A tool for assessing SCU environments.

There have traditionally been a variety of approaches to the conceptualization and measurement of longterm care "quality". One such approach is the judgment of an expert; although such evaluations are useful and often informed by years of experience, experts often find it difficult to articulate the specific criteria that shaped their judgment. Other approaches tend to focus on issues of safety and security which-though clearly critical-may reflect but a small part of the mission and program of an institution.

These concerns are timely, because interest in the assessment of environmental "quality" has been rekindled by the rapid growth in the number of Special Care Units (SCUs) for people with Alzheimer's disease and related dementias. People are eager to know what makes such units "special" and what impact such special characteristics have on quality of care, as experienced by residents, staff, and families. These questions are central to a set of ten multi-year research studies of SCUs being conducted by the National Institute on Aging. One of the products of this research initiative has been a new protocol for the assessment of SCU environments: the Professional Environmental Assessment Protocol (PEAP).

This instrument, now being field-evaluated, was developed by Gerald Weisman, PhD, and Margaret Calkins, M.Arch, of the Institute on Aging and Environment at the University of Wisconsin-Milwaukee; M. Powell Lawton, PhD, of the Philadelphia Geriatric Center; and Phillip Sloane, MD, MPH, of the Department of Family Medicine at the University of North Carolina, Chapel Hill. Development of the PEAP was supported by grants to Professor Sloane from NIA and the Helen Daniels Bader Foundation.

The PEAP endeavors to take a "middle road" in its approach to assessment of quality; it is not as global as the expert's rating, nor is it overly detailed and descriptive. Rather, it is organized with respect to eight therapeutic goals judged to be significant in the provision of dementia care. Each goal is defined in detail and a set of assessment questions is provided. Assessment questions do not constitute an exhaustive check list; rather they ask about selected environmental features commonly found in SCUs, and presumed to impact on realization of each of the eight goals.

At this point in its evolution, use of the PEAP requires some degree of expertise and specialized training. However, it is intended that the protocol and accompanying instructional materials, in their final form, will be usable by a broad range of care providers to assess their own facilities. The PEAP is currently being utilized in 20 SCUs in the state of Kansas, to assess degree of agreement among different raters as well as the relationship between PEAP scores and other techniques for measuring SCU "quality".

For further information, please contact, Prof. Gerald Weisman, Institute on Aging & Environment, University of Wisconsin-Milwaukee, PO Box 413, Milwaukee, WI 53201, 414/229-4014.

RELATED ARTICLE: Professional Environmental Assessment Protocol Criteria

MAXIMIZE SAFETY AND SECURITY

Definition: The extent to which the environment both minimizes threats to residents' safety and maximizes sense of security of residents, staff, and family members MAXIMIZE AWARENESS AND ORIENTATION

Definition: The extent to which users (often staff and visitors as well as residents) can effectively orient themselves to physical, social, and temporal dimensions of the environment. SUPPORT FUNCTIONAL ABILITIES

Definition: The extent to which the environment and the rules regarding the use of the environment support the practice or continued use of everyday skills. These skills can be divided into both activities of daily living (ambulation, grooming, bathing & toileting, eating) and independent activities of daily living, which will vary with stage of the disease. FACILITATION OF SOCIAL CONTACT

Definition: The extent to which the physical environment and rules governing its use support social contact and interaction among residents. PROVISION OF PRIVACY

Definition: The extent to which input from (e.g., noise) and output to (e.g., confidential conversations) the larger environment are regulated. OPPORTUNITIES FOR PERSONAL CONTROL

Definition: The extent to which the physical environment and the rules governing the use of the environment provide residents with opportunities, consistent with level of acuity, for exercise of personal preference, choice, and independent initiative to determine what they will do and when it is done. REGULATION AND QUALITY OF STIMULATION

Definition: People with dementia have decreased ability to deal with potentially conflicting stimuli, and have greater difficulty distinguishing between foreground and background stimulation. Therefore the environment must be sensitive to both the "qualify" of stimulation, and its effective regulation. The goal, in Mace's term, is "stimulation but not stress." CONTINUITY OF THE SELF

Definition: This scale focuses on attempts to preserve continuity between present and past environments and the self of past and present. This can be expressed in two different ways: through presence of personal items belonging to the individual, and creation of a non-institutional ambiance.