Reimagining Long-Term Care Architecture in Post-Pandemic Ontario—and Beyond (Part III)


This bibliography is in-depth survey of the literature published on this subject between 2005 (January) and the end of 2021. In this 16-year period, the field of environment and aging rapidly expanded. This literature review contains peer reviewed scientific publications, theory essays, and numerous non-peer reviewed reports. Most of the sources are available online. Varied types of publications were included because the professional design community needs both types of information in order to make well-informed decisions. The professional architect can benefit from knowing of theory and futurist essays, and technical reports issued by government agencies (often referred to as soft research) as much as from scientific knowledge (hard research). In this way the academic discipline and the profession of architecture can advance.

This survey is driven by a keyword search process. Over forty key words/phrases—including patient and staff outcomes; infection control; disease control; medical errors; pain; sleep deprivation; respiratory disease; environmental stress; privacy; noise; natural light; artificial lighting; room personalization; COVID-19; therapeutic gardens; wandering gardens, dementia special care units; biophilia in long-term care; long-term residential care models; nursing workstation design; unit layout and adaptability; family involvement; forced relocation; voluntary relocation; mortality and relocation; and skilled nursing facilities. Additional keywords included staff productivity; caregiver stress; family-centered care; noise mitigation; views; landscape; nature contact; view content from windows; resident-visitor and staff safety; the future of long-term care; and theoretical essays. Also, carbon neutral facilities; sustainable design and operations; nontoxic materials; renovation and retrofitting. Cross-searches were conducted based on various combinations of key words through the JSTOR and Google Scholar databases with advanced searches combing multiple databases including EBSCO, ScienceDirect, PsychINFO, MEDLINE, Ovid, ProQuest, PubMed, Web of Science, Science Digest, and NIH Public Access. This search process included any study or article that alluded or referred to the LTC physical built environment in its title or abstract. A first wave search yielded 379 citations. A 4-member research team perused every source to pare this number down. The final set of citations below totals 272 and the citations are listed alphabetically within each subsection.

The nine superordinate themes and their respective subsections are: 

1. Community-Based Aging in Place (43 citations)
1a. Immediate Neighborhood and Urban Environment
1b. Aging in Place in One’s Existing Home
1c. Multigenerational Dwelling Strategies

2. Residential Units and Residentialism (38 citations)
2a. Design Considerations and Case Studies
2b. Sense of Place and Well-being
2c. Prefab Modular Opportunities in LTC Residential Environments
2d. Personal Space and Cultural Factors

3. Nature, Landscape, Biophilia and the Aged (34 citations)
3a. Biophilia and Related Theories
3b. Design Considerations and Case Studies
3c. Therapeutic Gardens
3d. Dementia and Nature Engagement

4. Dementia Care Special Units—SCUs (35 citations)
4a. Cultural Factors and Dementia SCUs
4b. Immediate Living Spaces
4c. Influence of the Built Environment
4d. Design Innovations and Case Studies

5. Facility Closure and Resident Relocation (28 citations)
5a. Cultural Factors in Relocation
5b. Voluntary Relocation
5c. Involuntary Relocation—Adverse Outcomes
5d. Improving the Relocation Process

6. The Expanding Role of Family Engagement (10 citations)
6a. Family Engagement—Case Studies
6b. Family Engagement—Facility Design

7. Infection Control, Well-Being, and COVID-19 (40 citations)
7a. Safety and Infection Control
7b. Lighting, Noise, and Indoor Air Quality
7c. Covid-19

8. Ecological and Cost-Effective Facility Procurement (13 citations)
8a. Sustainable-Resilient Strategies

9. Recent Design Trends and Prognostications (31 citations) 
9a. The Green House Model
9b. The Future

1. Community-Based Aging in Place

1a. Immediate Neighborhood and Urban Environment

1. Abendroth, L. M., & Bell, B. (2018). Public Interest Design Education Guidebook : Curricula, Strategies, and SEED Academic Case Studies. 1st edition. Boca Raton, FL: CRC.

2. Alley, D., Liebig, P., Pynoos, J., Banerjee, T., & Choi, I.H. (2007). Creating elder-friendly communities: Preparations for an aging society. Journal of Gerontological Social Work, 49(1-2), 1-18. (PDF).

3. Aung, M., Koyanagi, Y., Ueno, S., Tiraphat, S., & Yuasa, M. (2021) A contemporary insight into an age-friendly environment contributing to the social network, active ageing and quality of life of community resident seniors in Japan, Journal of Aging and Environment, (35)2, 145-160. (PDF).

4. Baldwin, C., Osborne, C., & Smith, P. (2013). Planning for Age-Friendly Neighbourhoods. J. Fetherstone, ed.;1–9. In International Society of City and Regional Planners (ISOCARP) Proceedings.

5. Buffel, T., Phillipson, C., & Scharf, T. (2012). Ageing in urban environments: Developing ‘age-friendly’ cities. Critical Social Policy, 32(4), 597-617. (PDF).

6. Campbell, N. (2015). Designing for social needs to support aging in place within continuing care retirement communities. Journal of Housing and the Built Environment, 30(4), 645-665. (PDF).

7. Cao, W., & Dewancker, B. (2021). Interpreting spatial layouts of nursing homes based on partitioning theory. Journal of Asian Architecture and Building Engineering, 1–18. (PDF).

8. Cater, D., Tunalilar, O., White, D. L., Hasworth, S., & Winfree, J. (2021). “Home is home:” Exploring the meaning of home across long-term care settings. Journal of Aging and Environment, 1–18. (PDF).

9. Forsyth, A., Molinsky, J., & Kan, H. (2019). Improving housing and neighborhoods for the vulnerable: Older people, small households, urban design, and planning. Urban Design International, 24(3), 171–186. (PDF).

10. Matsumoto, H., Kageyama, M., Yamamoto-Mitani, N., & Nagata, S. (2021) The use of a public space in a public housing complex by senior citizens: A qualitative study. Journal of Aging and Environment, (35)2, 107-124. (PDF).

11. Nwoke, M. B., Chukwuorji, C.J., & Ebere, M. O. (2016). Number of dependents, community support, and mental health in later life: Does gender make a difference? International Journal of Aging & Human Development, 83(1), 63–87.

12. Sulander, T., Karvinen, E., & Holopainen, M. (2016). Urban green space visits and mortality among older adults. Epidemiology, 27(5), e34-e35. *


1b. Aging in Place in One’s Existing Home 

1. Abramsson, M., & Andersson, E. (2016). Changing preferences with ageing—Housing choices and housing plans of older people. Housing, Theory, and Society, 33(2), 217–241. (PDF). 

2. Anarde, S. (2019). Home sweet home: Aging in place in rural America. Generations: Journal of the American Society on Aging, 43(2), 17-23. R, (PDF).

3. Andersson, M., Granath, K., & Nylander, O. (2021). Aging-in-place: Residents' attitudes and floor plan potential in apartment buildings From 1990 to 2015. Health Environments Research & Design Journal, 14(4), 211-226.

4. Boge, J., Callewaert, S., & Petersen, K. A. (2017). The impact of bathroom design on privacy for users with special needs. Ageing International, 44(3), 300–317. (PDF). 

5. Dale, J. S. (2018). An Eichler-inspired mid-century granny flat. The Idaho Business Review. Retrieved from (PDF).

6. Demirkan, H. (2007). Housing for the aging population. European Review of Aging and Physical Activity, 4(1), 33-38. (PDF).

7. Leff, B., Carlson, C. M., Saliba, D., & Ritchie, C. (2015). The invisible homebound: Setting quality-of-care standards for home-based primary and palliative care. Health Affairs, 34(1), 21-29. (PDF).

8. Maaoui, M. (2018). A granny flat of one’s own? The households that build accessory-dwelling units in Seattle’s King County. Berkeley Planning Journal, 30(1), 102-116. (PDF).

9. Pettersson, C., Malmqvist, I., Gromark, S., & Wijk, H. (2020). Enablers and barriers in the physical environment of care for older people in ordinary housing: A scoping review. Journal of Aging and Environment, (34)3, 332-350. (PDF).

10. Poscablo, M. (2017). Improving the Quality of Life for Older Adults in High-Rise Residential Buildings in Urban Honolulu Through Responsive and Adaptive Design. ProQuest Dissertations & Theses. (PDF).

11. Rowles, G. D. (2018). “Housing for Older Adults.” Pp. 365-386 in Devlin, A (ed.), Environmental Psychology and Human Well-Being: Effects of Built and Natural Settings. New York: Elsevier Science & Technology.  (PDF).

