50 British Journal of Occupational Therapy February 2014 77(2) Research Introduction Ecological effect of the environment M Powell Lawton was the most important environmental theorist for dementia, disability and ageing from the last century (Calkins 2003). He used a transactional and ecological framework to understand the impact the whole environment had on people with dementia, disability, and debility. His Competence Press Hypothesis (Lawton and Nahemow 1973) states that negative consequences occur when the environment exerts too much or too little demand (‘press’). Too little press leads to lack of stimulation, boredom, and deconditioning. Too much press leads to stress, anxiety, and excessively challenging barriers within the environment (Cutler 2007). Lawton and Nahemow (1973) stated that the effects of the environment have a dispro- portionately large effect on those with the lowest competence (Environmental Docility Theory). They promoted enabling environments which provide: (a) maintenance of function through constancy and predictability, (b) stimulation through novel stimuli and interactions, and (c) support and compensation for reduced or lost competencies (Wahl and Weisman 2003). Occupational therapy theorists have promoted the ecological and trans- actional nature of the person in a complex whole environment (Turpin and Comparing communal environments using the Assessment Tool for Occupation and Social Engagement: using interactive occupation and social engagement as outcome measures Mark Morgan-Brown 1 and Gill Chard 2 Key words: Dementia, nursing home, observation. Introduction: Interactive occupation and social engagement are important components of quality of life for residents with dementia in nursing homes. Communal living spaces should be evaluated on these qualities. Two Irish nursing homes were compared pre and post conversion from a traditional to a household model unit using the Assessment Tool for Occupation and Social Engagement. This assessment uses interactive occupation and social engagement as positive outcome measures. Method: Residents, staff, and relatives were observed pre and post renovation over a 6-week period using a snapshot observational method over 4 hours on 7 different weekdays. Findings: Changing from a traditional to a household model nursing home increased the interactive occupation and social engagement of residents, staff, and visitors within the communal living areas. The role of a homemaker in the household unit was critical for maintaining residents’ participation and engagement, including engaging in familiar everyday domestic tasks. Conclusion: Interactive occupation and social engagement were significantly increased in the household model unit over the traditional model unit, particularly for residents. In the household model unit, more residents initiated and maintained their own interactions within the communal environment and did not require prompting from staff to do this. © The College of Occupational Therapists Ltd. Submitted: 11 April 2013. Accepted: 20 December 2013. 1 Senior Occupational Therapist, Mental Health Team for the Elderly, Cavan General Hospital, Cavan, Ireland. 2 Former Professor of Occupational Therapy, University College Cork, Cork, Ireland. Corresponding author: Dr Mark Morgan-Brown, Senior Occupational Therapist, Mental Health Team for the Elderly, Cavan General Hospital, Cavan, Ireland. Email: mark.brown@hse.ie Reference: Morgan-Brown M, Chard G (2014) Comparing communal environments using the Assessment Tool for Occupation and Social Engagement: using interactive occupation and social engagement as outcome measures. British Journal of Occupational Therapy, 77(2), 50–58. DOI: 10.4276/030802214X13916969446994