to provide care and living services in a home-like environment. The aim of this descriptive exploratory study was to explore the quality of life as perceived by seniors who reside in assisted living facilities (ALFs). This study utilized a descriptive exploratory design to investigate the quality of life of seniors living in ALFs. Seventeen residents from two ALFs were interviewed to gather their perspectives on the quality of their lives while living in an ALF. The interviews were conducted by the researcher and were audio-recorded and transcribed verbatim. The data were analysed using thematic analysis. Three major themes surfaced from residents' descriptions: 'physical environment', 'social environment' and 'home-like atmosphere'. The quality of life in ALFs was found to be predominantly an outcome of the exchange between the personal capability of residents to adapt to changes and the capacity of the facility to meet residents' diverse needs. Participants who discussed their quality of life in ALFs provided profound insights into this aspect of their lives. The findings from this study can potentiallyenlighten ALF stakeholders and enhance the quality of life for seniors residing in these facilities.

The Role of the Built Environment as a Therapeutic Intervention in Mental Health Facilities: A Systematic Literature Review.

This systematic literature review synthesizes and assesses empirical research concerning the use of the built environment as a therapeutic intervention in adult mental health inpatient facilities. The review explores the impact of facility design on patient outcomes. There is a growing recognition that the built environment in mental health facilities must strike a balance between ensuring safety and providing a therapeutic atmosphere. A review addressing how facility design contributes to this therapeutic environment is warranted. Database searches were conducted in CINAHL, Embase, PsychInfo, PubMed, and Web of Science from inception up to March 10, 2022. The Scottish Intercollegiate Guidelines Network (SIGN50) critical appraisal checklists were used to assess the quality of included studies. Of the 44 peer-reviewed studies identified from nine countries, several factors emerged as vital for the therapeutic environment in mental health inpatient facilities. These included personal spaces prioritizing privacy and control of the environment, daylight-optimized spaces, versatile communal areas promoting activities and interaction, designated areas for visits and spiritual/contemplative reflection, homelike environments, the inclusion of artwork in units, open nursing stations, and dedicated female-only areas. Yet, there is a need for research yielding stronger evidence-based designs harmonizing with therapeutic needs. This review offers initial guidance on designing mental health facilities that foster a therapeutic environment, while highlighting that the influence of facility design on mental health inpatients is considerably under-researched.

”It´s like walking in a bubble”, nursing students´ perspectives on age suit simulation in a home environment – group interviews from reflection seminars

BackgroundOlder persons with age-related and complex health problems will increasingly depend on care provision from nurses in their own homes. However, a barrier to quality care is ageism and nursing students´ disinterest in geriatrics. In addition, nurse education often falls short in preparing students for the complexity of geriatric care. Welfare technology (WT) is progressively implemented in home care to help older persons live at home despite their health problems. However, this process is intricate and requires acceptance and digital literacy among caregivers and older persons. Despite these challenges, nurse education can address and change negative attitudes through innovative teaching methods such as age suit simulation. Therefore, the study aims to describe nursing students´ experiences of age suit simulation in a home-like environment with WT and technical aids, and will reveal their perspective on ageing and providing care to older adults.MethodsA qualitative explorative design using semi-structured group interviews (n=39) among nursing students. Data was analysed through reflexive thematic analysis.ResultsThe analysis generated three main themes; “It’s like walking in a bubble”, “An eye opener” and “Concerns about ageing and the current structure of geriatric care”. The main themes included eight subthemes. Adapting to the sensory and physical limitations of the age suit was an immersive experience and caused feelings of frustration, loneliness and disconnection. A prominent result was a raised awareness of cognitive loss, especially impaired vision, and students felt the simulations had made them aware of the everyday challenges older persons faced. Students highlighted the importance of patience and giving enough time in care situations by being present and having a critical perspective of WT. The students were mostly negative towards their own ageing and could better relate to older persons´ vulnerability.ConclusionsAge suit simulation was described as an embodied and eye-opening experience, raising nursing students´ awareness of older persons´ functional limitations and the consequences for dignity and independence. Coping with cognitive loss was especially difficult. Students were motivated to apply their new knowledge to clinical practice. Age suit simulation can complement geriatric education, preparing students for the complex care needs of older persons.