12. Stall, N., Nowaczynski, M., & Sinha, S. K. (2014). Systematic review of outcomes from home‐based primary care programs for homebound older adults. Journal of the American Geriatrics Society, 62(12), 2243-2251. (PDF)

13. Steeves, J. (2005). Examination of universal design in kitchens and bathrooms of the Housing and Urban Development demonstration program: Elderly Cottage Housing Opportunity. (PDF).

14. Van Steenwinkel, I., Baumers, S., & Heylighen, A. (2012). Home in later life: A framework for the architecture of home environments. Home Cultures, 9(2), 195-217. (PDF).

15. Verma, I. (2019). Housing Design for All? The Challenges of Ageing in Urban Planning and Housing Design–The Case of Helsinki. Helsinki: Aalto University. (PDF).

16. Wahl, H.-W., Fänge, A., Oswald, F., Gitlin, L., & Iwarsson, S. (2009). The home environment and disability-related outcomes in aging individuals: What is the empirical evidence? The Gerontologist, 3(48), 355–368. (PDF).

17. Wiles, J. L., Leibing, A., Guberman, N., Reeve, J., & Allen, R. (2011). The meaning of “aging in place” to older people. The Gerontologist, 52(3), 357-366. (PDF).

18. Wiley, J., & Wyman, D. (2012). Key factors affecting valuation for senior apartments. The Journal of Real Estate Research, 34(2), 183-210. (PDF).


1c. Multigenerational Dwelling Strategies

1. Albuquerque, P. C. (2011) Grandparents in multigenerational households: The case of Portugal, European Journal of Ageing, 8(2), 189–198. (PDF).

3. Burgess, G., & Muir, K. (2020). The increase in multigenerational households in the UK: The motivations for and experiences of multigenerational living. Housing, Theory, and Society, 37(3), 322–338. (PDF).

4. Easthope, H., Liu, E., Judd, B., & Burnley, I. (2015). Feeling at home in a multigenerational household: The importance of control. Housing, Theory, and Society, 32(2), 151–170. (PDF).

5. Gale, A. & Park, N.K. (2010) Desired and achieved privacy and interaction in multigenerational homes, Housing and Society, 37(1), 25–41. (PDF).

6. Gardner, G., & Nasserjah, A. (2020). The future of multigenerational housing in existing communities: Insights for transatlantic cities. Cityscape, 22(1), 249-272. (PDF).

7. Gerards, S., Nuyts, E., & Vanrie, J. (2020). “Designed for all Ages: Multigenerational Housing as a Potential Housing Option in Flanders/Belgium.” In The Routledge Handbook of Housing Policy and Planning (1st ed)., 271–282). New York and London: Routledge.

8. Judd, B. (2016). Housing design for multigenerational living. In Easthope, H., & Liu, E. (eds.), Multigenerational Family Living: Evidence and Policy Implications from Australia. (pp. 150-173). London: Taylor and Francis. (PDF).

9. Liu, E. (2017) Living with the extended family: Experiences and outcomes of living in multigenerational households, in: E. Liu, & H. Easthope (eds.) Multigenerational Family Living: Evidence and Policy Implications from Australia, Pp. 73–92, New York and London: Routledge. (PDF).

10. Satpathy, L. (2006). Smart Housing: Technology to Aid Aging in Place-New Opportunities and Challenges (Doctoral dissertation, Architecture). (PDF).

11. Souralová, A., & Žáková, M. (2020). My home, my castle: Meanings of home ownership in multigenerational housing. Housing Studies, ahead-of-print), 1–19. (PDF).

12. D’ Suleman, R., & Bhatia, F. (2021). Intergenerational housing as a model for improving older-adult health. BC Medical Journal, 63(4), 171-173. .

2. Residential Units and Residentialism

2a. Design Considerations and Case Studies

1. Bergland, A., & Kirkevold, M. (2006). Thriving In nursing homes In Norway: Contributing aspects described by residents. International Journal Of Nursing Studies, 43(6), 681-691. (PDF).

2. Boydell, K. (2014). Best Practice In Housing Design For Seniors' Supportive Housing. Waterloo: Ontario: Regional Municipality Of Waterloo. (PDF).

3. Calkins, M. P. (2009). Evidence-based long-term care design. Neurorehabilitation, 25(3), 145–154. Https://Doi.Org/10.3233/Nre-2009-0512.

4. Carr, K., Weir, P. L., & Azar, N. R. (2013). Universal design: A step toward successful aging. Journal of Aging Research, 12(2),1-8. (PDF).

5. Gromark, S., & Andersson, B. (2020). Architecture For Residential Care and Ageing Communities: Spaces For Dwelling And Healthcare. New York and London: Routledge.  (PDF).

6. Kjellander, S. (2020). Elderly Care Sk€arvet

7. Mies Van Der Rohe, F. (2020). Residential Care Home Erika Horn, Andritz. European Prize For Contemporary Architecture. Https://Miesarch.Com/Work/3279.

8. Montgomery and Sisam (2015). Kipling Acres Long Term Care. Https://Www.Montgomerysisam.Com/Project/Kipling-Acres-Long-Term-Care/ 

9. Nagahama, M., Kinukawa, M., Yamaguchi, K., & Shigaki, T. (2016). A study on the floor plan composition of elderly housing supportive services from plan analyses. Aij Journal Of Technology And Design, 18(2), 271-279.  (PDF).

10. Neylon, S., Bulsara, C., & Hill, A.-M. (2019). Improving Australian residential aged care facilities: A review of minor refurbishment elements. Journal Of Housing For The Elderly, 33(3), 227–243. (PDF).

11. Peavey, E. (2015). Linking Long-Term Care and Healthcare Facilities: Examining Typologies, Culture Change and Universal Design Features. (PDF).

12. Province of Ontario Ministry of Health and Long-Term Care. (2015) Long-Term Care Home Design Manual.

13. Wahlroos, N., Stolt, M., Nordin, S., & Suhonen, R. (2021). Evaluating physical environments for older people—Validation of the Swedish version of the Sheffield Care Environment Assessment Matrix for use in Finnish long‐term care. International Journal Of Older People Nursing, 16(5), 1-11. (PDF).

14. Wei, D., & Li, X. (2021). Measuring the spatial quality of bedrooms in nursing homes with visual environmental performance. Frontiers of Architectural Research, 10(2), 332–350. (PDF).


2b. Sense of Place and Well-Being

1. Agosti, M., Andersson, I., Ejlertsson, G., & Janlöv, A. C. (2015). Shift work to balance everyday life—A salutogenic nursing perspective in home help service in Sweden. BMC Nursing, 14(1), 1-11. (PDF).

2. Burton, E., & Sheehan, B. (2010). Care-home environments and well-being: Identifying the design features that most affect older residents. Journal of Architectural and Planning Research, 27(3), 237-256. (PDF).

3. Chaudhury, H., Hung, L., & Badger, M. (2013). The role of physical environment in supporting person-centered dining in long-term care: A review of the literature. American Journal of Alzheimer’s Disease and Other Dementias, 28(5), 491–500. (PDF).

4. Chaudhury, H., Hung, L., Rust, T., & Wu, S. (2016). Do physical environmental changes make a difference? Supporting person-centered care at mealtimes in nursing homes. Dementia: The International Journal of Social Research and Practice. 12(2). 15-18. (PDF

5. Lee, E. J. & Park, S.J. (2021). A preference-driven smart home service for the elderly’s biophilic experience. Sensors (Basel, Switzerland), 21(15), 1-22. (PDF).

6. Nasrallah, E., & Pati, D. (2021). Can physical design help reduce loneliness in the elderly? A theoretical exploration. Health Environments Research & Design Journal, 14(3), 374–385. (PDF)

7. Rijnaard, M. D., Van Hoof, J., Janssen, B.M., Verbeek, H., Pocornie, W., Eijkelenboom, A., Beerens, H. C., Molony, S. L., & Wouters, E. J. M. (2016). The factors influencing the sense of home In nursing homes: A systematic review from the perspective of residents. Journal Of Aging Research, 16(3), 6143645. (PDF).

