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 Speaker Series

Aug 17, 2026
The CEAL@UNC Speaker Series invites organizations and experts committed to advancing well-being in assisted living through practice, research, and policy to present to CEAL@UNC affiliates on emerging and relevant topics. View Presentations

CEAL@UNC Speaker Series

by Lea Efird-Green

The CEAL@UNC Speaker Series invites organizations and experts committed to advancing well-being in assisted living through practice, research, and policy to present to CEAL@UNC affiliates on emerging and relevant topics. View Presentations

CEAL@UNC Strategic Advisor Presentations

May 14, 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

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

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

Dec 1, 2025
This qualitative study examined safety concerns from 32 residents, 34 family caregivers, and 38 staff members of AL communities across the US. Overall, 29 safety concerns emerged, with resident condition-related falls as the most commonly cited concern. Residents and family members were more likely than staff to report prompt use of assistive devices/technology, communication, and self-care as concerns, whereas staff were more likely to report environmental-related falls as a concern.

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

by Lea Efird-Green

This qualitative study examined safety concerns from 32 residents, 34 family caregivers, and 38 staff members of AL communities across the US. Overall, 29 safety concerns emerged, with resident condition-related falls as the most commonly cited concern. Residents and family members were more likely than staff to report prompt use of assistive devices/technology, communication, and self-care as concerns, whereas staff were more likely to report environmental-related falls as a concern.

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

Oct 1, 2025
This qualitative study examined the experiences of 12 staff in Taiwanese long-term care communities related to preventing infectious disease during the COVID-19 pandemic. Two challenges emerged: inadequate preparation, and physical/emotional strain; and two areas for improvement emerged: ongoing education and the need for adaptive surveillance and tailored crisis response plans.

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

by Lea Efird-Green

This qualitative study examined the experiences of 12 staff in Taiwanese long-term care communities related to preventing infectious disease during the COVID-19 pandemic. Two challenges emerged: inadequate preparation, and physical/emotional strain; and two areas for improvement emerged: ongoing education and the need for adaptive surveillance and tailored crisis response plans.

Mouth Care Without a Battle: Change in Assisted Living Staff Self-Efficacy and Attitudes

Sep 1, 2025
This study evaluated 24 AL communities to see if the modified Mouth Care Without a Battle (MCWB) for AL improved efficacy and attitudes of staff providing mouth care. AL staff's ratings of self-efficacy and attitudes did not significantly change after MCWB training, which differs from nursing home staff in another study. This may indicate AL staff do not view mouth care as high-priority, highlighting the need to emphasize it in training and supervision.

Mouth Care Without a Battle: Change in Assisted Living Staff Self-Efficacy and Attitudes

by Lea Efird-Green

This study evaluated 24 AL communities to see if the modified Mouth Care Without a Battle (MCWB) for AL improved efficacy and attitudes of staff providing mouth care. AL staff’s ratings of self-efficacy and attitudes did not significantly change after MCWB training, which differs from nursing home staff in another study. This may indicate AL staff do not view mouth care as high-priority, highlighting the need to emphasize it in training and supervision.

Perception of Therapeutic Music in Community Settings

Sep 1, 2025
This study focused on the experiences of 42 older adults relating to a live therapeutic music performance conducted in 1 Veterans Affairs Medical Center and 2 AL communities. Generally, participants enjoyed the performance and felt music was important in their lives; results indicate that customized therapeutic music could be supportive of a relaxed atmosphere.

Perception of Therapeutic Music in Community Settings

by Lea Efird-Green

This study focused on the experiences of 42 older adults relating to a live therapeutic music performance conducted in 1 Veterans Affairs Medical Center and 2 AL communities. Generally, participants enjoyed the performance and felt music was important in their lives; results indicate that customized therapeutic music could be supportive of a relaxed atmosphere.

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

Sep 1, 2025
This scoping review included 20 articles regarding the effects of person-focused interventions for risk assessment and prevention of falls in long-term care settings. The authors identified three types of person-focused interventions: exercise programs, multifactorial programs, and other interventions (including sensory interventions. Evidence suggests that well-designed person-focused interventions can reduce both falls and fear of falls for long-term care residents.

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

This scoping review included 20 articles regarding the effects of person-focused interventions for risk assessment and prevention of falls in long-term care settings. The authors identified three types of person-focused interventions: exercise programs, multifactorial programs, and other interventions (including sensory interventions. Evidence suggests that well-designed person-focused interventions can reduce both falls and fear of falls for long-term care residents.

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

Sep 1, 2025
This editorial discusses the implications of denture management in long-term care settings, focusing on barriers to consistent removal, the risks of continuous wear, and the nutritional consequences of poor denture fit. Strategies focusing on infection prevention, adequate nutrition, integrating tasks into routine workflows, and engaging both staff and families are presented to improve denture care.

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

by Lea Efird-Green

This editorial discusses the implications of denture management in long-term care settings, focusing on barriers to consistent removal, the risks of continuous wear, and the nutritional consequences of poor denture fit. Strategies focusing on infection prevention, adequate nutrition, integrating tasks into routine workflows, and engaging both staff and families are presented to improve denture care.

