Center for Excellence in Assisted Living CEAL@UNC

Advancing the well-being of the people who live and work in assisted living through research, practice, and policy.

Quality Improvement

CEAL@UNC Guest Columns: McKnight’s Senior Living

May 4, 2026
Dr. Sheryl Zimmerman, Executive Director of CEAL@UNC, is a guest columnist for McKnight’s Senior Living. These regularly published articles reflect the perspectives of CEAL@UNC advisors, and address timely topics relevant to the well-being of the people who live and work in assisted living. View Articles

CEAL@UNC Guest Columns: McKnight’s Senior Living

by Lea Efird-Green

Dr. Sheryl Zimmerman, Executive Director of CEAL@UNC, is a guest columnist for McKnight’s Senior Living. These regularly published articles reflect the perspectives of CEAL@UNC advisors, and address timely topics relevant to the well-being of the people who live and work in assisted living. View Articles

CEAL@UNC Strategic Advisor Presentations

Feb 19, 2026
CEAL@UNC regularly invites organizations and individuals committed to advancing well-being in assisted living through practice, research, and policy to present emerging and relevant topics to its Strategic Advisors. View Presentations

CEAL@UNC Strategic Advisor Presentations

by Lea Efird-Green

CEAL@UNC regularly invites organizations and individuals committed to advancing well-being in assisted living through practice, research, and policy to present emerging and relevant topics to its Strategic Advisors. View Presentations

Exploring Safety Concerns in Assisted Living Communities: A Qualitative Comparison of Resident, Family, and Staff Perspectives

Dec 1, 2025
Objectives: Safety concerns in assisted living (AL) communities are critical, yet understudied from the perspectives of residents, family caregivers, and staff. This study aimed to explore and compare safety concerns across these 3 groups. Design: This qualitative study conducted structured interviews to identify safety concerns from the perspectives of residents, family caregivers, and staff. Setting […]

Exploring Safety Concerns in Assisted Living Communities: A Qualitative Comparison of Resident, Family, and Staff Perspectives

by Lea Efird-Green

Objectives: Safety concerns in assisted living (AL) communities are critical, yet understudied from the perspectives of residents, family caregivers, and staff. This study aimed to explore and compare safety concerns across these 3 groups. Design: This qualitative study conducted structured interviews to identify safety concerns from the perspectives of residents, family caregivers, and staff. Setting […]

Challenges and Possibilities in Preventing Emerging Infectious Diseases in Long-Term Care: A Qualitative Descriptive Study

Oct 1, 2025
Background: Emerging infectious diseases pose significant risks to vulnerable populations, particularly older adults with underlying health conditions living in long-term care institutions. Yet, while the experiences of healthcare workers in managing these crises are invaluable, there remains limited research on the specific challenges they faced. Aim: To explore the experiences of long-term care workers-including nurses, […]

Challenges and Possibilities in Preventing Emerging Infectious Diseases in Long-Term Care: A Qualitative Descriptive Study

by Lea Efird-Green

Background: Emerging infectious diseases pose significant risks to vulnerable populations, particularly older adults with underlying health conditions living in long-term care institutions. Yet, while the experiences of healthcare workers in managing these crises are invaluable, there remains limited research on the specific challenges they faced. Aim: To explore the experiences of long-term care workers-including nurses, […]

The Role of Aesthetics in Promoting Health-Related Quality of Life for Older Adults Transitioning to Long-Term Services and Support

Sep 1, 2025
The aesthetics of a home can promote healthy connections, well-being, and health-related quality of life (HRQoL) among older adults. Increased understanding of the meaning of aesthetics assigned by older adults transitioning to long-term services and supports (LTSS) is needed. Informed by the HRQoL conceptual framework, this study used cross-sectional data (n = 376) to examine […]

The Role of Aesthetics in Promoting Health-Related Quality of Life for Older Adults Transitioning to Long-Term Services and Support

by Lea Efird-Green

The aesthetics of a home can promote healthy connections, well-being, and health-related quality of life (HRQoL) among older adults. Increased understanding of the meaning of aesthetics assigned by older adults transitioning to long-term services and supports (LTSS) is needed. Informed by the HRQoL conceptual framework, this study used cross-sectional data (n = 376) to examine […]

Delivering Engaging and Meaningful Activities for Older Adults in Long-Term Care Using Principles of Interpretation

Sep 1, 2025
Enjoyable, engaging, and meaningful group activities are critically needed and wanted by older adults, particularly by those living in long-term care communities (e.g., nursing homes and assisted living communities). While group activities are universally offered in long-term care settings, research has shown that participation rates are often moderate to low and that there is widespread […]

Delivering Engaging and Meaningful Activities for Older Adults in Long-Term Care Using Principles of Interpretation

by Lea Efird-Green

Enjoyable, engaging, and meaningful group activities are critically needed and wanted by older adults, particularly by those living in long-term care communities (e.g., nursing homes and assisted living communities). While group activities are universally offered in long-term care settings, research has shown that participation rates are often moderate to low and that there is widespread […]

Happy by Nature: Nature Connection as a Source of Psychological Well-Being in Assisted Living Facilities