8. Seah, B., Kowitlawakul, Y., Chokkanathan, S., Fong, J. J. Y., Espnes, G. A., Ang, E., & Wang, W. (2018). Salutogenic healthy ageing programme embracement (SHAPE) for senior‐only households: A study protocol. Journal of Advanced Nursing, 74(4), 946–956. (PDF

9. Stevens, R., Petermans, A., Vanrie, J., & Van Cleempoel, K. (2013). Well-Being From The Perspective Of Interior Architecture: Expected Experience About Residing In Residential Care Centers. Iasdr13, 26-30. (PDF)

10. Tan, J. Y., Tam, W. S. W., Goh, H. S., Ow, C. C., & Wu, X. V. (2021). Impact of sense of coherence, resilience and loneliness on quality of life amongst older adults in long‐term care: A correlational study using the salutogenic model. Journal of Advanced Nursing, 77(11), 4471–4489. (PDF)

11. Tsuchiya-Ito, R., Slaug, B., & Ishibashi, T. (2019), The physical housing environment and subjective well-being among older people Using long-term care services In Japan. Journal Of Housing For The Elderly, 33(4), 413-432. (PDF).

12. Wiesmann, U., Becker, M. L., & Hannich, H. J. (2017). Positive aging in nursing home residents: A salutogenic analysis. GeroPsych, 30(2), 71–78. (PDF)


2c. Prefab-Modular Opportunities in LTC Residential Environments 

1. Iulo, L. D. (2009). “Hybrid Prefabrication: Prototypes For Green Residential Construction.” In Clouston, P., Mann, R. K., & Schreiber, S. (eds.), Without A Hitch -- New Directions In Prefabricated Architecture: Proceedings: 2008 Northeast Fall Conference Of The Association Of Collegiate Schools Of Architecture, September, 2008, Amherst. University Of Massachusetts. *

2. Lahtinen, M., Sirola, P., Peltokorpi, A., Aalto, L., Kyrö, R., Salonen, H., Ruohomäki, V., & Reijula, K. (2020). Possibilities for user-centric and participatory design in modular health care facilities. Intelligent Buildings International (London), 12(2), 100–114. (PDF).

3. Russo, M. (2009). Make way for modular. Multi-Housing News, 44(2), 16–17. (PDF).

4. Smith, R. E., & Quale, J. D. (2017). Offsite Architecture: Constructing The Future. London: Routledge. (PDF).

5. Staib, G., Dörrhöfer, A., & Rosenthal, M. (2008). Components and Systems: Modular Construction—Design, Structure, New Technologies. Berlin: Walter De Gruyter Gmbh. (PDF).

6. Suchomel, J. L. (2018). Ready to assemble: Implementing prefabrication in health facility projects. Health Facilities Management, 31(6), 45. (PDF).

2d. Personal Space and Cultural Factors

1. Cao, W., & Dewancker, B.(2020). Analysis on the configuration condition and spatial position relationship of the main functions in residential type nursing home for the elderly in Japan. IOP Conference Series: Earth and Environmental Science, 495(4), 1-8. (PDF).

2. Van Hoof, J., Verhagen, M. M., Wouters, E. J. M., Marston, H. R., Rijnaard, M. D., & Janssen, B. M. (2015). Picture your nursing home: Exploring the sense of home of older residents through photography. Journal of Aging Research, 312931, 1-11. (PDF).

3. Van Hoof, J., Janssen, M. L., Heesakkers, C. M. C., van Kersbergen, W., Severijns, L. E. J., Willems, L. A. G., Marston, H. R., Janssen, B. M., & Nieboer, M. E. (2016). The importance of personal possessions for the development of a sense of home in nursing home residents. Journal of Housing for the Elderly, 30(1), 35–51. (PDF).

4. Verderber, S., & Song, J. H. (2005). Environment and aging in Japan: A review of recent research. Environment and Behavior, 37(1), 43–80. (PDF).

5. Verderber, S., Skouris, E., & Jake Pauls, W. (2020). Indigenous ecohumanist architecture for health in Canada’s Far North. Health Environments Research & Design Journal, 13(3), 41–56. (PDF).

6. Yamaguchi, K. (2020). An experimental study on motion space around bed in facilities for the elderly. AIJ Journal of Technology and Design, 26(62), 227-232. (PDF).

3. Nature, Landscape, Biophilia and the Aged

3a. Biophilia and Related Theories

1. Browning, W. D., Ryan, C. O., & Clancy, J. O. (2014). 14 Patterns of Biophilic Design. New York: Terrapin Bright Green. (PDF).

2. Chi, P., Gutberg, J., & Berta, W. (2020). The conceptualization of the natural environment in healthcare facilities: A scoping review. Health Environments Research & Design Journal, 13(1), 30–47. (PDF).

3. Finlay, J., Franke, T., McKay, H., & Sims-Gould, J. (2015). Therapeutic landscapes and wellbeing in later life: Impacts of blue and green spaces for older adults. Health & Place, 34(2), 97–106. (PDF).

4. Hsieh, C.-H., Chen, C.-M., Yang, J.-Y., Lin, Y.-J., Liao, M.-L., & Chueh, K.-H. (2021). The effects of immersive garden experience on the health care of elderly residents with mild-to-moderate cognitive impairment living in nursing homes after the Covid-19 pandemic. Landscape And Ecological Engineering, 18(1), 45–56. (PDF).

5. Jo, H., Song, C., & Miyazaki, Y. (2019). Physiological benefits of viewing nature: A systematic review of indoor experiments. International Journal of Environmental Research and Public Health, 16(23), 4739. (PDF).

6. Kellert, S. R. (2008). “Dimensions, elements, and attributes of biophilic design.” In Biophilic Design: The Theory, Science and Practice of Bringing Buildings to Life. Washington, DC: US Green Building Council.  (PDF).

7. Ottosson, J., & Grahn, P. (2006). Measures of restoration in geriatric care residences: The influence of nature on elderly people’s power of concentration, blood pressure, and pulse rate. Journal of Housing for the Elderly, 19(3-4), 227–256. (PDF).

8. Peters, T., & Verderber, S. (2021). Biophilic design strategies in long-term residential care environments for persons with dementia. Journal of Aging and Environment, 12(3), 11–29. (PDF).

9. Ryan, C. O., Browning, W. D., Clancy, J. O., Andrews, S. L., & Kallianpurkar, N. B. (2014). Biophilic design patterns: Emerging nature-based parameters for health and well-being in the built environment. I-JAR—International Journal of Architectural Research, 8(2), 62–76.

10. Van den Berg, V., Maas, J., Van den Hoven, L., & Tanja-Dijkstra, K. (2021) Greening a geriatric ward reduces functional decline in elderly patients and is positively evaluated by hospital staff, Journal of Aging and Environment, 35(2), 125-144. (PDF).

11. Vecellio, D. J., Bardenhagen, E. K., Lerman, B., & Brown, R. D. (2021). The role of outdoor microclimatic features at long-term care facilities in advancing the health of its residents: An integrative review and future strategies. Environmental Research, 201, 111583–111583. (PDF).

12. Xie, Q., & Yuan, X. (2021). Functioning and environment: Exploring outdoor activity-friendly environments for older adults with disabilities in a Chinese long-term care facility. Building Research and Information : The International Journal of Research, Development and Demonstration, 5(1-2), 1–17. (PDF).


3b. Design Considerations and Case Studies

1. Archello, P. (2018). Wellcare Garden Fukasawa.

2. Cooper, M. C., & Sachs, N. (2014). Therapeutic Landscapes: An Evidence-Based Approach to Designing Healing Gardens and Restorative Outdoor Spaces. New York: John Wiley. (PDF). 


3c. Therapeutic Gardens

1. Algase, D. L., Beattie, E. R., Antonakos, C., Beel-Bates, C. A., & Yao, L. (2010). Wandering and the physical environment. American Journal of Alzheimer’s Disease and Other Dementias, 25(4), 340–346. (PDF).

2. Bengtsson, A., & Carlsson, G. (2006). Outdoor environments at three nursing homes. Journal of  Housing For the Elderly, 19(3), 49-69. (PDF).

3. Bengtsson, A., Hägerhäll, C., Englund, J.-E., & Grahn, P. (2015). Outdoor environments at three nursing homes: Semantic environmental descriptions. Journal of Housing for the Elderly, 29(1-2), 53-76. (PDF).

4. Dahlkvist, E., Hartig, T., Nilsson, A., Högberg, H., Skovdahl, K., & Engström, M. (2016). Garden greenery and the health of older people in residential care facilities: A multi-level cross-sectional study. Journal of Advanced Nursing, 72(9), 2065–2076. (PDF).

5. Edwards, C. A., McDonnell, C., & Merl, H. (2013). An evaluation of a therapeutic garden’s influence on the quality of life of aged care residents with dementia. Dementia (London, England), 12(4), 494–510. (PDF).

