Residential Facilities Research Articles

Proximal Discourses in Residential Facility Care Providers’ Sense-Making of Their Communication with Family Members of a Loved One with Alzheimer’s Disease

ABSTRACT Families often stay involved in the care of a loved one with Alzheimer’s disease even after relocation to a residential care facility, and through this transition, communication between the residential care providers and families becomes integral to keeping family informed and providing good care to the patient. However, care providers of people with Alzheimer’s living in residential facilities find themselves overwhelmed by expectations related to their caregiving role and struggle with making sense of their experiences. Fifteen care providers of people with Alzheimer’s disease living in a residential facility participated in qualitative, semi-structured interviews. Using relational dialectics theory as the framework through which to examine how residential facility care providers make sense of their communication with families of patients with Alzheimer’s, analysis revealed three sets of competing proximal discourses: family inclusion and exclusion, reality and positivity, and expert and layperson provision of care. We address conclusions for scholars, implications for care providers and facilities, limitations, and suggestions for future research.

Seeking residents' views regarding Australian residential aged care: A scoping review.

This scoping review aimed to explore topics on which the views of residents of Australian residential aged care facilities (RACFs) have been sought. Scoping review methodology as outlined by Arksey and O'Malley was used to identify, explore and report on the range of literature regarding views of RACF residents. Seven electronic databases were searched using broad search terms relevant to the RACF context. Descriptive numerical analysis was completed for publication year, journal name and target profession, research methods and participant types. Thematic analysis then focussed on the aims of the included studies. Four thousand two hundred and ninety studies were screened, and 104 publications met the inclusion criteria. A broad range of topics were explored by researchers, with the largest number of papers focused on residents' views of systems within RACFs (n = 24) and new programs and interventions (n = 21). Smaller topic areas included health conditions and health-care services (n = 13), socialisation (n = 13), physical activity (n = 3), self-care (n = 4), leisure (n = 4), general everyday life (n = 20) and aspects of the residential aged care environment (n = 15). There was limited exploration of meaningful activity (n = 13). The inclusion of residents with cognitive impairment was inconsistent, and the voices of other stakeholders were often privileged. Voices of residents must be heard in order to prioritise the health and well-being of this population. More research which focuses on what is important to residents is needed and must include residents with cognitive impairment more effectively. Identification of optimal research methods with this population would make an important contribution in this area.

Teaching basic personal finance to justice‐involved youth

AbstractJustice‐involved youth (JIY) display skills deficits in a variety of domains, but particularly in life skills such as health habits, obtaining a job, and maintaining finances. These skills are particularly important for JIY, who often come from historically disenfranchised communities. This population encounters many challenges as they transition from juvenile correctional facilities to their respective communities. To have the greatest impact, these skills should likely be taught prior to the transition. Thus, the purpose of this study was to teach basic personal finance skills to adolescent males in a juvenile residential treatment facility, using an information packet with rehearsal and feedback. The intervention was specifically chosen to be minimally invasive due to the challenges presented by the COVID‐19 pandemic relating to providing services to JIY. Data were analyzed visually using nonconcurrent multiple baseline designs. The results of the study showed the intervention was moderately effective at teaching basic financial skills relating to budgeting, banking, and credit to four participants.

IMPROVING THE NETWORK OF SECONDARY ROADS IN URBAN SETTLEMENTS: CASE STUDY ISTOČNO NOVO SARAJEVO

<p>The spatial development of the city and urban residential areas is inextricably linked with the spatial planning of transport networks. The concentration of population and residential facilities in a small area certainly creates traffic problems and affects the quality of life of individuals and the sustainability of urban settlements. The increase in population standard and the use of individual means of transport creates the need for huge spatial areas for the movement and rest of vehicles. This paper presents one possible way of modifying the planning document (regulatory plan) in the domain of the organization of traffic and free areas with the aim of increasing accessibility to end users, as well as improving the quality of life of individuals.</p>

Factors influencing senior care and living preferences among older adults in Jiangsu, China: a cross-sectional survey study

