Methods: Between January and May 2017, data was collected at one Assisted Living facility for older Japanese Americans in California, USA and a Group Care facility for older Japaneses in Chiba prefecture in Japan. A Group Care facility comprised of several Group Care units, each housed up to ten residents. We assessed the appropriateness of four environmental scales: Environmental Audit Tool-High Care [EAT-HC] (Fleming, Bennett, 2010); Professional Environmental Assessment Protocol [PEAP] (Weisman, Lawton, Sloane, Calkins, & Norris-Baker, 1996); and PEAP Japanese Version 3 [PEAP-J3] (Care and Kankyo Kenkyukai, 2005); Therapeutic Environment Screening Survey for Nursing Homes and Residential Care [TESS-NH/RC] (Sloane & Zimmerman, 2009). To assess QOL of older adults living in LTC facilities, we used the Dementia Care Mapping (DCM) and the Quality of Life-Alzheimer’s Disease (QOL-AD) scales. Dementia Care Mapping (Dementia Care Mapping, 8th Edition) was conducted via observation by a certified user. QOL-AD was assessed subjectively and objectively by collecting data from both residents and LTC staff. We conducted individual interview with the residents (subjective) and administered the same questions to LTC staff (objective) in paper format. We then compared these two scores.
Results: Our findings indicated that TESS focuses more on the physical environment of LTC facilities (e.g., grab bar, lighting, flooring) while EAT is more appropriate to measure dementia care. Because there is no open space in group care unit (GCU) facility in Japan, we omitted all the EAT questions regarding outside areas (e.g., access to patio, outside activities, etc…). PEAP and PEAP-J3 quantify independence of individual resident. Approximately 10 - 15% of the total questions in PEAP and PEAP-J3 do not apply to Assisted Living (USA) and GCU (Japan) facilities. For example, the questions about access to cooking facilities or cleaning utilities are not applicable to residents in Assisted Living facilities (USA) and GCU (Japan) due to physical and mental limitations. In terms of physical functioning, residents in Assisted Living facility (USA) are able to move from room to room to attend different activities that keep them active and energetic. Because GCU (Japan) does not provide activities and residents spend most of their time in the living/dining room, GCU residents were noted to “withdraw (disengaged or sleeping)” 20% of the time. Higher Mood and Engagement (ME) values were reflected in Assisted Living facility (USA) through daily activity programs and socializing with volunteers. The space for socialization and extra chairs for visitors are important to enhance residents' QOL. QOL-AD scores obtained from LTC residents in both USA and Japan were higher than the QOL-AD scores from the LTC staff.
Conclusion: There are similarities and differences in LTC physical design in the USA and Japan. In both countries, physical environment of LTC facilities has an impact on LTC residents’ QOL. Our findings indicated that without a social area that is accessible for LTC residents, lack of social activity programs conducted either by volunteers or staff contributed to lowered residents’ ME values. More studies are needed to determine effective design of the LTC physical environment in order to improve LTC residents’ QOL.