Factors affecting resident morale of nursing homes in Taiwan: Application of the multiphasic environmental assessment procedure

As the population of Taiwan has aged, nursing homes continue to grow in number. Quality of life for residents is of prime concern to policymakers, researchers, and practitioners. From the perspective of environmental gerontology, the adaptive competency and subjective well-being of nursing home residents maybe enhanced when environmental resources and demands are congruent with the competencies and needs of nursing home residents. However, little empirical research has examined environmental influences on morale among nursing home residents in Taiwan. Utilizing the Multiphasic Environmental Assessment Procedure (MEAP), the primary goal of this study is to identify contextual, environmental, and personal predictors of resident morale among residents of a purposively selected sample of Taiwanese nursing homes. A secondary goal is the development and effective application of a Taiwanese version of the MEAP useful to environmental researchers, policymakers, and practitioners in skilled care settings.; To accomplish the research goal, a multi-dimensional cross-sectional survey was administered to 210 cognitively competent residents and 309 staff recruited from 35 nursing facilities in Kaohsiung city, Taiwan from May to July of 2002. Instruments adapted from the MEAP and Philadelphia Geriatric Morale Scale (PGCMS) formed the core of the survey. Facility physical resources were evaluated using an adapted measure of the Physical and Architectural Features Checklist (PAF) from the MEAP.; Stepwise-regression analysis using 3 contextual factors, 30 environmental attributes, and 11 personal predictors yielded a model explaining 39.6% of variance in resident morale [perceived physical comfort (26.3%), physical amenities (6.2%), perceived cohesion (5.4%), and religion (1.7%)]. A second analysis using 8 environmental composite variables (replacing the 30 environmental variables) revealed a model predicting 28.5% of the variance in resident morale [perceived rapport (18.1%), physical comfort (4.8%), policy autonomy (3.3%), and religion (2.3%)]. Overall, the predictive effect of the subjective environmental factors (i.e. perceived rapport and perceived physical comfort) appears to be stronger than the contextual, objective environmental, and personal factors in the current sample.; The findings from this study suggest that cohesive, supportive, comfortable, and spiritually-supportive environments may significantly enhance the morale of elders residing in long-term care settings in Taiwan. Toward this end, specific suggestions are offered for environmental gerontologists, nursing home administrators, policymakers, and practitioners.