BackgroundAs the population ages, senior care for older adults in China has become increasingly important and has attracted the attention of both government and society. This study aimed to explore preferences and influencing factors related to senior care among older Chinese adults and thus propose effective and targeted strategies for the development of a comprehensive care system for older adults in the aging Chinese population.MethodsData were obtained from a cross-sectional survey conducted in sixteen communities or villages in Jiangsu Province, China, from July to September 2021. Guided by the Andersen Behavioral Model, multivariate logistic regression was conducted to identify factors associated with preferences for senior care arrangements.ResultsA total of 870 respondents were included in the study, 60.11% of whom preferred receiving care in their own homes, while only 13.68% chose residential care facilities (RCFs). For predisposing factors, rural respondents preferred receiving care in their own homes compared to urban respondents (children’s home: OR = 0.55, P < 0.01; RCF: OR = 0.58, P < 0.01). Concerning enabling factors, respondents who were not employed (OR = 2.30, P < 0.01) and those without financial support (OR = 2.73, P < 0.05) preferred RCFs to their own homes. Respondents receiving life assistance (sometimes: OR = 2.76, P < 0.001; regularly: OR = 2.57, P < 0.01; every day: OR = 3.57, P < 0.001) preferred their children’s homes to their own homes. In terms of need factors, respondents with noncommunicable diseases (NCDs, OR > 1, P < 0.05), those who knew about RCFs (some: OR = 0.53, P < 0.005; no: OR = 0.10, P < 0.001) and those with a good impression of RCFs (fair: OR = 3.72, P < 0.05; good: OR = 11.91, P < 0.001) preferred receiving care in RCFs compared to their counterparts.ConclusionsOlder Chinese adults’ senior care preferences were affected by predisposing factors, enabling factors, and need factors. Policy-makers should consider targeted measures to identify more precise senior care services and thus address aging challenges in China.

Supporting self-determination of individuals with severe or profound intellectual and multiple disabilities according to relatives and healthcare professionals: A concept mapping study.

This study aimed to identify perspectives of relatives and healthcare professionals regarding self-determination support for people with severe or profound intellectual and multiple disabilities, highlighting agreements and differences in their viewpoints. Following a concept mapping study, online focus group meetings yielded statements on self-determination support from relatives (residential facilities: n = 6, family homes: n = 7) and healthcare professionals (residential facilities: n = 9, family home: n = 5). Participants clustered and rated statements, resulting in four concept maps interpreted by experts (N = 6). The 285 statements were categorised into 5-7 clusters per map, revealing key strategies for self-determination support: communication and choice making (facilitated by aids), sensitivity, familiarity, and collaboration among involved parties. Each group placed different emphasis on these strategies, highlighting importance of continuous support in their implementation. Future research should prioritise practical implementations of these strategies to enhance self-determination.

Safety First! Residential Group Climate and Antisocial Behavior: A Multilevel Meta-analysis

A systematic review and multilevel meta-analysis was performed (28 studies and 313 effect sizes) on the relation between residential group climate (i.e., safety, atmosphere, repression, support, growth, structure) and antisocial behavior, including aggression and criminal recidivism. A systematic search was conducted in PsychINFO, ERIC, and OVID Medline up to February 2023. Results showed a small but significant association ( r = .20) between residential group climate and antisocial behavior, equivalent to a 23% reduction of antisocial behavior in all clients receiving care in a residential facility with a therapeutic group climate. Moderator analyses showed that experienced safety was more strongly related to antisocial behavior ( r = .30) than the other dimensions of group climate (.17 &lt; r &lt; .20), while the effect size was somewhat larger for adults ( r = .24) than for youth ( r = .15). We conclude that residential facilities should consider safety as a priority and should involve clients in a positive process of change through the development of a therapeutic environment and delivery of evidence-based treatment, addressing their needs from the perspective of rehabilitation.

Multidisciplinary, multicomponent interventions to reduce frailty among older persons in residents of residential care facilities: a scoping review

