'Does the design of settings where acute care is delivered meet the needs of older people? Perspectives of patients, family carers, and staff

Background: Older people with an acute illness, many of whom are also frail, form a significant proportion of the acute hospital inpatient population. Attention is focusing on ways of improving the physical environment to optimize health outcomes and staff efficiency.

Purpose: This paper explores the effects of the physical environment in three acute care settings: Acute Hospital Site, In-patient Rehabilitation Hospital, and Intermediate Care Provision (a nursing home with some beds dedicated to intermediate care) chosen to represent different steps on the acute care pathway for older people and gain the perspectives of patients, family carers and staff.

Methods: Semi structured interviews were undertaken with 40 patient/carer dyads (where available) and three staff focus groups were conducted in each care setting with a range of staff.

Results: Multiple aspects of the physical environment were reported as important by patients, family carers, and staff. For example, visitors stressed the importance of access and parking; patients valued environments where privacy and dignity were protected; storage space was poor across all sites; security was important to patients but visitors want easy access to wards.

Conclusions: The physical environment is a significant component of acute care for older people, many of whom are also frail, but often comes second to organization of care, or relationships between actors in an episode of care.