What do we mean by the ‘care environment’?
The care environment encompasses all the physical, sensory, and social aspects of the spaces in which the older person receives care. These elements should work together to support their comfort, safety, and wellbeing. The physical environment includes rooms that provide privacy and personalisation, quiet spaces such as gardens or chapels for reflection, prayer, or solitude, and communal spaces that allow people to meet with visitors, including children. Sensory considerations in ensuring a supportive environment include attention to noise, lighting, odour, and temperature levels. Safety aspects of the environment are also important, and cover falls prevention, the availability of alarms and alerts, and devices to assist with mobility and wayfinding.
Why the care environment matters at the end of life
End-of-life care requires environments that prioritise comfort, safety, and dignity. Thoughtfully designed spaces that provide privacy, natural light, and access to nature can greatly enhance emotional wellbeing for older people and their families. For instance, visibility and exposure to natural views have been shown to reduce stress and improve quality of life. [1] Additionally, optimal lighting designed to improve visibility can help reduce confusion and aid orientation, particularly for those with sensory impairments, including those living with dementia. [2] These design features not only promote physical wellbeing but also contribute to emotional comfort.
A well-designed care environment balances opportunities for social connection with the need for private moments. Spaces that accommodate both privacy and engagement foster dignity and emotional security. [3] A practical framework for care environments identifies three key elements—proximity, comfort, and engagement—as essential for improving the experiences of individuals, families and carers at the end of life. [4]
Under the Aged Care Quality Standards, aged care providers must deliver palliative care in a suitable environment that supports the comfort, dignity, and preferences of older people receiving end-of-life care (Outcome 5.7.3). [5] Additionally, providers are required to maintain a safe, welcoming, and accessible physical environment, designed to meet the diverse needs of older people and enhance their quality of life, including during end-of-life care (Standard 4). [5]
What the evidence tells us
Noise and privacy
Noise and privacy are important in creating environments that support comfort and dignity at the end of life. Quiet, private spaces help minimise stress, foster emotional wellbeing, and can improve the overall quality of the dying experience. Striking a balance between privacy and social connection is essential, allowing individuals to maintain relationships while also having quiet moments for reflection and peace. [6] Designating separate quiet zones or private spaces has been particularly effective in reducing distress and preserving dignity. [3]
Lighting
Lighting plays an important role in shaping the atmosphere of care settings. Soft, adjustable lighting can help reduce glare and enhance comfort, creating a welcoming and calming environment. Ensuring adequate, glare-free illumination and avoiding shadows is important as it enhances visibility, comfort and safety, thereby reducing the risk of falls and confusion among older adults living with dementia. [2] Thoughtfully placed lighting that incorporates natural light can foster a sense of openness and calmness. When combined with views of nature, these design elements can further reduce stress. [1] In palliative care settings, such thoughtful lighting choices contribute to a more dignified and comforting experience for care recipients and their families. [6,7]
Personalisation and comfort
Personalisation helps create environments that promote comfort, identity, and a sense of belonging at the end of life. Incorporating familiar items, such as family photographs, personal belongings, and favourite scents, can foster emotional wellbeing by providing a sense of familiarity and security. [8] Thoughtful furniture arrangements that balance accessibility with familiarity can enhance comfort while addressing individual needs. Small personal touches strengthen emotional connection and provide reassurance, which is particularly meaningful in the context of end-of-life care. [9]
Dementia-specific care environments
Creating environments tailored for people living with dementia helps reduce confusion, agitation, and emotional distress. Dementia-friendly environments emphasise features such as clear and simple signage, contrasting colours, and unobstructed pathways to assist navigation and promote independence. [10]
Reducing background noise and auditory overstimulation may improve comfort, reduce agitation, and support the wellbeing of residents living with dementia in care homes. [1,9] Acoustic separation between communal and private areas further supports a sense of calm. Access to outdoor spaces, including sensory gardens, provides additional emotional benefits, fostering relaxation and engagement with nature. [10]
Personalised environments that include culturally meaningful items, familiar objects, and homelike designs enhance identity and emotional security. This is particularly important at the end of life, as personal touches can help individuals feel connected and supported. [3] Flexible spaces that balance privacy with social opportunities, such as quiet rooms adjacent to communal areas, cater to diverse needs and improve overall quality of life for people living with dementia and their carers. [4,11]
Cultural considerations
Culturally inclusive care environments enhance the experiences of people with life-limiting illnesses and their families. For Aboriginal and Torres Strait Islander peoples, incorporating traditional practices, such as smoking ceremonies, storytelling, and access to Elders, supports emotional and spiritual well-being by maintaining a connection to culture. [12] Outdoor spaces with native plants provide opportunities for connection to Country, which is often a central element of healing and comfort in palliative care. [13] In home care settings, facilitating cultural rituals and connecting people to community resources, including cultural healers, helps to align care with their values and traditions. [12,14] For multicultural populations, residential aged care homes may benefit from spaces designed for family gatherings and private rituals, while culturally appropriate design elements, such as religious symbols and familiar objects, can foster comfort and belonging. Personalised environments in home care also help maintain dignity and support cultural identity. [15,16]
Effective communication and culturally informed training are important for delivering sensitive care across both settings. Multilingual signage and interpreter services help bridge communication gaps, especially in residential aged care homes with culturally and linguistically diverse (CALD) populations. [14] Co-designing care plans with families and involving cultural leaders can assist in ensuring care practices reflect residents’ values, including beliefs about autonomy and family roles. [14] In home care, collaboration with community organisations can provide access to resources that uphold cultural practices, such as support for rituals or ceremonies. Addressing barriers like limited resources or staff training requires strong partnerships with cultural organisations and ongoing education for staff. [12,13]
Implications for families and carers
Care environments in aged care settings can shape the experiences of families and carers during end-of-life care. Thoughtfully designed spaces, such as private rooms for family gatherings or communal areas for shared rituals, can help families feel more engaged and connected during the care process. [17] Quiet areas or family rooms in residential aged care offer families and carers moments of reflection and peace, while sensory gardens and personalised spaces can alleviate emotional strain. In home care, practical advice on adapting the physical environment—such as improving lighting, rearranging furniture for safety, and using familiar objects—can help families and carers create supportive and comforting spaces for their loved ones. [18]
Practical resources, such as care checklists and guidance documents, equip families to manage care environments effectively. This includes advice on symptom relief, care environments and end-of-life rituals, fostering a sense of confidence and purpose. [8] Involving families in decisions about personalising care spaces, whether through cultural or sentimental items, promotes a sense of agency and reduces stress. By providing inclusive and well-structured environments, aged care providers can enhance the overall experience for families and carers, helping them feel supported throughout the end-of-life journey. [9,17]
Page updated 20 March 2025