6. Gonzalez, M. T., & Kirkevold, M. (2016). Design characteristics of sensory gardens in Norwegian nursing homes: A cross-sectional E-Mail survey. Journal of Housing for the Elderly, 30(2), 141–155. (PDF).

7. Kwack, H., Relf, P. D., & Rudolph, J. (2005). Adapting garden activities for overcoming difficulties of individuals with dementia and physical limitations. Activities, Adaptation & Aging, 29(1), 1–13. (PDF).

8. Raske, M. (2010). Nursing home quality of life: Study of an enabling garden. Journal of Gerontological Social Work, 53(4), 336–351. (PDF).

9. Rodiek, S., Nejati, A., Bardenhagen, E., Lee, C., & Senes, G. (2016). The seniors’ outdoor survey: An observational tool for assessing outdoor environments at long-term care settings. The Gerontologist, 56(2), 222-233. (PDF).

10. Yari, M., Lee, K., Cassidy, J., & Chen, Z. (2021). Transforming space into place: A person-environment interchange approach for designing an assisted living facility courtyard. Journal of Aging and Environment, 35(2), 188-206. (PDF).


3d. Dementia and Nature Engagement

1. Calkins, M., Szmerekovsky, J. G., & Biddle, S. (2007). Effect of increased time spent outdoors on individuals with dementia residing in nursing homes. Journal of Housing for the Elderly, 21(3-4), 211-228. (PDF).

2. Chapman, N. J., Hazen, T., & Noell-Waggoner, E. (2007). Gardens for people with dementia. Journal of Housing for the Elderly, 21(3-4), 249–263. (PDF).

3. Cohenmansfield, J. (2007). Outdoor wandering parks for persons with dementia. Journal of Housing for the Elderly, 21(1-2), 35–53.  (PDF).

4. de Boer, B., Hamers, J. P., Zwakhalen, S. M., Tan, F. E., Beerens, H. C., & Verbeek, H. (2017). Green care farms as innovative nursing homes, promoting activities and social interaction for people with dementia. Journal of the American Medical Directors Association, 18(1), 40-46. (PDF).

5. Detweiler, M. B., Murphy, P. F., Myers, L. C., & Kim, K. Y. (2008). Does a wander garden influence inappropriate behaviors in dementia residents? American Journal of Alzheimer’s Disease and Other Dementias, 23(1), 31–45. (PDF).

6. Detweiler, M. B., Murphy, P. F., Kim, K. Y., Myers, L. C., & Ashai, A. (2009). Scheduled medications and falls in dementia patients utilizing a wander garden. American Journal of Alzheimer’s Disease and Other Dementias, 24(4), 322–332. (PDF).

7. Grant, C. F., & Wineman, J.D. (2007). The garden-use model: An environmental tool for increasing the use of outdoor space by residents with dementia in long-term care facilities. Journal of Housing for the Elderly, 21(1-2), 89-115. (PDF).

8. Hernandez, R. O. (2007). Effects of therapeutic gardens in special care units for people with dementia: Two case studies. Journal of Housing for the Elderly, 21(1-2), 117–152. (PDF).

9. Motealleh, P., Moyle, W., Jones, C., & Dupre, K. (2019). Creating a dementia-friendly environment through the use of outdoor natural landscape design intervention in long-term care facilities: A narrative review. Health & Place, 58(2), 102148. (PDF).

10. Whear, R., Coon, J. T., Bethel, A., Abbott, R., Stein, K., & Garside, R. (2014). What is the impact of using outdoor spaces such as gardens on the physical and mental well-being of those with dementia? A systematic review of quantitative and qualitative evidence. Journal of the American Medical Directors Association, 15(10), 697–705. (PDF).

4. Dementia Special Care Units—SCUs

4a. Cultural Factors and Dementia SCUs

1. Morgan-Brown, M., Newton, R., & Ormerod, M. (2013). Engaging life in two Irish nursing home units for people with dementia: Quantitative comparisons before and after implementing household environments. Aging & Mental Health, 17(1), 57–65.

2. Van Hoof, J., Kort, H., & Van Waarde, H. (2009). Housing and care for older adults with dementia: A European perspective. Journal of Housing and the Built Environment, 24(3), 369-390. (PDF).

3. Wong, J. K. W., Skitmore, M., Buys, L., & Wang, K. (2014). The effects of the indoor environment of residential care homes on dementia suffers in Hong Kong: A critical incident technique approach. Building and Environment, 73(4), 32–39. (PDF).

4b. Immediate Living Spaces

1. Campo, M., & Chaudhury, H. (2012). Informal social interaction among residents with dementia in special care units: Exploring the role of the physical and social environments. Dementia: The International Journal of Social Research and Practice, 11(3), 401–423. (PDF). 

2. Chaudhury, H., Hung, L., & Badger, M. (2013) The role of physical environment in supporting person-centered dining in long-term care: A review of the literature. American Journal of Alzheimer’s Disease and Other Dementias, 28(5), 491–500.

3. Verbeek, H., van Rossum, E., Zwakhalen, S., M.Kempen, G. I., & Hamers, J. P. (2009). Small, homelike care environments for older people with dementia: A literature review. International Psychogeriatrics, 21(2), 252–264.

4. Verbeek, H., Zwakhalen, S. M., van Rossum, E., Ambergen, T., Kempen, G. I., & Hamers, J. P. (2010). Dementia care redesigned: Effects of small-scale living facilities on residents, their family caregivers, and staff. Journal of the American Medical Directors Association, 11(9), 662–670.

5. Yokoyama, Y.,  Koga, T., Miura, K., & Yamaguchi, K. (2009). The relationship between behavioral errors of the elderly with dementia and their residential environment. Man-Environment Research Association, 11(2), 1-10. (PDF).


4c. Influence of the Built Environment

1. Beerens, H. C., Zwakhalen, S. M., Verbeek, H., Ruwaard, D., & Hamers, J. P. (2013). Factors associated with quality of life of people with dementia In long-term care facilities: A systematic review. International Journal Of Nursing Studies, 50(9), 1259-1270. (PDF).

2. Charras, K., Eynard, C., & Viatour, G. (2016). Use of space and human rights: Planning dementia friendly settings. Journal Of Gerontological Social Work, 59(3), 181-204. (PDF).

3. Chaudhury, H., & Cooke, H. (2014). “Design matters in dementia care: The role of the physical environment in dementia care settings.” In M. Downsb. Bowers (eds.), Excellence In Dementia Care (2nd Ed). Pp. 144–158. UK: Open University Press. (PDF).

4. Chaudhury, H., Cooke, H. A., Cowie, H., & Razaghi, L. (2018). The influence of the physical environment on residents with dementia in long-term care settings: A review of the empirical literature. The Gerontologist, 58(5), 325-337. (PDF).

5. Olson, N. L., & Albensi, B. C. (2021). Dementia-friendly “Design”: Impact on COVID-19 death rates in long-term care facilities around the world. Journal of Alzheimer’s Disease, 81(2), 427–450. (PDF).

6. Slaughter, S., Calkins, M., Eliasziw, M., & Reimer, M. (2007). Measuring physical and social environments in nursing homes for people with middle-to-late stage dementia. Journal of the American Geriatric Society, 54(9) ,1436-1441. Https://Doi.Org/10.1111/J.1532-5415.2006.00851.X

7. Steele, L., Carr, R., Swaffer, K., Phillipson, L., & Fleming, R. (2020). Human rights and the confinement of people living with dementia in care homes. Health and Human Rights, 22(1), 7-19. (PDF).

8. Tartarini, F., Cooper, P., Fleming, R., & Batterham, M. (2017). Indoor air temperature and agitation of nursing home residents with dementia. American Journal of Alzheimer’s Disease and Other Dementias, 32(5), 272–281. 1533317517704898.


4d. Design Innovations and Case Studies

1. Burke, R. L., & Veliz Reyes, A. (2021). Socio-spatial relationships in design of residential care homes for people living with dementia diagnoses: A grounded theory approach. Architectural Science Review, 1–15. (PDF).

2. Cadigan, R., Grabowski, D., Givens, J., & Mitchell, S. (2012). The quality of advanced dementia care in the nursing home: The role of special care units. Medical Care, 50(10), 856-862. (PDF).

3. Calkins, M. P. (2018). “Memory Care and Alzheimer’s Units.” In Devlin, A. (ed.), Environmental Psychology And Human Well-Being: Effects Of Built And Natural Settings. Pp. 365-386. New York. Elsevier Science & Technology. (PDF).