BackgroundFrailty reduction and reversal have been addressed successfully among older populations within community settings. However, these findings may not be applicable to residential care settings, largely due to the complex and multidimensional nature of the condition. Relatively, few attempts at frailty prevention exist in residential settings. This review aims to identify and describe best practice models of care for addressing frailty among older populations in residential care settings. This research also sets out to explore the impact of multidisciplinary health service delivery models on health outcomes such as mortality, hospitalisations, quality of life, falls and frailty.MethodsA scoping review of the literature was conducted to address the project objectives. Reference lists of included studies, bibliographic databases and the grey literature were systematically searched for literature reporting multidisciplinary, multidimensional models of care for frailty.ResultsThe scoping review found no interventions that met the inclusion criteria. Of the 704 articles screened, 664 were excluded as not relevant. Forty articles were fully assessed, and while no eligible studies were found, relevant data were extracted from 10 near-eligible studies that reported single disciplines or single dimensions rather than a model of care. The physical, nutritional, medicinal, social and cognitive aspects of the near eligible studies have been discussed as playing a key role in frailty reduction or prevention care models.ConclusionThis review has identified a paucity of interventions for addressing and reducing frailty in residential care settings. High-quality studies investigating novel models of care for addressing frailty in residential care facilities are required to address this knowledge gap. Similarly, there is a need to develop and validate appropriate screening and assessment tools for frailty in residential care populations. Health service providers and policy-makers should also increase their awareness of frailty as a dynamic and reversible condition. While age is a non-modifiable predictor of frailty, addressing modifiable factors through comprehensive care models may help manage and prevent the physical, social and financial impacts of frailty in the ageing population.

Advanced practice nurses’ daily practices delivering primary care to residents in long-term care facilities: a qualitative study

BackgroundGlobally, there is a growing shortage of primary care professionals, including those who serve residents in long-term care facilities (LTCFs). In recent decades, numerous new care models have been implemented to improve these residents’ care. Many incorporate Advanced Practice Nurses (APNs) into interprofessional healthcare teams. In Switzerland, little is known about how these models function, and few facilities have integrated APNs. This study aims to explore the everyday practice of APNs employed at a medical centre in the Bernese Seeland region delivering care to LTC residents and collaborating with LTCFs staff.MethodsThis qualitative study uses the “Interpretive Description” methodology, which builds on existing knowledge and examines phenomena interpreted through a social constructivist approach. We conducted six semi-structured individual interviews, one semi-structured focus group interview, and an examination of secondary data. Our thematic analysis followed Braun and Clarke’s guidelines for data analysis.ResultsIn LTCFs, APNs perform tasks similar to those of primary care physicians, e.g., patient visits and therapy adjustments, within the limits set by their supervising physicians. In addition, they contribute significantly to facility-wide quality improvement. We identified three fundamental elements for successful collaboration between APNs and LTCF staff: 1) clarifying roles and responsibilities; 2) establishing well-defined communication methods and pathways; and 3) building and maintaining trust. Together with LTCF staff, APNs provide multidimensional, person-centred care that focuses on medical, social, and nursing issues with the goal of maintaining the residents’ best possible quality of life.ConclusionsOur results suggest that integrating APNs into the LTCF care system improves care quality for residents and increases staff members’ job satisfaction.

Ethical challenges in residential care facilities during COVID-19: Leaders' perspective.

Person-centred care is based on ethical principles, and it is regarded as high-quality care. Care of older persons should embrace person-centredness. During the pandemic, older persons were highlighted as a vulnerable group at risk of developing serious illness and/or suffering death from COVID-19. Several pandemic-related measures were introduced in residential care facilities (RCFs) to reduce this risk, which influenced the possibilities to lead and provide a person-centred care. This study's aim was to explore ethical challenges in relation to person-centredness during the COVID-19 pandemic, from the perspective of leaders in RCFs. The study had a qualitative descriptive design. Semi-structured interviews were conducted with 26 leaders working in RCFs in Sweden. Data were analysed using conventional content analysis. The study was approved by the Swedish Ethical Review Authority. The participants received oral and written information about the study and gave written consent. The study was conducted in accordance with the Declaration of Helsinki. The overarching ethical challenge was Having to disregard the individual needs of the person in order to protect the group and society. This included (a) Protecting the group versus promoting the older person's autonomy; (b) Being forced to lead care based on uncertainty instead of evidence; (c) Striving to provide dignified care but lacking opportunities; and (d) Going far beyond ordinary duty and endangering one's own and the staff's health. The ethical challenges meant being torn between the person's individual needs and protecting the group and society, with clashing ethical principles as a consequence. The leaders faced ethical situations resulting in undignified and compromised person-centred care, which has implications for stakeholders and management who need to address the work conditions in RCFs.

Co-design of a walking activity intervention for stroke survivors.