A Transferable Lidar-Based Method to Conduct Contactless Assessments of Gait Parameters in Diverse Home-like Environments.

Gait abnormalities in older adults are linked to increased risks of falls, institutionalization, and mortality, necessitating accurate and frequent gait assessments beyond traditional clinical settings. Current methods, such as pressure-sensitive walkways, often lack the continuous natural environment monitoring needed to understand an individual's gait fully during their daily activities. To address this gap, we present a Lidar-based method capable of unobtrusively and continuously tracking human leg movements in diverse home-like environments, aiming to match the accuracy of a clinical reference measurement system. We developed a calibration-free step extraction algorithm based on mathematical morphology to realize Lidar-based gait analysis. Clinical gait parameters of 45 healthy individuals were measured using Lidar and reference systems (a pressure-sensitive walkway and a video recording system). Each participant participated in three predefined ambulation experiments by walking over the walkway. We observed linear relationships with strong positive correlations (R2>0.9) between the values of the gait parameters (step and stride length, step and stride time, cadence, and velocity) measured with the Lidar sensors and the pressure-sensitive walkway reference system. Moreover, the lower and upper 95% confidence intervals of all gait parameters were tight. The proposed algorithm can accurately derive gait parameters from Lidar data captured in home-like environments, with a performance not significantly less accurate than clinical reference systems.

UNCOVERING THE HIDDEN WORKFORCE: A STUDY OF DIRECT CARE WORKERS IN ASSISTED LIVING HOMES

Abstract A growing number of 4.5 million U.S. direct care workers (DCWs) provide hands-on care to older adult residents in assisted living homes (ALHs) -- the smallest type of assisted living residences that require employment of DCWs. These homes typically have capacity for 8-10 residents, and they no longer resemble the original non-medical, home-like environment. With an aging population, increasing complexity of residents’ medical and functional needs, and increasing closure of nursing homes, demand for DCWs in ALHs continues to grow. Better information on this growing workforce segment, federal oversight, and consistent licensure are needed. The few available studies indicate high resident acuity and quality of care issues. To address this knowledge gap, a study explored and described the learning interests and needs and technology use of ALH DCWs. Guided by a human factors framework and an interpersonal perspective, DCWs (N = 14/ median age 41) were interviewed one-on-one using semi-structured questions. Data analysis involved qualitative content analysis of transcribed taped interviews. Findings revealed DCWs are interested in work-related topics and acknowledge the complexity of their residents. They use various health-related technologies in the care they provide, but need more access to educational opportunities that accommodate their long work hours and low salaries. The study also noted the expanded scope of practice, high risk of injury, and underrepresentation of DCWs in the literature. This study highlights learning and technology needs of DCWs in ALHs, emphasizing the need for more recognition and support for this vital segment of the long-term care workforce.

“THEY’VE KIND OF SHUT THAT DOWN WITH COVID”: HOME-LIKE ENVIRONMENTS FOR RESIDENTS WITH DEMENTIA

Abstract Current guidelines recommend providing a home-like dining environment for older adults living in long-term care (LTC) facilities, as this atmosphere has a positive impact on resident independence, social interaction, mealtime experience, and food intake. In LTC settings, registered dietitians (RDs) play a crucial role in providing nutritional care for residents with dementia. Our study explored RDs’ perspectives on how they provide home-like mealtime environments for LTC residents with dementia. RDs who work with residents with dementia in the U.S. (n = 18) participated in one of five focus groups. Focus groups were led by a trained moderator using a semi-structured interview guide, transcribed verbatim, and audited by the research team for accuracy. Transcripts underwent descriptive content analyses using NVivo© software. Data analyses revealed a significant barrier, the Coronavirus Diseases of 2019 (COVID-19), in providing home-like environments for LTC residents with dementia. RDs reported the negative impact of COVID-19-related isolation among LTC residents with dementia. To mitigate the spread of COVID-19 among vulnerable residents, strict infection control policies were implemented. Therefore, many LTC facilities suspended communal dining, resulting in increased isolation and a sense of social disconnection, exacerbating the progression of dementia in many residents. Thus, COVID-19 presented a significant barrier for RDs to provide a mealtime environment that is home-like for LTC residents. To provide optimal nutrition care for LTC residents with dementia, having a middle road between the COVID-19 policies and traditional practices has been suggested.