4. Caspi, E. (2014). Wayfinding difficulties among elders with dementia In an assisted living residence. Dementia (London, England), 13(4), 429–450. (PDF).

5. Connell, B. R., Sanford, J. A., & Lewis, D. (2007). Therapeutic effects of an outdoor activity program on nursing home residents with dementia. Journal Of Housing For The Elderly, 21(3-4), 194–209. (PDF).

6. Davis, S., Byers, S., Nay, R., & Koch, S. (2009). Guiding design of dementia friendly environments in residential care settings: Considering the living experience. Dementia, 8(2), 185-203. Https://Doi.Org/10.1177/1471301209103250.

7. de Boer, B., Bozdemir, B., Jansen, J., Hermans, M., Hamers, J. P., & Verbeek, H. (2021). The Homestead: Developing a conceptual framework through co-creation for innovating long-term dementia care environments. International Journal of Environmental Research and Public Health, 18(1), 57–74. (PDF).

8. De Rooij, A. H., Luijkx, K. G., Schaafsma, J., Declercq, A. G., Emmerink, P. M., & Schols, J. M. (2012). Quality of life of residents with dementia in traditional versus small-scale long-term care settings: A Quasi-Experimental Study. International Journal Of Nursing Studies, 49(8), 931–940. (PDF).

9. Feng, Y., Van Reijmersdal, R., Yu, S., Rauterberg, M., Hu, J., & Barakova, E. (2018). Dynamorph: “Montessori Inspired Design For Seniors With Dementia Living In Long-Term Care Facilities.” Https://Doi.Org/10.1007/978-3-319-73062-2_4.  In Chisik Y., Holopainen J., Khaled R., Luis Silva J., & Alexandra Silva P. (eds). Intelligent Technologies for Interactive Entertainment. Lecture Notes of the Institute for Computer Sciences, Social Informatics and Telecommunications Engineering, Vol 215. New York: Springer (PDF).

10. Ferdous, F. (2021). Redesigning memory care in the COVID-19 era: Interdisciplinary spatial design interventions to minimize social isolation in older adults. Journal of Aging & Social Policy, 33(4-5), 555–569. (PDF).

11. Fleming, R., & Purandare, N. (2010). Long-term care for people with dementia: Environmental design guidelines. International Psychogeriatrics, 22(7), 1084–1096. Https://Doi.Org/10.1017/S1041610210000438.

12. Garre-Olmo, J., López-Pousa, S., Turon-Estrada, A., Juvinyà, D., Ballester, D., & Vilalta-Franch, J. (2012). Environmental determinants of quality of life in nursing home residents with severe dementia. Journal Of The American Geriatrics Society, 60(7), 1230–1236. Https://Doi.Org/10.1111/J.1532-5415.2012.04040.X.

13. Kok, S., J.Heuvelen, M. J.G., Berg, I. J., & Scherder, E. J. A. (2016). Small scale homelike special care units and traditional special care units: Effects on cognition in dementia—A longitudinal controlled intervention study. BMC Geriatrics,16(47), 1-8. (PDF).

14. Lee, S. Y., Chaudhury, H., & Hung, L. (2016). Exploring staff perceptions on the role of physical environment in dementia care setting. Dementia (London, England), 15(4), 743–755. Https://Doi.Org/10.1177/1471301214536910.

15. Marquardt, G., Bueter, K., & Motzek, T. (2014). Impact of the design of the built environment on people with dementia: An evidence-based review. Health Environments Research & Design Journal, 8(1), 127–157. https://Doi:10.1177/193758671400800111.

16. Marquardt, G. (2011). Wayfinding for people with dementia: A review of the role of architectural design. Health Environments Research & Design Journal, 4(2), 75-90. Https://Doi-Org.Myaccess.Library.Utoronto.Ca/10.1177%2f193758671100400207.

17. Marquardt, G., & Schmieg, P. (2009). Dementia-friendly architecture: Environments that facilitate wayfinding in nursing homes. American Journal Of Alzheimer’s Disease And Other Dementias, 24(4), 333–340. (PDF).

18. Milke, D. L., Beck, C. H., Danes, S., & Leask, J. (2009). Behavioral mapping of residents’ activity in five residential style care centers for elderly persons diagnosed with dementia: Small differences in sites can affect behaviors. Journal Of Housing For The Elderly, 23(4), 335–367. (PDF).

19. Orfield, S. (2015). Dementia environment design in seniors housing: Optimizing resident perception and cognition. Seniors Housing And Care Journal, 23(1), 58-69. (PDF).

5. Facility Closure and Resident Relocation

5a. Cultural Factors in Relocation

1. Aminzadeh, F., Dalziel, W. B., Molnar, F.J., & Garcia, L. J. (2009) Symbolic meaning of relocation to a residential care facility for persons with dementia. Aging Mental Health, 13(3), 487–96. (PDF).

2. Aminzadeh, F., Dalziel, W. B., Molnar, F. J., & Garcia, L. J. (2010). Meanings, functions, and experiences of living at home for individuals with dementia at the critical point of relocation. Journal of Gerontological Nursing, 36(6), 28–35.

3. Horttana, B. M., Ahlström, G., & Fahlström, G. (2007). Patterns of and Reasons For Relocation in Dementia Care. Geriatric Nursing, 28(3), 193-200. (PDF).


5b. Voluntary Relocation 

1. Johnson, R., Popejoy, L. L., & Radina, M. E. (2010). Older adults’ participation in nursing home placement decisions. Clinical Nursing Research, 19(4), 358–375.

2. Kelsey, S., Laditka, S., & Laditka, J. (2009). Dementia and transitioning from assisted living to memory care units: Perspectives of administrators in three facility types. The Gerontologist, 50(2), 192–203.

3. Söderberg, M., Ståhl, A., & Emilsson, U. M. (2012). Family members' strategies when their elderly relatives consider relocation to a residential home—Adapting, representing and avoiding. Journal of Aging Studies, 26(4), 495-503. (PDF).

4. Wu, C. S., & Rong, J. R. (2020). Relocation experiences of the elderly to a long-term care facility in Taiwan: A qualitative study. BMC geriatrics, 20(1), 1-11. (PDF).


5c. Involuntary Relocation—Adverse Outcomes

1. Capezuti, E., Boltz, M., Renz, S., Hoffman, D., & Norman, R. G. (2006). Nursing home involuntary relocation: Clinical outcomes and perceptions of residents and families. Journal of the American Medical Directors Association, 7(8), 486–492.

2. Castle, N.G. (2005). Changes In health status subsequent to nursing home closure. Ageing International, 30(3), 263–277. (PDF).

3. Desai, R., Williams, C.E., Greene, S. B., Pierson, S., & Hansen, R. A. (2011). Medication errors during patient transitions into nursing homes: Characteristics and association with patient harm. The American Journal of Geriatric Pharmacotherapy, 9(6), 413–422. (PDF).

4. Ellis, J.M. (2010). Psychological transition into a residential care facility: Older people’s experiences. Journal of Advanced Nursing, 66(5), 1159–1168.

5. Engberg, J. B. , & Castle, N. (2008). Health outcomes of nursing home residents following post Katrina relocation. The Gerontologist, 33(6), 661-687.

6. Falk, H., Wijk, H., & Persson, L.-O. (2011). Frail older persons’ experiences of interinstitutional relocation. Geriatric Nursing (New York), 32(4), 245–256. (PDF).

7. Hagen, B., Esther, C. A., Ikuta, R., Williams, R. J., Le Navenec, C.-L., & Aho, M. (2005). Antipsychotic drug use in Canadian long-term care facilities: Prevalence, and patterns following resident relocation. International Psychogeriatrics, 17(2), 179–193.

8. Holder, J. M., & Jolley, D. (2012). Forced relocation between nursing homes: Residents' health outcomes and potential moderators. Reviews in Clinical Gerontology, 22(4), 301-319.

9. Jolley D., Jefferys P., Katona C., & Lennon S. (2011). Enforced relocation of older people when care homes close: A question of life and death? Age and Ageing, 40(5), 534–37. (PDF).

10. Koppitz, A. L., Dreizler, J., Altherr, J., Bosshard, G., Naef, R., & Imhof, L. (2017). Relocation experiences with unplanned admission to a nursing home: A qualitative study. International psychogeriatrics, 29(3), 517-527. (PDF).

11. Laughlin, A., Parsons, M., Kosloski, K. D., & Bergman-Evans, B. (2021). Predictors of mortality: Following involuntary interinstitutional relocation. Journal of Gerontological Nursing, 33(9), 20–26.