Stroke survivors may not maintain gains made in gait performance after task-oriented circuit training. Behavior change interventions may enhance the long-term adoption of physical activity. This study uses a co-design methodology to develop an intervention and tools to facilitate physical and exercise therapists in supporting an active lifestyle in stroke survivors, which is defined as a lifestyle that integrates daily walking performance with day-to-day activity. (1) To describe the insights generated during the co-design process; and (2) To describe the tools that were developed during the co-design process. A multidisciplinary team consisting of staff members of the Royal Dutch Society for Physical Therapy, exercise and physical therapists specializing in neurorehabilitation and conducting task-oriented circuit class training in primary care settings or day therapy centers within residential care facilities, stroke survivors and their carers, experts in measuring movement behavior in stroke survivors, a company specializing in manufacturing sensors and related software, behavior change specialists, and co-designers all collaborated in a three-stage (define, develop, and deliver) co-design process. In the design process, the team iteratively developed a prototype accelerometer system for measuring walking performance with a feedback function for stroke survivors and their therapists and a prototype toolbox for therapists to support the facilitation of behavior change in their stroke survivors. This study shows how co-design can be applied to develop interventions for stroke survivors. Both the prototype system for measuring walking performance and the toolbox incorporate behavior change techniques to support a more physically active lifestyle in stroke survivors. Further research will investigate the feasibility of the intervention.

Research on Optimization Design Strategies for Natural Ventilation in Living Units of Institutional Elderly Care Facilities Based on Computational Fluid Dynamics Simulation

As China transitions into a deeply aging society, the elderly population’s growth has driven a rapid increase in elderly care institutions and facilities during the “13th Five-Year Plan” period, rising by over 235% compared to the “12th Five-Year Plan”. The ongoing normalization of COVID-19 prevention measures has underscored the urgent need to improve natural ventilation in elderly care residential facilities. This study conducted empirical surveys to assess the current state of natural ventilation in typical elderly care facilities and analyzed the architectural elements influencing it. By examining the needs and preferences of the elderly for natural ventilation, two basic living space layout types were identified through typological analysis. Suitable CFD simulation software was then employed to model key elements, and effective methods to enhance ventilation were summarized. This study found that modifying the floor plan to reduce the depth of south-facing rooms to 8.4 m, relocating external openings to the center of the rooms, adjusting the ratio of ventilation openings to room area to greater than 1/12, and adding 0.5 m high windows facing internal traffic roads can significantly improve indoor ventilation while maintaining privacy. Furthermore, placing the main activity and resting areas of the elderly in well-ventilated zones with minimal drafts can enhance both comfort and ventilation effectiveness. The research provides a scientific basis and methodological guidance for the construction and renovation of elderly care residential facilities.

A systematic review and meta-analysis of the dietary fiber menu provision and consumption for older adults living in residential care facilities

BackgroundOlder adults living in residential care facilities are commonly given laxatives to treat constipation; however, these may not always provide full relief, and side effects include diarrhea. Dietary fiber effectively prevents constipation, and international guidelines recommend 25 g/d for optimal laxation. Older adults in residential care rely on the facility menu to provide their nutritional requirements, including adequate dietary fiber. Little is known about how much dietary fiber is provided and consumed. ObjectivesWe aimed to determine the provision and consumption of dietary fiber for older adults living in residential care facilities. MethodsWe systematically searched available literature for studies reporting the analysis of residential care menus and meals consumed by residents aged over 65 y. A meta-analysis was performed on the studies that provided the mean amount of dietary fiber provided and consumed by residents. A random effect model was applied due to the heterogeneity of study methodologies. ResultsThe literature search yielded 4406 publications, but only 28 studies were eligible for our meta-analysis. The study sample comprised 4817 residents. The mean amount of fiber provided to residents was 21.4 g/d [standard error (SE): 1.2; 95% confidence interval: 18.8, 24.2 g/d], the mean amount of fiber consumed by residents was 15.8 g/d (SE: 0.6; 95% confidence interval: 14.7, 16.9 g/d). ConclusionsOlder adults living in care facilities are provided with dietary fiber below the recommended guidelines. Compounding this is that residents consume much less than what is provided and do not meet the recommendations for dietary fiber consumption. There is scope to improve dietary fiber provision, promote consumption to residents to aid laxation, and potentially reduce laxative use and the unwanted side effects of diarrhea.This trial was registered at PROSPERO as CRD42023427265.