Sep 1, 2025
Objectives: Contact with nature is a source of resilience and well-being, and nature-based interventions (NBIs) potentially support older adults’ health and self-efficacy. Health-related outcomes of NBIs depend not only on the surroundings and activity, but also on the perceived nature connection. Although NBIs are implemented in assisted living facilities (ALFs), the nature connection has not […]

Happy by Nature: Nature Connection as a Source of Psychological Well-Being in Assisted Living Facilities

by Lea Efird-Green

Objectives: Contact with nature is a source of resilience and well-being, and nature-based interventions (NBIs) potentially support older adults’ health and self-efficacy. Health-related outcomes of NBIs depend not only on the surroundings and activity, but also on the perceived nature connection. Although NBIs are implemented in assisted living facilities (ALFs), the nature connection has not […]

Perception of Therapeutic Music in Community Settings

Sep 1, 2025
Background: Therapeutic music has been shown to reduce stress and anxiety, while boosting mood and overall well-being in numerous settings. Building on the success of Vanderbilt University Medical Center’s (VUMC) Therapeutic Music Program, and in collaboration with AARP Tennessee and the Blair School of Music at Vanderbilt, a community-based therapeutic music program was introduced, focusing […]

Perception of Therapeutic Music in Community Settings

by Lea Efird-Green

Background: Therapeutic music has been shown to reduce stress and anxiety, while boosting mood and overall well-being in numerous settings. Building on the success of Vanderbilt University Medical Center’s (VUMC) Therapeutic Music Program, and in collaboration with AARP Tennessee and the Blair School of Music at Vanderbilt, a community-based therapeutic music program was introduced, focusing […]

Person-Focused Interventions for Fall Risk Assessment, Fall Prevention and Fall Injury Prevention in Long-Term Care Facilities: A Scoping Review

Sep 1, 2025
Objective: Falls are a significant concern in long-term care facilities (LTCFs) as fall-related injuries can result in functional impairment, disability and death. Older adults living in LTCFs are at greater risk for falls than those in the community. Using scoping review methodology, we aimed to synthesise evidence examining intervention effects of person-focused interventions for risk […]

Person-Focused Interventions for Fall Risk Assessment, Fall Prevention and Fall Injury Prevention in Long-Term Care Facilities: A Scoping Review

by Lea Efird-Green

Objective: Falls are a significant concern in long-term care facilities (LTCFs) as fall-related injuries can result in functional impairment, disability and death. Older adults living in LTCFs are at greater risk for falls than those in the community. Using scoping review methodology, we aimed to synthesise evidence examining intervention effects of person-focused interventions for risk […]

Denture Care in Assisted Living: Best Practices and Clinical Importance for Resident Health

Sep 1, 2025
Oral health is a critical yet frequently underrecognized component of care in assisted living. Among residents, complete edentulism affects approximately one third, while partial edentulism remains highly prevalent, both conditions requiring the use of dentures for functional and nutritional support. Insufficient denture hygiene has been associated with significant adverse outcomes, including denture-related stomatitis, systemic fungal […]

Denture Care in Assisted Living: Best Practices and Clinical Importance for Resident Health

by Lea Efird-Green

Oral health is a critical yet frequently underrecognized component of care in assisted living. Among residents, complete edentulism affects approximately one third, while partial edentulism remains highly prevalent, both conditions requiring the use of dentures for functional and nutritional support. Insufficient denture hygiene has been associated with significant adverse outcomes, including denture-related stomatitis, systemic fungal […]

Primary Palliative Care in Assisted Living and Residential Care: A Metasynthesis

Aug 1, 2025
Assisted living (AL) and residential care (RC) settings are experiencing substantial growth as older adults with lower care needs seek alternatives to nursing homes. Despite this trend, there is a lack of skilled nursing care to support palliative care (PC) in these environments. Primary PC delivered by AL staff has emerged as a potential model […]

Primary Palliative Care in Assisted Living and Residential Care: A Metasynthesis

by Lea Efird-Green

Assisted living (AL) and residential care (RC) settings are experiencing substantial growth as older adults with lower care needs seek alternatives to nursing homes. Despite this trend, there is a lack of skilled nursing care to support palliative care (PC) in these environments. Primary PC delivered by AL staff has emerged as a potential model […]

Yearlong Evaluation of Fall Risk Determinants Among 40 Older Adults in Two Residential Assisted Living Facilities

Aug 1, 2025
BACKGROUND Falls among the elderly, the second leading cause of death from unintentional injury globally, represent significant social and economic challenges. We evaluated the relationship between physical activity, physical performance, falls, and cognitive functioning at 1 year in 40 older adults living in 2 residential assisted living facilities in 2 communities in Wisconsin, USA. MATERIAL […]

Yearlong Evaluation of Fall Risk Determinants Among 40 Older Adults in Two Residential Assisted Living Facilities

by Lea Efird-Green

BACKGROUND Falls among the elderly, the second leading cause of death from unintentional injury globally, represent significant social and economic challenges. We evaluated the relationship between physical activity, physical performance, falls, and cognitive functioning at 1 year in 40 older adults living in 2 residential assisted living facilities in 2 communities in Wisconsin, USA. MATERIAL […]