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

Sep 1, 2025
This study of over 850 residents in 25 Finnish AL communities examined whether connection with nature is associated with psychological well-being and mobility. A higher nature connection score was associated with higher psychological well-being, especially for residents with poor mobility. Other findings revealed residents experience nature in different ways, and that customized access to the outdoors is a framework for the development of nature-based interventions.

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

by Lea Efird-Green

This study of over 850 residents in 25 Finnish AL communities examined whether connection with nature is associated with psychological well-being and mobility. A higher nature connection score was associated with higher psychological well-being, especially for residents with poor mobility. Other findings revealed residents experience nature in different ways, and that customized access to the outdoors is a framework for the development of nature-based interventions.

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

Sep 1, 2025
This article presented new guidelines to promote more meaningful activities for long-term care residents using principles of interpretation, originating in the environmental education field. Example guidelines include activities that are "personally relatable" and "facilitate meaning."

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

by Lea Efird-Green

This article presented new guidelines to promote more meaningful activities for long-term care residents using principles of interpretation, originating in the environmental education field. Example guidelines include activities that are “personally relatable” and “facilitate meaning.”

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

Sep 1, 2025
This study investigated the relationship between the sense of aesthetics in the physical structure of a long-term care community and quality of life for 376 older adults recently enrolled in long-term services and supports. Increased social interaction and religious participation were positively associated with a sense of aesthetics, as was being in AL rather than nursing homes.

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

This study investigated the relationship between the sense of aesthetics in the physical structure of a long-term care community and quality of life for 376 older adults recently enrolled in long-term services and supports. Increased social interaction and religious participation were positively associated with a sense of aesthetics, as was being in AL rather than nursing homes.

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

Aug 1, 2025
This study examined the relationships among the physical activity, physical performance, falls, and cognitive functioning of 40 residents of 2 AL communities in Wisconsin. Up to 40% of participants had at least 1 fall in 6 months, and a significant association was found between number of falls, fear of falling, and a number of physical and cognitive measurements, offering new potential intervention points to reduce falls.

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

by Lea Efird-Green

This study examined the relationships among the physical activity, physical performance, falls, and cognitive functioning of 40 residents of 2 AL communities in Wisconsin. Up to 40% of participants had at least 1 fall in 6 months, and a significant association was found between number of falls, fear of falling, and a number of physical and cognitive measurements, offering new potential intervention points to reduce falls.

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

Aug 1, 2025
This metasynthesis of 88 qualitative studies examined the provision of palliative care in residential care settings, including challenges and opportunities of providing care in these settings. Resulting themes included addressing physical symptoms, psychological distress, social isolation, and spiritual needs among residents with serious illness and highlight the important role of palliative care in improving quality of life care continuity of residents.

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

by Lea Efird-Green

This metasynthesis of 88 qualitative studies examined the provision of palliative care in residential care settings, including challenges and opportunities of providing care in these settings. Resulting themes included addressing physical symptoms, psychological distress, social isolation, and spiritual needs among residents with serious illness and highlight the important role of palliative care in improving quality of life care continuity of residents.

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
This scoping review of 28 studies examined how physical, social, and organizational factors influence activity engagement for residents with dementia in long-term care (LTC) settings. Factors such as small house-like environments, familiar routines, and closer staff-resident relationships can increase participation, highlighting the importance of using inclusive and person-centered approaches to improve activity planning in LTC settings.

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

This scoping review of 28 studies examined how physical, social, and organizational factors influence activity engagement for residents with dementia in long-term care (LTC) settings. Factors such as small house-like environments, familiar routines, and closer staff-resident relationships can increase participation, highlighting the importance of using inclusive and person-centered approaches to improve activity planning in LTC settings.

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

Jul 1, 2025
This qualitative study examined 910 Finnish nurse managers in home care and AL to understand the impact of using care teams. Teams allowed nurses to improve planning and evaluation of care, increase well-being and ability to cope with the workload, and higher quality of care. Perceived challenges to team care were incorporating temporary workers, poor collaboration among teams, and hindering professional development.

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

by Lea Efird-Green

This qualitative study examined 910 Finnish nurse managers in home care and AL to understand the impact of using care teams. Teams allowed nurses to improve planning and evaluation of care, increase well-being and ability to cope with the workload, and higher quality of care. Perceived challenges to team care were incorporating temporary workers, poor collaboration among teams, and hindering professional development.

Ensuring Safety in Assisted Living Facilities: A Comprehensive Risk Management Program

Jul 1, 2025
This editorial outlines a risk management program for AL communities based on the 5 Rs: Recognize, Rank, Respond, Report, and Review. It outlines that for successful risk management a community must first recognize potential risks, then rank them based on likelihood and impact, then respond appropriately while reporting the status of the risks, and finally regularly review risk management processes.

Ensuring Safety in Assisted Living Facilities: A Comprehensive Risk Management Program

by Lea Efird-Green

This editorial outlines a risk management program for AL communities based on the 5 Rs: Recognize, Rank, Respond, Report, and Review. It outlines that for successful risk management a community must first recognize potential risks, then rank them based on likelihood and impact, then respond appropriately while reporting the status of the risks, and finally regularly review risk management processes.