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Letter to the editor: Light's impact on residents

December 4, 2008
by RMeinking
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Hello, my name is Rick Meinking and I am the Plant Operations Director at Seventy Five State Street. We are a non-profit long term care facility providing care for 160 elderly residents. The reason I am writing is to offer some input to the article “Risk management: Lighting’s impact on residents" in the DON’s corner of the November 2008 edition of Long-Term Living.

While I do concur that lighting issues are extremely important for this population, I feel that Carmen Bowman's was a bit over the top with her assessment. I’m particularly concerned with her findings of the level of “blindness” in 40 of the homes she tested with her meter. I am suggesting that her findings were flawed because of a faulty light meter. Having used many types of light meters for many years, I would say that if her light meter was reading ZERO it wouldn’t be possible to even read the meter. ZERO is total darkness, therefore why would you even use a meter to assess the “foot-candles” in a totally dark room?

There is no doubt; lighting issues need to be discussed in long-term care facilities. Each facility is in some way unique in that the residents all have different lighting needs. Discoveries in the last few years have suggested that lighting needs for the aging are more towards the shorter wavelength or the blue part of the spectrum. Daylight is certainly an effective way if harvesting that part of the spectrum. I highly recommend IENA/ANSI document 2001 Lighting and the Visual Environment for Senior Living as a source of guidance when addressing the needs of your facility and the impact is will have on your residents.

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Comments

Response to a Letter to the Editor dated 12/4/08 from Carmen Bowman original author of article Risk Management: Lighting's impact on residents in the DON's corner of Long Term Living Nov. 08 issue.


Thank you Rick for sharing your thoughts and bringing up a few things I should expound upon. Believe it or not, the reference to the "blindness" level is a direct quote from the CMS funded study called Measures, Indicators, and Improvement of Quality of Life in Nursing Homes. CMS contracted with the University of Minnesota to develop and test measures and indicators of quality of life for nursing home residents which included lighting. Data was collected from 1,988 residents living in 131 nursing units in 40 nursing homes located in five States and released in 2004. This is what is stated in the Executive Summary of this study,

"Descriptive analysis showed many environmental deficits, including ... lighting levels that approximated conditions of blindness (Executive Summary, June 2004, p. 26)."

Additionally, the primary researcher Lois Cutler of the University of Minnesota wrote a paper and gave a presentation at the Creating Home national symposium in April of 2008. Here are some of her comments from her paper:

"Using a light meter, I took 3,053 total light meter readings.... The intent was to measure the average amount of light that the users — staff and resident — had available to them as they used a space.... The highest level was taken directly under the brightest fixture. The lowest level reading was often in a corner or in a shower room where it tended to be directly under the shower head." She then refers to a table that shows the "sub-optimal lighting" (p. 17).

Rick, the table she refers to here shows the light meter readings and you are right, none of them are zero. The lowest are 1, 2 and 4. So, it is my mistake to have stated "zero" and I apologize. So it follows that these very low light meter levels are why the researchers claimed that the lighting levels approximated conditions of blindness. Thank you for making me investigate and clarify.

Additionally, Dr. Cutler stated this story verbatim at the Creating Home national symposium in her presentation about the U of Minn. study:

Inadequate light levels. Betsy did such a wonderful job this morning. There's a little story about this. But first I took 3053 total light meter readings. In each of the areas, we took four readings so it was not like you [just] walk in a room. There was a protocol that Les Grant designed and we followed it. But Karen [Schoeneman] was with me when I was in Florida. She was a good trooper, she was doing assessments and measuring chair height etc. So I sent her in a bathroom. You remember, Karen? And she came out, she said, "This thing isn't working" one of the light meters. So I said let's take it to a window and see. Of course then it was, of course working. And she came out and it was literally one, one foot candle. And as Betsy said, we wonder why people fall. On top of it, it was a yellow light bulb. But time and again it was ridiculous. What I'm so proud about this study is that we cannot just say it's dark in here, no we took 3053 light meter readings (Transcript of the Proceedings of the Creating Home national symposium, pp. 51 and 52).

For the Creating Home symposium we actually had another expert gerontological designer speak on the topic of lighting Elizabeth Brawley of Design Concepts Unlimited. In her paper and presentation entitled Lighting: Partner in Quality Care Environments, she too recommends that facility use and that CMS adopts the ANSI/IESNA standard that you recommend and shares that the 2001 edition has been updated to a 2007 edition:

The IESNA RP-28-98: Lighting and the Visual Environment for Senior Living was first developed in 1998 by the Lighting for Aging and Partially Sighted Committee of the IESNA - the Illuminating Engineering Society of North America. IESNA is the recognized authority to set light levels in the United States, Canada and Mexico. The document was adopted in 2001 by the American National Standards Institute (ANSI) making it a national building standard for buildings for older adults. The name was changed to ANSI/IESNA RP-28-2001 and it is included in the American Institute of Architects Guidelines for Design and Construction of Healthcare Facilities 2006. The recently updated ANSI/IESNA RP-28-2007 edition is ANSI approved. It has gained broad acceptance and is now the recommended lighting design practice for older adults.

Below are the above mentioned references and where to find them. Thank you for your comments as they gave me the opportunity to elaborate in more detail.

Carmen Bowman, Edu-Catering

References

Brawley, Elizabeth and Eunice Noell-Waggoner Lighting: Partner in Quality Care Environments. Prepared for Creating Home in the Nursing Home: A National Symposium on Culture Change and the Environmental Requirements April 2008. Available at www.pioneernetwork.net.

Cutler, Lois J. Nothing is Traditional about Lighting in a Traditional Nursing Home: Nursing Homes as Places to Live Now and in the Future. Prepared for Creating Home in the Nursing Home: A National Symposium on Culture Change and the Environmental Requirements April 2008. Available at www.pioneernetwork.net.

Kane, Rosalie A., Robert L. Kane, Boris Bershadsky, Lois J. Cutler, Katherine Giles, Jiexin
Jason Liu, Kyoungrae Kang, and Lixin Zhang, Measures, Indicators, and
Improvement of Quality of Life in Nursing Homes, Final Report. Submitted to
Centers for Medicare and Medicaid Services. 2004. http://www.cms.hhs.gov/NursingHomeQualityInits/35_NHQIArchives.asp#TopOf...
Year 2005 Archive, Quality of Life Vol. 1 and Quality of Life Vol. 2, Executive Summary

Rick,
Great take on the article. As a manufactuer of custom bedside lamps for long term care, accurate footcandle readings at the bedside and at task areas (desks, end tables next to sitting areas), are critical.
If I can be of any help to readers on this subject, contact me @ www.jeslighting.com or call me @ (888) 330-5267 x201. My email address is jamie@jeslighting.com
Thanks. Jamie Schumaker, President, JES Lighting,Inc.

RMeinking