Light for Health and Wellness Is Missing in Nursing Home Environments, Policies, and Standards

Bright days and dark nights are required to support the circadian system and nocturnal sleep-wake cycle, but these conditions are missing in most nursing homes (NHs). This study examined how the Centers for Medicare and Medicaid Services (CMS) NH surveyors’ guidelines and Minimum Data Set (MDS) address light and lighting, and how ninety-four NH websites in three US cities communicate the importance of light in the NH environment. Results indicate that the CMS surveyor’s guidance for light and lighting in NHs is general and focused on task illumination and fire safety. Daylight was listed once, with no information regarding light for health (sleep, circadian rhythms, and vitamin D). National lighting standards for aging vision are not required. The MDS evaluation revealed that sleep disturbances and vision impairment are listed as factors that can affect residents’ behavior and social involvement, but no guidance is provided for the practice of care or the NH environment. Content analysis of written and visual information on NH websites revealed that only 49% of the NHs in Sacramento, CA, had planned outdoor spaces followed by Tallahassee, FL (33%), and Austin, TX (28%). A high percentage of NHs showed no visual evidence of access to daylight or views of nature from windows in shared bedrooms (CA = 62%; TX = 53%; FL = 78%). Our evaluation indicates that CMS guidelines and NH websites place little importance on the benefits of light for residents’ health. Lighting for health recommendations are provided for NH providers, policy makers, and the design community.