Reducing Leak and Increasing Comfort of an N95 Filtering Facepiece Respirator for Aged-Care Workers Using a Customized, Soft, and Compliant Mask Frame

Abstract This prospective cohort study examines the quantitative fit-factor and tolerability impact of a novel custom frame designed to fit beneath N95 filtering facepiece respirators (FFRs) in a healthcare setting. Conducted at a medium-sized metropolitan residential aged care facility (RACF) in South Australia, sixty participants underwent quantitative fit testing while wearing institutional-provided N95 FFRs. Utilizing three-dimensional (3D) face scanning with a proprietary iPhone app, personalized frames were created using flexible silicone foam with a rigid plastic interior “backbone” to ensure compliance and comfort. Following the fitting of custom frames, participants underwent repeat quantitative fit testing using the same style and size of N95 FFRs. Results indicate a remarkable improvement, with 81.5% of participants achieving a pass on quantitative fit testing when using their custom frame in conjunction with the N95 FFRs, compared to a baseline pass rate of only 21.7% (odds ratio (OR) 20.9, 95% confidence interval (CI): 8.26, 58.50, p &amp;lt; 0.001 via logistic regression). Additionally, participants reported a 2.4 times higher level of tolerability when wearing the custom frame with their N95 FFRs compared to using FFRs alone (p &amp;lt; 0.001). In conclusion, the study demonstrates that wearing a customized frame device under an N95 FFR significantly enhances the likelihood of achieving a pass on quantitative fitting and offers a substantially more tolerable experience for wearers. These findings highlight the potential of personalized frame devices to improve respiratory protection efficacy and wearer comfort in healthcare settings.

End of life and death of residents: Experiences and practices of care facility directors in Portuguese residential care facilities

Residential care facilities (RCFs) are places where older people live and usually die. This exploratory qualitative study aims to describe the experiences and practices of the directors of Portuguese RCFs regarding residents’ end of life and death. Data were obtained from 17 care facility directors (CFDs) who participated in three focus groups. Thematic data analysis was performed. The CFDs described their practices and experiences framed within three moments in the life journey of the residents in RCFs: admission and living in RCF; end of life and death; postmortem and new admission – continuing and occupying the vacancy. The results suggest that end of life and death are only addressed in the last days/hours of life of the resident. However, the CFDs’ approach throughout the stay of the residents in the RCF could allow for the expression of their wishes and wills, which could facilitate a good and dignified death.

Dietitians' perceptions of employment models used in Australian residential aged care facilities.

The qualitative study aimed to explore dietitians' perceptions of employment status and engagement models with residential aged care facilities (RACF) and the impact on work activities and resident care. Dietitians currently working in RACF were recruited through convenience and snowball sampling, including contacting a list of dietitians who had previously consented to be contacted for research. A semi-structured interview guide was developed by the research team, pilot-tested and then used in each individual interview. Data were analysed using constant comparison and reflexive thematic analysis. Thirty-one dietitians (n = 29 female; median age, 39 years) with a range of experience working in different employment status and engagement models in RACF participated in an interview. Five themes were identified: (1) Being an employee allows for better integration and utilisation in the RACF, (2) Contract work creates a scarcity of time, (3) Ad hoc work does not meaningfully address nutrition challenges and may not be good for resident care, (4) Regularly scheduled visits support positive outcomes for residents and (5) Acknowledging many different employment models. Characteristics of engagement models likely affect dietitian work job satisfaction, individual resident care and food service in RACF. Regular dietetic engagement in RACFs is required to support resident-centred evidence-based dietetic practice and to improve residents' nutrition care. There is an opportunity for policy mandates to assist RACFs in regularly engaging a dietitian to ensure all residents have access to timely, high-quality nutrition care.

The Tell on Telehealth.

Telehealth in epilepsy care is not new. During the COVID-19 public health emergency, telehealth became more readily used to deliver epilepsy care. However, a summarized guidance of use in caring for people with epilepsy utilizing telehealth is needed. Existing literature was reviewed to provide guidance on various aspects of telehealth. Billing aspects are reviewed. Recommendations and considerations along with benefits and barriers to telehealth are provided. Telehealth can be a preferred delivery route of care for people with epilepsy in specific situations. Examples include psychiatric complaints, medication management, and follow-up visits for noncomplicated epilepsy care. In addition, telehealth is useful for patients who need postoperative visits, are not able to travel, or live in residential facilities. In-person care may be more suitable for patients who are medically complex, have language barriers or difficulty with resource access, hearing impaired, or have neurostimulation devices where remote monitoring or programming options are infeasible. Telehealth care for people with epilepsy can be a useful and important method of care delivery. It should remain an option for providers to use in epilepsy clinical care. It is important for the neurology provider to understand the benefits, billing, and barriers to providing telehealth.