Teamwork and Use of Teams in Services for Older People: A Qualitative Study of Finnish Nurse Managers’ Experiences

Jul 1, 2025
Background: In Finnish services for older people, teams (a permanent group with a common task, divided for example by geographical or spatial criteria) have been implemented with the goal of improving the quality of care, individualized care and continuity of care as well as the wellbeing of nurses. Our aim was to describe nurse managers’ […]

Teamwork and Use of Teams in Services for Older People: A Qualitative Study of Finnish Nurse Managers’ Experiences

by Lea Efird-Green

Background: In Finnish services for older people, teams (a permanent group with a common task, divided for example by geographical or spatial criteria) have been implemented with the goal of improving the quality of care, individualized care and continuity of care as well as the wellbeing of nurses. Our aim was to describe nurse managers’ […]

The Influence of Physical, Social, and Organizational Environments on Recreational Activities in Long-Term Care for Residents With Dementia: A Scoping Review

Jul 1, 2025
Background: This scoping review explores how physical, social, and organizational factors influence recreational activity engagement for residents with dementia in long-term care settings. Methods: A literature search in AgeLine, PsycINFO, CINAHL, Medline, and Web of Science identified studies on environmental factors affecting recreational activities for long-term care residents with dementia. A narrative approach was used […]

The Influence of Physical, Social, and Organizational Environments on Recreational Activities in Long-Term Care for Residents With Dementia: A Scoping Review

by Lea Efird-Green

Background: This scoping review explores how physical, social, and organizational factors influence recreational activity engagement for residents with dementia in long-term care settings. Methods: A literature search in AgeLine, PsycINFO, CINAHL, Medline, and Web of Science identified studies on environmental factors affecting recreational activities for long-term care residents with dementia. A narrative approach was used […]

Optimizing Ethical Care, Quality, and Safety in Long-Term Services and Supports: A Position Paper from the American College of Physicians

Jun 1, 2025
WHAT THIS MEANS FOR YOU: This position paper examines the ethical implications of current business models and practices of long-term services and supports (LTSS) in the United States, and their effects on vulnerable populations. The paper reports four positions that would improve outcomes for vulnerable populations: optimizing care quality and incentivizing patient preferences, respecting individuals, prioritizing improvements in LTSS, and increased transparency and accountability, all of which support person-centered care.

Optimizing Ethical Care, Quality, and Safety in Long-Term Services and Supports: A Position Paper from the American College of Physicians

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This position paper examines the ethical implications of current business models and practices of long-term services and supports (LTSS) in the United States, and their effects on vulnerable populations. The paper reports four positions that would improve outcomes for vulnerable populations: optimizing care quality and incentivizing patient preferences, respecting individuals, prioritizing improvements in LTSS, and increased transparency and accountability, all of which support person-centered care.

The Importance of Nature and Wishes for Nature-Based Experiences Among Older Adults in Assisted Living Facilities

May 1, 2025
WHAT THIS MEANS FOR YOU: This cross-sectional study of 25 assisted living communities in Finland examined 854 residents' views of nature-based interventions. Only 24% of residents could move outdoors independently, and only 51% had the amount of nature exposure they wanted, although 96% consider nature important and 83% stated interest in nature-based interventions. Results indicate developing nature-based interventions could be appealing for older adults.

The Importance of Nature and Wishes for Nature-Based Experiences Among Older Adults in Assisted Living Facilities

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This cross-sectional study of 25 assisted living communities in Finland examined 854 residents’ views of nature-based interventions. Only 24% of residents could move outdoors independently, and only 51% had the amount of nature exposure they wanted, although 96% consider nature important and 83% stated interest in nature-based interventions. Results indicate developing nature-based interventions could be appealing for older adults.

Differences in Quality of Care Interactions Across Care Tasks in Assisted Living

May 1, 2025
WHAT THIS MEANS FOR YOU: This descriptive study of four assisted living communities in Maryland examined 152 staff-resident interactions to understand if quality of care interactions differs by care task type. Different categories of care interactions were identified with positive care interactions being the most common (36%), and supportive care being the most common type of task (34%). Supportive/ambulatory care (i.e., distracting, transferring, and walking) interactions were more negative than intimate personal care (i.e., bathing, dressing, and toileting) interactions, suggesting improvements in care interaction quality may be needed for supportive care.

Differences in Quality of Care Interactions Across Care Tasks in Assisted Living

by Lea Efird-Green

WHAT THIS MEANS FOR YOU: This descriptive study of four assisted living communities in Maryland examined 152 staff-resident interactions to understand if quality of care interactions differs by care task type. Different categories of care interactions were identified with positive care interactions being the most common (36%), and supportive care being the most common type of task (34%). Supportive/ambulatory care (i.e., distracting, transferring, and walking) interactions were more negative than intimate personal care (i.e., bathing, dressing, and toileting) interactions, suggesting improvements in care interaction quality may be needed for supportive care.