© 2013 Taylor & Francis Aging & Mental Health, 2013 Vol. 17, No. 1, 57–65, http://dx.doi.org/10.1080/13607863.2012.717250 Engaging life in two Irish nursing home units for people with dementia: Quantitative comparisons before and after implementing household environments Mark Morgan-Brown ab * , Rita Newton a and Marcus Ormerod a a SURFACE Inclusive Design Research Centre, School of the Built Environment, The University of Salford, Salford, UK; b Assessment and Rehabilitation Unit, Cavan General Hospital, Cavan, Ireland (Received 15 August 2011; final version received 27 July 2012) Objectives: This study compares the Social Engagement and Interactive Occupation of residents with dementia in two Irish nursing homes, before and after conversion to a household model environment. The changes were an open plan design and a functioning unit kitchen, supported by a homemaker role and operational policies which reduced task-based work in favour of person-centred care offering choice. Method: A snapshot observation method was used to obtain quantitative data of resident activity using the Assessment Tool for Occupation and Social Engagement (ATOSE). Residents were assessed for four hours, on seven different weekdays, over a six-week period both pre- and post-renovation. The exception to this was the assessment of the traditional model unit (TMU) for Nursing Home 1 which was reduced to four days due to the early start of the building work. Results: The results were consistent for both nursing homes and data were aggregated. Residents spent more time in the communal living spaces and were more likely to be active and engaged in the household model units (HMUs) compared to the TMUs. Using the independent t-test, these changes were found to be highly significant (p 5 0.001). Conclusion: Creating an HMU increased the Interactive Occupation and Social Engagement of residents in the communal areas of the two nursing homes. The physical environment change, in conjunction with supportive staff procedures and organizational initiatives, improved the well-being of residents with dementia. The outcomes must be viewed in context with financial implications. Keywords: building conversion; household model; Interactive Occupation; post-occupancy assessment; Social Engagement Introduction Assessment of physical, operational and cultural change Since the 1980s, there has been international interest in providing homelike and group living environments for people with dementia. In contrast to the traditional ward style nursing home environments, defined by imposing nursing stations and over 30 residents (Calkins, 2009), the smaller more homelike environ- ments typically have from 5 to 15 residents (Verbeek et al., 2009). These smaller domestic environments have been associated with improved well-being and quality of life, improved independence and interest and improved emotional state (Annerstedt, Gustafson, & Nilsson, 1993; Funaki, Kaneko, & Okamura, 2005; Reimer, Slaughter, Donaldson, Currie, & Eliaszie, 2004; Torrington, 2006). However, other research studies show that small group homes environments can create little or no change and can even lead to boredom and can exacerbate behavioural problems (McFadden & Lunsman, 2010; Parker-Oliver, Aud, Bostick, Schwarz, & Tofle, 2005; Wood, Harris, & Snider, 2005; Wood, Womack, & Hooper, 2009). Household model units (HMUs) are often created from traditional ward type environments. They are distinguished by having approximately 16 residents, a functioning kitchen, their own front door entrance and a separation of the bedrooms from the main communal living rooms (Calkins, 2009). There is a philosophy of facilitating person-centred care, as opposed to institu- tional routines, supported by a consistent team of care workers providing much of the unit management and decision making for each household (Shields & Norton, 2006). They encourage domestic style rela- tionships between residents, staff and relatives. Resident choice is facilitated in important issues such as when to get up in the morning, when to have a meal and participation in activities (Shields & Norton, 2006). Research into nursing homes is complex. Researchers have dealt with this complexity by focus- ing on the prominent features of the environment such as size of the unit or by using a check list of desirable physical design features on a one-off visit. Size alone is only one component of the operational and social cultural change that is required to make a better living environment (Koren, 2010). However, there is often discrepancy between the design of a building and how its potential is used in reality (Saperstein, Calkins, van Haitsma, & Curyto, 2004). There is a deficiency of research information which explores how an *Corresponding author. Email: Mark.Morgan-Brown@hotmail.com