Therapeutic Environment Screening Survey For Nursing Homes (TESS-NH)

  An Overview for Potential Users 

The TESS-NH is an observational instrument that gathers systematic data on the physical environment of a long-term care facility.  The TESS-NH contains over 80 specific items measuring characteristics that are believed to be of importance to persons with Alzheimer’s disease and related disorders.  The TESS-NH was designed primarily to survey individual environmental characteristics.  It is not a scale.  However, within the TESS-NH is one scale, the Special Care Unit Environmental Quality Scale (SCUEQS), which is a valid, reliable measure of overall environmental quality from the perspective of dementia care.

The TESS-NH was developed over nearly 10 years by a team of investigators.   The project director was Dr. Philip Sloane, and the project manager was C. Madeline Mitchell.  Other contributors to development of the TESS-NH included:

  • Gerald Weissman (University of Wisconsin at Milwaukee)
  • Kristie M. Long (Wake Forest University of School of Medicine)
  • Mary Lynn (University of North Carolina at Chapel Hill)
  • Margaret Calkins (I.D.E.A.S. Incorporated)
  • M. Powell Lawton (Philadelphia Geriatric Center)
  • Jeanne Teresi (Hebrew Home for the Aged)
  • Leslie Grant (University of Minnesota)
  • David Lindeman (Mather Institute on Aging, Evanston, Illinois, and Rush Institute on Aging, Chicago)
  • Rhoda Montgomery (University of Kansas)
Portions of the development of the TESS-NH were supported by grants from the National Institute on Aging, the Retirement Research Foundation, and the Helen Bader Foundation. 

Major development of the instrument was carried out as part of the National Institute on Aging’s cooperative agreement on Special Care Units for Alzheimer’s disease (Marcia Ory, PhD, Project Officer). 

The TESS-NH replaces two previous instruments:

        The Therapeutic Environment Screening Scale (TESS), a 12-item instrument developed in the late 1980’s for briefly screening nursing home Special Care Units for Alzheimer’s disease; and

        The TESS – 2+, a provisional instrument developed in the early 1990’s for a National Institute on Aging cooperative agreement on Special Care Units.

Composition of the TESS-NH

The theoretical basis of the TESS-NH was developed in 1990-1992 by the committee on environmental assessment of the National Institute on Aging cooperative agreement on Special Care Units.  The NIA committee identified 6 major goals of the physical environment in caring for persons with dementia.   These were further developed into 13 domains.

The structure of the TESS-NH is described in the table below, which lists the major target goals and domains, and finally further classifies the specific question items:

Therapeutic Goal Domain
Items (Item # from TESS-NH is in parentheses)
Safety / security / health Exit control Doors disguised (5a-b)
Number of exits (6a-6b)
Locks (6c-f)
Alarms (6g-j)
Maintenance Shared social space maintenance (7a)
Hall Maintenance (7b)
Resident room maintenance (7c)
Resident bathroom maintenance (7d)
Cleanliness Shared social space cleanliness (8a)
Hall cleanliness (8b)
Resident room  cleanliness (8c)
Resident bathroom cleanliness (8d)
Odors of bodily excretions (9)
Safety Floor Surfaces (10)
Handrails (11)
Orientation Orientation / cueing Cues to individual resident rooms (28(1a-g))
Cues to resident bathrooms (28(2a-c))
Cues to activity areas (28(3a-c))
Privacy / control / autonomy Privacy Privacy provision in shared rooms (29a-b)
Unit autonomy Relationship to nursing stations (1)
Staff paperwork provisions (2)
Unit as pathway (3)
Where residents eat (4a)
Where activities take place (4b)
Where residents bathe / shower (4c)
Outdoor access Access to outdoors (26)
Attractiveness of outdoor areas (27a)
Functionality of outdoor areas (27b)
Lighting Intensity (12)
Glare (13)
Evenness (14)
Noise Television use in main public area (30)
Resident, staff or mechanical noise (31)
Visual / tactile stimulation Views from rooms (24a-b)
Tactile stimulation (25a)
Visual stimulation (25b)
Social milieu Space / seating Chairs in resident rooms (15)
Size and seating of public rooms (16a-i)
Absence / presence of dead ends (17a)
Places to sit along corridors (17b)
Length of hallways (18)
Homeliness of public areas (19)
Kitchen available t residents / families (20)
Pictures / mementos in resident rooms (21)
Non-institutional furniture (22)
Residents appearance individualized (23)

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