HOME TRIAD: A NEW WAY TO UNDERSTAND THE MEANING OF HOME FOR PEOPLE LIVING WITH DEMENTIA

Abstract Highlighted by the frequent stating “I want to go home,” understanding the meaning of home for people living with dementia (PLWD) is crucial to provide them better care and environment. Our novel theoretical framework, termed ’home triad’, abstracts “home” into three interconnected pillars: conceived, perceived, and lived home. We conducted in-depth interviews with five PLWD, who were over 65 years old with MMSE scores between 11-24, received home care, and could understand and consent to the study. Their caregivers were also consulted for member-checking. The findings showed that the early memories of home were more vivid. The lived home experience held paramount significance; while stable housing was vital, family was of utmost importance to PLWD. Additionally, a gender-based distinction in lived home was evident. It was also found that PLWD’s perceived daily activities and lived memories expanded their home beyond their immediate residence, encompassing neighborhoods, villages, and cities. Within home triad, we noticed that the conceived home, focusing on the discourses of power and knowledge, could easily be overlooked. Yet, focusing on this pillar revealed the pivotal roles of design and caregivers in shaping PLWD’s home, which in turn influenced perceived and lived experiences. Through home triad, we can better appreciate profound home memories for PLWD. This could bolster reminiscence therapy and enable more effective home modifications, or even improve institutional homelike environments. Our future direction aims to refine and apply home triad with more home stories, thereby informing research and practice to enhance dementia-friendly environment and PLWD’s well-being.

EXPLORING THE ROLE OF THE COMMUNITY AT THE END OF LIFE: EXPERIENCES FROM A SMALL COMMUNITY-LED END-OF-LIFE PROJECT

Abstract ‘Care and living in community’ (CALICO) is an intergenerational co-housing and co-caring project in Brussels. Within this larger project, a small community-based initiative for palliative and end-of-life care was founded, called Maison Mourance. This initiative aims to mobilize capacity in the broader community to make ‘dying-in-place’ possible. Given the innovative and grassroots nature of Maison Mourance, the present study wants to understand its vision, functioning, roles of stakeholders involved and the challenges it faces. Therefore a qualitative study was conducted consisting of 10 in-depth interview with several stakeholders and 1 focus group with the steering committee. Their vision centers on creating a homelike environment where people at the end of their lives still feel part of the community. As organisation they want to be nonhierarchical in which each member, formal and informal, is valued and assigned a certain role. Attention is given to the central role of the patient and breaking taboos about dying and death by making it part of the (broader) community. Creating a supportive network of informal and formal actors in palliative care, and thus embedding care in the neighbourhood, is seen as a great added value. Future challenges are financing the project, expanding and keeping the network of volunteers motivated, designing an evaluation plan and selecting evaluation tools. Although this is a promising initiative in terms of community-led palliative care and for making ‘dying-in-place’ possible, the initiative faces several challenges and threats and thus it will be important to monitor future developments.

How do professionals working in the field of dementia care define quality of nursing home care and how do they believe warm technology contributes to this?

