As great as all outdoors: A study of outdoor spaces as a neglected resource for nursing home residents

Lois J. Cutler, Rosalie A Kane

Research output: Contribution to journalArticlepeer-review

35 Scopus citations


Purpose. Previously, most information on outdoor amenities in nursing homes and the use of outdoor space by nursing home residents has been anecdotal. Using data collected from the Center for Medicare and Medicaid Services (CMS) study on Quality of Life (QOL), this paper describes the availability of outdoor amenities in 40 nursing homes and the resident's perception of their use of that space. Design and Methods. Resident data were collected from nineteen hundred and eighty-eight residents in 131 nursing units in 40 nursing homes located in 5 states on a broad array of topics including how often they get outdoors and if that amount was as much as they want, too much, or not enough. For each of those nineteen hundred and eightyeight residents, staff was questioned on how often the resident participated in planned outdoor activities. Environmental data were collected using theoretically-derived observational tools that were developed to observe in detail the physical environments experienced by those nineteen hundred and eighty-eight nursing home residents at three nested levels: their rooms (112 items), the nursing unit (140 items); and the facility as a whole (134 items). These analyses focus on the presence or absence of items specific to outdoor space at the unit and facility level. Results. Descriptive statistics showed great variation in outdoor amenities and access to those amenities across facilities. The majority, 55.7% (n = 73), of the environments of the 131 units had no items featured on the outdoor amenities index. Of the residents who are physically able to go outdoors, thirty two percent do so less than once a month. Implications. Only recently have the effects of the outdoor environment on well being been systematically studied. This resident-specific data collection on the availability of outdoor amenities and research at the resident level permits hierarchical analysis to examine the effects of outdoor space on resident quality of life.

Original languageEnglish (US)
Pages (from-to)29-48
Number of pages20
JournalJournal of Housing for the Elderly
Issue number3-4
StatePublished - Dec 1 2005


  • Environmental assessment
  • Outdoor amenities
  • Resident use of outdoor space


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