The Influence of Service Quality on Customer Loyalty through Customer Satisfaction Mediation

One of the causes of the decline in sales at CitraLand Palu was the earthquake and tsunami of 2018 and the COVID-19 pandemic of 2019. One way to overcome this problem is to provide better quality services. In the context of the housing industry, previous research has been limited to studying the impact of service quality and customer satisfaction on loyalty. In research with campus and bank objects, different research results showed that service quality did not have a significant effect on satisfaction and loyalty. The relationship between existing variables shows that the influence of service quality on customer loyalty is tentatively unlimited, and there are still differences in research results. It needs to be tested in further research and is a gap for research in the context of housing objects. This research examines the influence of service quality in residential facilities on customer satisfaction. This study also examines customer satisfaction as a mediating factor in creating customer loyalty. Based on the type of data obtained, the author uses quantitative methods; a questionnaire is used as a tool for data collection. Data analysis in research uses path analysis, assisted by SPSS software.

The risk of repeated suicidal presentations following residential treatment for substance use disorders: A recurrent event analysis using linked administrative data

BackgroundIndividuals seeking alcohol and other drug (AOD) treatment consistently experience higher rates of suicidal behaviours and death by suicide when compared to the general population. By linking residential AOD treatment data to administrative healthcare and death datasets, we aimed to examine suicide-related behaviours and identify risk and protective factors for these events following discharge from residential treatment. MethodsParticipants included 1056 individuals aged 18–69 (M = 32.06, SD = 9.55, male = 696,65.9 %) admitted to three residential treatment facilities in Queensland, Australia from January 1, 2014 to December 31, 2016. Treatment data was linked to administrative hospital, emergency department (ED), mental health service, and Registry of Deaths data 2-years post-discharge. ICD-10 codes were used to identify and analyse suicide-related events. ResultsWithin 2-years post-discharge, 175 (16.6 %) individuals had a suicide-related event (n = 298 episodes). The highest proportion of episodes (11.1 %) occurred within 1-month of discharge. Higher risk of a recurrent suicide-related event was associated with receiving a Disability Support Pension (aHR = 1.69 (95%CI:1.10,2.59), two or more previous episodes of residential AOD treatment (aHR = 1.49 (95%CI:1.30,2.15). Completing residential treatment was associated with a lower risk of suicide-related events (aHR = 0.54 (95%CI:0.35,0.83). LimitationsThe amalgamation of suicidal ideation, attempts, and death into a single outcome oversimplifies their complex nature and interplay. The exclusive focus on one service provider limits generalisability, and data constraints and missingness preclude many analyses. ConclusionsUnderstanding suicidal behaviours and critical risk periods following discharge from residential treatment is crucial for improving continuing care, developing effective suicide prevention, and implementing targeted interventions among this high-risk population.

Optimal design guidelines for net zero energy residential buildings in cooling-dominated climates: Case study of Ghana

Net zero energy buildings (NZEBs) are regarded as an achievable solution for reducing energy use and carbon emissions in the built environment and addressing climate change. However, the ultimate objective of NZEBs is to enhance the energy performance of buildings by changing how they are designed and constructed. Consequently, identifying cost-effective energy efficiency strategies at the early design stages of buildings has become imperative and often required in several countries. This study describes a systematic analysis approach to optimize the design of residential facilities considering both energy efficiency and renewable energy systems. The design optimization is based on life cycle cost (LCC) analysis, which considers capital and energy costs over the lifecycle of the building. The analysis consistently shows that LCC-based optimal designs significantly reduced the building's annual energy consumption, achieving 34–35% energy-saving across the various climates compared to the baseline case. The most cost-effective energy efficiency measures that proved effective across all the climate zones include north orientation of the building at 180 azimuth degrees, natural ventilation, adequate window-to-wall ratio, minimal façade air leakage (i.e., about 5-7 ACH @50 Pa), and high efficient fans, air conditioning, and dehumidification. The integration of the PV system indicates that the net zero energy (NZE) design for the building is technically feasible and cost-effective across the climate zones considered. The sensitivity analysis further shows that the cost of integrating PV systems is even more cost-effective over a more extended period of the building's lifecycle. The study provides an optimal path for designing NZEBs and offers guidelines to achieve NZE across the building's lifecycle.