Assessing Staff Satisfaction with Indoor Environmental Quality in Assisted Living Facilities

Presented by: Qun Zuo, Eileen E. MaloneBeach

Evidence-based design (EBD) and environmental sustainability principles have been increasingly integrated into healthcare environments (Wingler & Hector, 2015). Design of health care built environment has been linked to health and well-being of patients and staff, job satisfaction, retention, and turnover (Kotzer & Arellana, 2008). Yet, evidence-based results addressing employees’ perceptions and demands are sparse. This pilot study contributes to knowledge of Indoor Environmental Quality (IEQ) in Assisted Living Facilities (ALF) by examining job satisfaction and perceived productivity of employees by age and position. METHODS After initial contacts, surveys were delivered to qualified ALFs in a Midwest state, which were new construction or renovated within the last ten years. Subsequently, returned surveys were picked up at a designated time. Participants (N = 94; n = 85 women) ranged in age 19-73 (M = 34.83; SD = 14.30). Twelve participants (12.8%) had been employed for 10+ years; fourteen (14.9%) for 5-10 years; forty (42.6%) for 1-5 years; twenty-seven (28.7%) had worked less than one year at the facility. In a typical week, thirty-six participants (38.3%) worked 30-40 hours and thirty-four (36.2%) worked 40+ hours. The survey instrument incorporates the Occupant IEQ Survey, developed by the Center for the Built Environment, and the Leadership in Energy and Environmental Design rating criteria. It comprised 11 sections, seven of which are discussed in this study (N = 43 items), including Personal Background, Workspace Location and Layout, Thermal Control and Comfort, Air Quality, Lighting and View, Acoustic Quality, and Cleanliness and Maintenance. ANALYSIS Data were entered into SPSS v22. Nonparametric variables were examined through Kruskal-Wallis, Mann-Whitney U, and Spearman’s Rank-Order Correlation Coefficient Tests. Measures of association, bivariate, and multivariate relationships were analyzed among age groups and work positions. FINDINGS Employees responded to questions concerning their satisfaction with IEQ of the facility. Table 1 shows statistical significances of employee satisfaction with ten IEQ criteria including: amount of work space, temperature, air quality, amount of light, visual comfort of light, level of noise, level of visual privacy and sound privacy, cleanliness and maintenance. Table 2 documents statistical significances of the perceived productivity across six major IEQ criteria. A significant positive correlation was found between satisfaction with IEQ criteria and productivity. Further analysis of employees’ satisfaction with IEQ focused on age. Participants were divided into three groups: Group 1 (N=46): 19-30 years old, Group 2 (N=30): 30-50 years old, and Group 3 (N=17): 51-73 years old. Table 3 shows that Group 1’s satisfaction was significantly lower than the other two groups in workspace filling and storage, temperature, productivity influenced by thermal comfort, air quality, and cleanliness, as well as productivity influenced by air quality. Group 1 identified six factors that caused poorer air quality: stuffiness/staleness, cleanliness, odors, tobacco smoke, feces, urine, and body fluids, and use of perfumes and air refreshers. All differences were statistically significant. Table 4 indicates there are significant differences between two categories of job positions: MED staff (N=76) refers to direct care staff; Non-MED staff (N=18) comprises activity staff. Satisfaction differences were in the cleanliness of air, odors, cleanliness regarding spills and debris, cleaning trash cans, as well as overall satisfaction with cleanliness and their influence on productivity. CONCLUSIONS Results suggest a positive work environment for employees in newer ALFs and imply significant variation on the perception of the work environment between age groups and job positions. The results can aid ALF stakeholders in understanding users’ demands and in improving IEQ conditions for various users.


  • Kotzer, A., & Arellana, K. (2008). Defining an evidence-based work environment for nursing in the USA. Journal of Clinical Nursing, 17, 1652-1659.
  • Wingler, D., & Hector, R. (2015). Demonstrating the effect of the built environment on staff health-related quality of life in ambulatory care environments. Health Environment Research & Design Journal, 8(4), 25-40.