Nursing Homes During COVID-19 Pandemic—A Systematic Literature Review for COVID-19 Proof Architecture Design Strategies

The immense impact of the coronavirus disease 2019 (COVID-19) pandemic on older adults living in nursing homes (NH) and other long-term care facilities, who at baseline are at increased risk of infection due to fragility, cognitive impairments, and complex comorbidities, has renewed the attention of researchers to the unmet needs of this population. It is well known that the built environment can significantly influence human health, a reality which is often overlooked in the setting of NHs. Recognizing how qualities of the NH built environment can influ-ence resident outcomes, particularly in the context of the COVID-19 pandemic, can provide architects and medical professionals implementable strategies. As such, we conducted a systematic literature review from May to November 2021 to identify components of the NH built environment and their potential impacts on the health and well-being of NH residents during the COVID-19 pandemic. Relevant articles were identified with a search of Scopus, Web of Science, and PubMed scientific databases, as well as a search of gray literature. The initial search resulted 481 arti-cles, though after the application of eligibility criteria and full-text screening, 17 articles remained for inclusion. From these, a total of 24 built environment features were identified, divided across four domain levels of NHs: Overall Facility, Building, Service Space, and Residential Room. These features were differentially linked to improved facility infection control, decreased COVID-19 incidence and mortality from COVID-19, better air quality, and enhanced resident health, quality of life, and socialization. This research defines a set of design/architecture strategies that NHs may implement to improve COVID-19-related outcomes as well as the overall health and quality of life of their residents. Additional research utilizing primary data and testing these identified interventions is needed to provide stronger evidence-based suggestions.