12. Williams, J., Netten, A., & Ware, P. (2007). Managing the care home closure process: Care managers’ experiences and views. The British Journal of Social Work, 37(5), 909–924.

13. Yamamoto, K. (2008). Influences of relocation on well-being of elderly people: A study on city planning and housing considering the adaptation to the town residence of the elderly. Nihon Kenchiku Gakkai keikakukei ronbunshū, 73(628), 1297–1304. (PDF).


5d. Improving the Relocation Process

1. Cheek, J., Byers, L., Ballantyne, A., & Quan, J. (2006). Improving the retirement village to residential aged care transition. Australian Health Review, 30(3), 344–352. (PDF).

2. de Boer, B., Caljouw, M., Landeweer, E., Perry, M., Stoop, A., Groen, W., Schols, J., & Verbeek, H. (2021). The need to consider relocations WITHIN long-term care. Journal of the American Medical Directors Association, 1-3. (PDF).

3. Dubin, S. (2007). When the patient suffers: Optimization of transitions between care facilities. Geriatric Nursing (New York), 28(5), 298–300. (PDF).

4. Koren, M. E., Robertson, J. F., Titler, M. G., Adams, S., Rossetti, J., & Hertz, J. E. (2007). Evidence-based guideline: Management of relocation in cognitively intact older adults. Journal of Gerontological Nursing, 33(11), 12–18.

5. LaMantia, M. A., Scheunemann, L. P., Viera, A. J., Busby-Whitehead, J., & Hanson, L. C. (2010). Interventions to improve transitional care between nursing homes and hospitals: A systematic review. Journal of the American Geriatrics Society, 58(4), 777–782. (PDF).

6. McFadden, S. H., & Lunsman, M. (2010). Continuity in the midst of change: Behaviors of residents relocated from a nursing home environment to small households. American Journal of Alzheimer’s Disease and Other Dementias, 25(1), 51–57. (PDF).

7. Williams, J., & Netten, A. (2005). English local authority powers, Responsibilities and guidelines for managing the care home closure process. The British Journal of Social Work, 35(6), 921–936. (PDF).

8. Yamada, M., Yamaguchi, K., & Takada, M. (2014). A study of the process of residential relocation of the elderly and its impacts among residents before and after. Journal of Architecture and Planning, 79(695), 11-20.

6. The Expanding Role of Family Engagement

6a. Family Engagement—Case Studies

1. Abrahamson, K., Bernard, B., Magnabosco, L., Nazir, A., & Unroe, K. T. (2016). The experiences of family members in the nursing home to hospital transfer decision. BMC Geriatrics, 16(1), 184–184. (PDF)

2. Ben Natan, M. (2008). Perceptions of nurses, families, and residents in nursing homes concerning residents’ needs. International Journal of Nursing Practice, 14(3), 195–199.

3. Gaugler, J. (2005). Promoting Family Involvement in Long-Term Care Settings : A Guide to Programs That Work. New York: Health Professions Press.

4. Havreng-Thery, C., Giner-Perot, J., Zawieja, P., Bertin-Hugault, F., Belmin, J., & Rothan-Tondeur, M. (2020). Expectations and needs of families in nursing homes: An integrative review. Medical Care Research and Review, 78(4), 311-325. (PDF)

5. Jervis, L. L. (2006). The missing family: Staff perspectives on and responses to familial noninvolvement In two diverse nursing homes. Journal of Aging Studies, 20(1), 55-66.

6. Voutilainen, P., Backman, K., Isola, A., & Laukkala, H. (2006). Family members’ perceptions of the quality of long-term care. Clinical Nursing Research, 15(2), 135–149.


6b. Family Engagement—Facility Design

1. Cioffi, J. M., Fleming, A., Wilkes, L., Sinfield, M., & Le Miere, J. (2007). The effect of environmental change on residents with dementia: The perceptions of relatives and staff. Dementia (London, England), 6(2), 215–231.

2. Garcia, L. J., Hébert, M., Kozak, J., Sénécal, I., Slaughter, S. E., Aminzadeh, F., Dalziel, W., Charles, J., & Eliasziw, M. (2012). Perceptions of family and staff on the role of the environment in long-term care homes for people with dementia. International Psychogeriatrics, 24(5), 753–765.

3. Hasson, H., & Arnetz, J. E. (2011). Care recipients’ and family members’ perceptions of quality of older people care: A comparison of home‐based care and nursing homes. Journal of Clinical Nursing, 20(9‐10), 1423-1435. (PDF)

4. Innes, A., Kelly, F., & Dincarslan, O. (2011). Care home design for people with dementia: What do people with dementia and their family carers value? Aging & Mental Health, 15(5), 548–556. (PDF)

7. Infection Control, Well-Being, and COVID-19

7a. Safety and Infection Control

1. Agarwal, M., Stone, P. W., & Dick, A. (2019). Evaluation of nursing home infection control programs: A pre-and post-study. American Journal of Infection Control, 47(6), S34–S34. (PDF)

2. Bentayeb, M., Norback, D., Bednarek, M., Bernard, A., Cai, G., Cerrai, S., Eleftheriou, K. K., Gratziou, C., Holst, G. J., Lavaud, F., Nasilowski, J., Sestini, P., Sarno, G., Sigsgaard, T., Wieslander, G., Zielinski, J., Viegi, G., & Annesi-Maesano, I. (2015). Indoor air quality, Ventilation and respiratory health In elderly residents living In nursing homes in Europe. The European Respiratory Journal, 45(5), 1228–1238. (PDF)

3. Public Health Ontario (2012). Best Practices for Environmental Cleaning for Prevention and Control of Infections in All Health Care Settings (2nd Edition). Public Health Ontario.

4. Brown, K. A., Jones, A., Daneman, N., Chan, A. K., Schwartz, K. L., Garber, G. E., Costa, A. P., & Stall, N. M. (2021). Association between nursing home crowding and COVID-19 infection and mortality in Ontario, Canada. JAMA Internal Medicine, 181(2), 229–236. (PDF).

5. Castle, N. G., Wagner, L. M., Perera, S., Ferguson, J. C., & Handler, S. M. (2010). Assessing resident safety culture in nursing homes: Using the nursing home survey on resident safety. Journal of Patient Safety, 6(2), 59–67. (PDF).

6. Jiang, Y., Xia, Q., Zhou, P., Jiang, S., Diwan, V. K., & Xu, B. (2021). Environmental hazards increase the fall risk among residents of long-term care facilities: A prospective study In Shanghai, China. Age and Ageing, 50(3), 875–881.

7. Kovach, C. R., Taneli, Y., Neiman, T., Dyer, E. M., Arzaga, A. J. A., & Kelber, S. T. (2017). Evaluation of an ultraviolet room disinfection protocol to decrease nursing home microbial burden, infection and hospitalization rates. BMC Infectious Diseases, 17(1), 186–186.

8. Nichols, J. (2014) Private rooms not always a better place for residents. Caring for the Ages, 15(2), 3. (PDF).

9. Nuño, M., Reichert, T. A., Chowell, G., & Gumel, A. B. (2008). “Protecting residential care facilities from pandemic influenza.” Proceedings of the National Academy of Sciences--PNAS, 105(30), 10625–10630. (PDF).

10. Stone, P. W., Herzig, C. T. ., Pogorzelska-Maziarz, M., Carter, E., Bjarnadottir, R. I., Semeraro, P. K., Cohen, C. C., Travers, J., & Schweon, S. (2015). Understanding infection prevention and control in nursing homes: A qualitative study. Geriatric Nursing (New York), 36(4), 267–272. (PDF).

11. Van Baarle, D., Bollaerts, K., Del Giudice, G., Lockhart, S., Luxemburger, C., Postma, M. J., Timen, A., & Standaert, B. (2020). Preventing infectious diseases for healthy ageing: The VITAL public-private partnership project. Vaccine, 38(37), 5896–5904. (PDF).

12. Yasuda, K., & Miura, K. (2021). Planning of shared space in senior citizens living facility using visibility analysis. Journal of Architectural and Planning Research, 86(781), 727. (PDF).


7b. Lighting, Noise and Indoor Air Quality 

1. Barrick, A. L., Sloane, P. D., Williams, C. S., Mitchell, C. M., Connell, B. R., Wood, W., Hickman, S. E., Preisser, J. S., & Zimmerman, S. (2010). Impact of ambient bright light on agitation in dementia. International Journal of Geriatric Psychiatry, 25(10), 1013–1021. (PDF).

