Risk management: Lighting’s impact on residents

An issue receiving more and more attention by researchers and designers in long-term care is lighting and glare. The Centers for Medicare & Medicaid Services (CMS) funded a quality of life study conducted by researchers at the University of Minnesota from May 1998 to July 2003. The study, Measures, Indicators, and Improvement of Quality of Life in Nursing Homes, developed and tested measures and indicators of quality of life for nursing home residents, and how the physical environment, including private rooms, affect resident quality of life.

Data was collected from 1,988 residents living in 131 nursing units in 40 nursing homes located in five states. One of the most profound findings was that lighting levels in the 40 homes observed equated the level of blindness. Yes, blindness. This means the average light measure, measured in foot-candles, was zero. CMS project officer on the contract, Karen Schoeneman, did some measuring one day in one of the nursing homes in Florida and thought her light meter was broken, as it showed nothing. But when she took it over to the window and it registered a measurement, she realized it was not broken—it was dark!

Compound problem

Thoughtful attention is often not being given to lighting and the problem of glare in nursing homes, which is then compounded by the loss of vision as we age. “If I could change just one thing, it would be the lighting,” says Elizabeth Brawley, a gerontological designer and lighting expert. Brawley makes the case that eye diseases are more prevalent in older adults, such as macular degeneration, which is the foremost cause of blindness over the age of 60; cataracts, which are found in 50% of individuals ages 65 to 75; glaucoma; and diabetic retinopathy. Aside from diseases, there are these facts of life as we age:

  • Reduced visual acuity

  • Restricted field of vision

  • Sensitivity to glare

  • Change in depth perception

  • Impaired ability to adapt to changes in light levels

  • Contrast sensitivity

  • Restricted color recognition

We are familiar with the implications of age-related vision loss, including limited mobility, especially in unfamiliar areas, limited independence and, the most predominant, an increase in falls. Did you know a third of people 65+ fall each year? Half of the falls are recurrent. One in 10 falls result in serious injury, and 87% of fractures in the elderly are the result of falls. And did you know that of the long list of risk factors for falls, two main factors are vision loss and environmental hazards? So, assuming you are very interested in diminishing the number of falls anyone experiences in your care, the environmental supports that can encourage mobility and independence, according to Brawley, are:

  • Improved lighting

  • Higher light levels

  • Even illumination

  • Elimination of glare

  • Task lighting

  • Balanced daylight and electric light

  • Combination of direct and indirect lighting

  • Gradual changes in light levels such as when entering a building from the outdoors

  • Strong contrast such as grab bars in a contrasting color to the wall

  • Handrails for support

As an advocate for proper lighting, Brawley makes the strong case that, “Lighting can and will make a greater difference in the success of a healthcare setting than any other single feature except the healthcare itself” because “visual performance, ambience, safety, and security all depend on lighting.”

Integral element

What must we do to ensure that lighting is considered an integral element for achieving a healthy environment? Would stronger regulation do it? Do we want regulations to drive practice? A focus of AANEX as a support to nurse leaders is just that—promoting leadership. As leaders, you have such a great opportunity to give focus to any topic, especially ones related to resident care. Why not lighting? Just look at the positive outcomes waiting to happen. Will you begin to look into lighting, talk about it with your staff and residents? Guide staff to become cognizant of lighting and what each resident can and cannot see. Will you take the lead in helping those you work with to “open their eyes” (pun intended) to see what lighting is needed, perhaps adding it to your assessment process and training in how to evaluate it? See what good things can come from it!

Carmen Bowman, MHS, ACC, is the Owner of Edu-Catering: Education for Compliance and Culture Change in LTC, a consulting and training company in Firestone, Colorado. She can be reached at (303) 833-1492.

To send your comments to the author and editors, e-mail bowman1108@iadvanceseniorcare.com.


  1. Brawley EC. Alzheimer’s research yields better living designs. McKnight’s Long-Term Care News. October 25, 2002; Vol. 23, No. 14, p. 26.
  2. Brawley EC. Design Innovations for Aging and Alzheimer’s: Creating Caring Environments. Hoboken New Jersey:John Wiley & Sons, Inc., 2006.
Long-Term Living 2008 November;57(11):38-40

Topics: Articles , Facility management , Risk Management