AbstractBackgroundWarm technology (WT) aims to improve quality of life of people living with dementia by supporting and enhancing human potential, social connectedness, dignity and self‐reliance. However, how care researchers and dementia care professionals think about the relationship between WT and quality of care (QOC) in nursing homes (NHs) is unknown. Also, there is a lack of international consensus on the definition of QOC in NHs. The goal of this project was to explore how care researchers and dementia care professionals define the concept QOC in NHs and how they believe WT contributes to this. The Tovertafel, a research based technology that activates nursing home residents with dementia by projecting interactive games on a surface, served as an example for WT in this study.MethodSemi‐structured (online) interviews were held in England, Ireland, Canada, United States of America and the Netherlands with 9 researchers and 11 care managers, 6 activity coordinators and 3 specialized nurses working in dementia care units of NHs. All care professionals had access to a Tovertafel. The interview guide was based on three existing multidimensional quality of nursing home care frameworks. To analyze the interviews, a thematic analysis was employed by means of open, axial, and selective coding using ATLAS.Ti.ResultsMost research and care professionals made a clear distinction between the clinical domains of QOC (e.g. providing effective and safe care) and the social domains of QOC (e.g. building relationships, trust, and providing person centered care) in NHs. According to the interviewees, the Tovertafel contributes to several social domains of QOC by: 1. supporting care professionals in the provision of person centered care and gaining trust from residents, 2. improving work pleasure of dementia care professionals, 3. creating a safe, pleasant and homelike environment, 4. increasing family involvement, and 5. increasing (non‐verbal) communication. The interviewees reported fewer and more indirect effects on the clinical domains of QOC in NHs. The results were comparable between countries.ConclusionWarm technology, such as the Tovertafel, seems to have a positive effect on QOC in NHs, primarily by having a positive impact on several social QOC domains.

S9: Green care farms and other innovative care environments for older people living with dementia: concept, mechanisms and impact on residents

Key goals of the dementia care environment focus on increasing autonomy, supporting independence and trying to enable the own lifestyle of older people living with dementia for as long as possible. To meet these goals, innovative, small-scale and homelike care environments have been developed across the world that have radically changed of the physical, social and organizational aspects. This symposium presents examples of these facilities in the Netherlands (Green Care Farms) and Germany (Shared Housing Arrangements) for people living with dementia. These presentations cover the whole spectrum of long-term care from day-care services, assisted living facilities and nursing home care. It focuses on the concepts and their impact on older people living with dementia. Furthermore, it presents an overview of other innovative long-term care environments across the world, aiming to provide care for older people living with dementia. The first presentation will highlight working mechanisms of green care farms as alternative to nursing homes in the Netherlands and how these mechanisms can be transferred to other regular care settings. The second presentation focuses on the potential of green care farming as a daycare service for older people living with dementia from ethnic minority backgrounds. The third presentation discusses shared housing arrangements in Germany and has investigated the impact of a complex care intervention to reduce the number of hospital admissions for people living with dementia in these facilities. The final presentation provides an overview of international concepts of innovative care environments for older people living with dementia and gives insights in their characteristics.

P182: Effects of Physical Environment on Quality of Life of Residents in Dementia Facilities in Canada & South Korea: A Longitudinal Observational Study

Approximately 44% of new residents of care facilities in Korea were diagnosed with dementia (Song, Park & Kim, 2013), and in Canada, about one-third of older adults younger than 80 who have been diagnosed with dementia live in long-term care facilities (Canadian Institute for Health Information, 2018). Due to the rapid increase of these figures in the future, continuing to provide assistance services and appropriate environment for residents with dementia could be challenging for both countries.This longitudinal observational study aims to examine whether residents with dementia in long-term care facilities with variability in physical environment attributions in Vancouver (N=11), Canada and Seoul (N=9), South Korea had a distinction in their quality of life (QoL). Physical environmental assessment was conducted using the Therapeutic Environment Screening Survey for Nursing Homes (TESS-NH) (Sloane et al., 2002). QoL was assessed three times over one year using Dementia Care Mapping tool (DCM) (University of Bradford, 2010). The results of the study demonstrated that the residents with dementia living in an institutional large-scale setting showed statistically more withdrawn behavior and spent more time to be negative mood or affect compared to the ones in a small-scale setting. This study also found that the number of potential positive behaviors of residents in a small-scale setting was three times higher than that of residents in an institutional large-scale setting. When looking at the distinction between two countries in the behavior category with a large average time difference, the residents with dementia in Korea had shorter meal/dessert times compared to those in Canada. The study supports that the small-scale homelike environment is intensely associated with a therapeutic environment for older adults with dementia.