2. Bharathan, T., Glodan, D., Ramesh, A., Vardhini, B., Baccash, E., Kiselev, P., & Goldenberg, G. (2007). What do patterns of noise in a teaching hospital and nursing home suggest? Noise & Health, 9(35), 31–34.

3. De Lepeleire, J., Bouwen, A., De Coninck, L., & Buntinx, F. (2007). Insufficient lighting in nursing homes. Journal of the American Medical Directors Association, 8, 314–317.

4. Dowling, G. A., Mastick, J., Hubbard, E. M., Luxenberg, J. S., & Burr, R. L. (2005). Effect of timed bright light treatment for rest-activity disruption in institutionalized patients with Alzheimer’s disease. International Journal of Geriatric Psychiatry, 20(8), 738–743.

5. Fetveit, A., & Bjorvatn, B. (2005). Bright-light treatment reduces actigraphic measured daytime sleep in nursing home patients with dementia—A pilot study. The American Journal of Geriatric Psychiatry, 13(5), 420–423.

6. Friedman, L., Spira, A. P., Hernandez, B., Mather, C., Sheikh, J., Ancoli-Israel, S., Yesavage, J. A., & Zeitzer, J. M. (2012). Brief morning light treatment for sleep/wake disturbances in older memory-impaired individuals and their caregivers. Sleep Medicine, 13(5), 546–549.

7. Giggins, D. J., Hogan, K., & George, M. (2019). The Impact of a cycled lighting intervention on nursing home residents: A pilot study. Gerontology and Geriatric Medicine, 5(2), 1-6. (PDF).

8. Hickman, S. E., Barrick, A. L., Williams, C. S., Zimmerman, S., Connell, B. R., Preisser, J. S., Madeline Mitchell, C., & Sloane, P. D. (2007). The effect of ambient bright light therapy on depressive symptoms in persons with dementia. Journal of the American Geriatrics Society (JAGS), 55(11), 1817–1824.

9. Joosse L. L. (2011). Sound levels in nursing homes. Journal of Gerontological Nursing, 37(8), 30–35.

10. Joosse L. L. (2012). Do sound levels and space contribute to agitation in nursing home residents with dementia? Research in Gerontological Nursing, 5(3), 174–184.

11. Kim, D., Chang, C., & Margrett, J. (2021). Understanding older adults’ perception and usage of indoor lighting in independent senior living. Health Environments Research & Design Journal, 14(3), 215–228.

12. Riemersma-van der Lek, R. F., Swaab, D. F., Twisk, J., Hol, E. M., Hoogendijk, W. J. G., & Van Someren, E. J. W. (2008). Effect of bright light and melatonin on cognitive and noncognitive function in elderly residents of group care facilities: A randomized controlled trial. Journal of the American Medical Association (JAMA), 299(22), 2642–2655.

13. Royer, M., Ballentine, N. H., Eslinger, P. J., Houser, K., Mistrick, R., Behr, R., & Rakos, K. (2012). Light therapy for seniors in long-term care. Journal of the American Medical Directors Association, 13(2), 100–102. (PDF).

14. Sloane, P. D., Williams, C. S., Mitchell, C. M., Preisser, J. S., Wood, W., Barrick, A. L., Hickman, S. E., Gill, K. S., Connell, B. R., Edinger, J., & Zimmerman, S. (2007). High-intensity environmental light in dementia: Effect on sleep and activity. Journal of the American Geriatrics Society (JAGS), 55(10), 1524–1533. (PDF).

15. Tartarini, F., Cooper, P., Fleming, R., & Batterham, M. (2017). Indoor air temperature and agitation of nursing home residents with dementia. American Journal of Alzheimer’s Disease and Other Dementias, 32(5), 272–281. (PDF)

16. Thomas, A. F., Filipan, K., Mynsbrugge, T. V., De Geetere, L., Dijckmans, A., Botteldooren, D., Petrovic, M., Van de Velde, D., De Vriendt, P., & Devos, P. (2020). (PDF).

17. White, M., Ancoli-Israel, S., & Wilson, R. (2013). Senior living environments: Evidence-based lighting design strategies. Health Environments Research & Design Journal, 7(1), 60–78. (PDF).


7c. COVID-19

1. Anderson, D. C., Grey, T., Kennelly, S., & O'Neill, D. (2020). Nursing home design and COVID-19: Balancing infection control, quality of life, and resilience. Journal of the American Medical Directors Association, 21(11), 1519–1524.

2. Carazo, S., Laliberté, D., Villeneuve, J., Martin, R., Deshaies, P., Denis, G., Adib, G., Tissot, F., Dionne, M., & De Serres, G. (2021). Characterization and evolution of infection control practices among severe acute respiratory coronavirus virus 2 (SARS-CoV-2)-infected healthcare workers in acute-care hospitals and long-term care facilities in Québec, Canada, Spring 2020. Infection Control and Hospital Epidemiology, 12, 1–9. (PDF).

3. Chu, C. H., Donato‐Woodger, S., & Dainton, C. J. (2020). Competing crises: COVID‐19 countermeasures and social isolation among older adults in long‐term care. Journal of Advanced Nursing, 76(10), 2456–2459.

4. Gordon, A. ., Goodman, C., Achterberg, W., Barker, R. ., Burns, E., Hanratty, B., Martin, F., Meyer, J., O’Neill, D., Schols, J., & Spilsbury, K. (2020). Commentary: COVID in care homes-challenges and dilemmas in healthcare delivery. Age and Ageing, 49(5), 701–705. (PDF).

5. Government of Canada (2021). Infection Prevention and Control for COVID-19: Interim Guidance for Long Term Care Homes. Ottawa: Health Canada,

6. Koshkouei, M., Abel, L., & Pilbeam, C. (2020). How Can Pandemic Spreads be Contained in Care Homes? Washington, DC: The Center for Evidence-Based Medicine. (PDF).

7. Lynch, R. M., & Goring, R. (2020). Practical steps to improve air flow in long-term care resident rooms to reduce COVID-19 infection risk. Journal of the American Medical Directors Association, 21(7), 893–894. (PDF).

8. Olson, N. L., & Albensi, B. C. (2021). Dementia-friendly “Design”: Impact on COVID-19 death Rates in long-term care facilities around the world. Journal of Alzheimer’s Disease, 81(2), 427–450. (PDF).

9. Thompson, D.-C., Barbu, M.-G., Beiu, C., Popa, L. G., Mihai, M. M., Berteanu, M., & Popescu, M. N. (2020). The impact of COVID-19 pandemic on long-term care facilities worldwide: An overview on international issues. BioMed Research International, 2020, 8870249–8870249. (PDF).

10. Wang, Z. (2021). Use the environment to prevent and control COVID-19 in senior-living facilities: An analysis of the guidelines used in China. Health Environments Research & Design Journal, 14(1), 130–140. (PDF).

11. Zhu, X., Lee, H., Sang, H., Muller, J., Yang, H., Lee, C., & Ory, M. (2022). Nursing home design and COVID-19: Implications of guidelines and regulations. 67(2), 46-52. Journal of the American Medical Directors Association. (PDF).

8. Ecological and Cost-Effective Facility Procurement

8a. Sustainable-Resilient Strategies

1. Baldwin, R. F.,Powell, R. B., & Kellert, S. R. (2011). Habitat as architecture: Integrating conservation planning and human health. Ambio, 40(3), 322–327.

2. Banerjee, S., & Ford, C. (2018). Sensory Rooms for Patients with Dementia in Long-Term Care: Clinical and Cost-Effectiveness, and Guidelines. Ottawa: Canadian Agency for Drugs and Technologies in Health.

3. Calkins, M., & Cassella, C. (2007). Exploring the cost and value of private versus shared bedrooms in nursing homes. The Gerontologist, 47(2), 169–183. (PDF).

4. Ivanko, D., Walnum, H., & Nord, N. (2020). Development and analysis of hourly DHW heat use profiles in nursing homes in Norway. Energy and Buildings, 222(4), 1-13.

5. Jenkens, R., Sult, T., Lessell, N., Hammer, D., & Ortigara, A. (2011) Financial implications of the Green House® model. Seniors Housing & Care Journal, 19(1), 3-22.

6. Nova Scotia Department of Health and Wellness (DHW). (2020). Long Term Care Facility Requirements: Requirements for Nursing Home Design in Nova Scotia. Nova Scotia: Nova Scotia Department of Health and Wellness (DHW).

7. Peters, T., & Verderber, S. (2019). Reconciling LEED with salutogenic affordances in long-term care environments for the aged: A call for inclusive assessment metrics. In Proceedings of the 5th European Healthcare Design 2019 Congress and Exhibition. Architects for Health and SALUS Global Knowledge Exchange.

8. Peterson, L., Hyer, K., & Brown, L. M. (2014). “Building Resilience in Nursing Homes in Disasters.” Pp. 103-117 in Cefalu, C.A. (ed.), Disaster Preparedness for Seniors: A Comprehensive Guide for Health care Professionals. New York: Springer. (PDF).

9. Sun, K., Specian, M., & Hong, T. (2020). Nexus of thermal resilience and energy efficiency in buildings: A case study of a nursing home. Buildings and Environment, 177(2), 1-25. (PDF).

10. Tavares, L. N., & Freire, F. (2019). Embodied energy and greenhouse gas emissions analysis of a prefabricated modular house: The “Moby” case study. Journal of Cleaner Production, 212(1) 1044–1053. (PDF).

11. Teni, M., Culo, K., & Krstic, H. (2019). Renovation of public buildings towards nZEB: A case study of a nursing home. Buildings (Basel), 9(7), 1-14. (PDF).

12. Verderber, S., & Peters, T. (2019). Integrating LEED with biophilic design attributes: Toward an inclusive rating system. Pp. 311-327 in Battisto, D. & Wilhelm, J.J. (eds.), Architecture and Health: Guiding Principles for Practice. London and New York: Routledge.

13. Wu, J. (2019). Linking landscape, land system and design approaches to achieve sustainability. Journal of Land Use Science, 14(2), 173–189.

9. Recent Design Trends and Prognostications

9a. The Green House Model

1. Afendulis, C. C., Caudry, D. J., O’Malley, A. J., Kemper, P., & Grabowski, D. C. (2016). Green house adoption and nursing home quality. Health Services Research, 51(S1), 454–474.

2. Brown, P. B., Hudak, S. L., Horn, S. D., Cohen, L. W., Reed, D. A., & Zimmerman, S. (2016). Workforce characteristics, perceptions, stress, and satisfaction among staff in Green House and other nursing homes. Health Services Research, 51(S1), 418–432. (PDF).

3. Cohen, L. W., Zimmerman, S., Reed, D., Brown, P. B., Bowers, B. J., Nolet, K., Hudak, S. L., & Horn, S. D. (2016). The Green House model of nursing home care in design and practice. Health Services Research, 51(1), 352–377.

4. Cutler, L.J., & Kane, R.A. (2009). Post-occupancy evaluation of a transformed nursing home: The first four Green House settings. Journal of Housing for the Elderly, 23(4), 304-334. (PDF).

5. Fishman, N. W., Lowe, J. I., & Ryan, S. F. (2016). Promoting an alternative to traditional nursing home care: Evaluating the Green House small home model. Introduction from the Funders and the Green House Project. Health Services Research, 51(S1), 344–351.

6. Jenkens, R., Thomas, W., & Barber, V. (2012). Can community-based services thrive in a licensed nursing home? Generations: Journal of the American Society on Aging, 36(1), 125-130. (PDF).

7. Kane, R.A., Lum, T. Y, .Cutler, L. J., Degenholtz, H. B., & Yu, T. C. (2007). Resident outcomes in small-house nursing homes: A longitudinal evaluation of the initial Green House program. Journal of the American Geriatrics Society, 55(6), 832–839. (PDF).

8. NCB Capital Impact’s Community Solutions Group. (2010). Green House Project Guide Book. Arlington, VA.

9. Regnier, V. (2018). Housing Design for an Increasingly Older Population: Redefining Assisted Living for the Mentally and Physically Frail. New York. John Wiley.

10. Wrublowsky, R. (2018) Design Guide for Long Term Care Homes. MMP Architects. (PDF).

11. Zimmerman, S., Bowers, B. J., Cohen, L. W., Grabowski, D. C., Horn, S. D., & Kemper, P. (2016). New evidence on the Green House model of nursing home care: Synthesis of findings and implications for policy, practice, and research. Health Services Research, 51(S1), 475–496. (PDF).


9b. The Future

1. Canadian Association for Long Term Care. (2017). Caring for Canada’s Seniors: Recommendations for Meeting the Needs of an Aging Population.

2. Chiou, S.-T., & Chen, L.-K. (2009). Towards age-friendly hospitals and health services. Archives of Gerontology and Geriatrics, 49(2), S3–S6.

3. Clark, M. et al. (2016). Innovative Public-Private Partnerships to Enhance Aging in Place in the United States, Human Research Center Research Report #26. New Brunswick, NJ: Rutgers School of Social Work.

4. Craig, C. (2017). Imagined futures: Designing future environments for the care of older people. The Design Journal, 20(1), S2336–S2347.

5. Engelen, L., Rahmann, M., & de Jong, E. (2017). Design for healthy aging—The relationship between design, well-being, and quality of life: A review. Building Research and Information: International Journal of Research, Development and Demonstration, 14(2),1–17.

6. Hills, W.E. (2019). Behavioral health and new models of service delivery for an aging world: Public/private partnerships to develop best practices of care for older adults. Medical Science Pulse, 13(1), 29–33.

7. Hodgson, N. A. (2020) Aging in Place: The Role of Public-Private Partnerships. Wharton Pension Research Council Working Papers #691.

8. Kerbler, B. (2016). An innovative built environment form for dwellings for the elderly. METU Journal of the Faculty of Architecture, 31(1).  10.4305/METU.JFA.2014.1.6.

9. Lundstedt, R., Håkansson, C., Lõhmus, M., & Wallergård, M. (2021). Designing virtual natural environments for older adults in residential care facilities. Technology and Disability, 33(4), 305–318.

10. McFadden, E.S., & Lucio, J. (2014). Aging in (privatized) places: Subsidized housing policy and seniors. Journal of Housing for the Elderly, 28(3), 268–287.

11. Nasrallah, E., & Pati, D. (2021). Can physical design help reduce loneliness in the elderly? A theoretical exploration. Health Environments Research & Design Journal, 14(3), 374–385.

12. Orfield, S. J. (2013). Aging research, design education, and the perceptual limits in seniors housing design: Development of a research-based design model for better aging environments. Seniors Housing & Care Journal, 21(1), 136-144.

13. Pirinen, A. (2016). Housing concepts for and by the elderly: From subjects of design to a design resource. Journal of Housing for the Elderly, 30(4), 412-429.

14. Regnier, V., & Denton, A. (2009). Ten new and emerging trends in residential group living environments. NeuroRehabilitation, 25(3), 169-188.

15. Schwarz, B. (2012) Environmental gerontology: What now?, Journal of Housing For the Elderly, 26(1-3), 4-19,

16. van Hoof, J., Wetzels, M., Dooremalen, A. M., Wouters, E. J., Nieboer, M., Sponselee, A. A., Eyck, A. M., van Gorkom, P. J. L., Zwerts-Verhelst, E. L., Peek, S. T., Vissers-Luijcks, C., van der Voort, C., Moonen, M. J. G., van de Vrande, H., van Dijck-Heinen, C. J. M., Raijmakers, T., Oude Weernink, C., Paricharak, N., Hoedemakers, C. G. J., Woudstra, J.M.M., van der Voort, L., van de Werff, T.C.F., van der Putten, B., & Overdiep, R. (2014). Technological and architectural solutions for Dutch nursing homes: Results of a multidisciplinary mind mapping session with professional stakeholders. Technology in Society, 36(1), 1–12.

17. Wang, C., & Kuo, N. (2006). Zeitgeists and development trends in long-term care facility design. Journal of Nursing Research, 14(2), 123–132.

18. Westchester County Public-Private Partnership for Aging-in-Place (2018). 2018 Annual Report.

19. Zhao, Y., Sazlina, S.-G., Rokhani, F. Z., Su, J., & Chew, B.-H. (2021). The expectations and acceptability of a smart nursing home model among Chinese elderly people: A mixed methods study protocol. PloS One, 16(8), 1-19.

Some Probable Questions

  • Must the minimum architectural design standards be revisited for LTC homes in Ontario? 
  • Can’t we just tweak the existing standards and get by?
  • How much will implementing this report’s findings cost?
  • Who is going to pay for building smaller but more numerous LTC homes in the Province? 
  • Is this what the general public really wants? Is this what the aged themselves want?


Bottom Line: If nothing is done more will needlessly suffer in Ontario’s LTC homes—