Creating a home away from home: a resident-centred systematic review and meta-synthesis of ideal nursing home qualities from the perspectives of cognitively intact residents

Abstract Background A home-like environment is crucial for the well-being of nursing home residents, promoting autonomy, comfort and social connection. This review addresses gaps in understanding factors shaping cognitively intact nursing home residents’ perceptions of a home-like environment. By synthesising the best available evidence, it identifies and describes key characteristics of an ideal home-like nursing home environment from the perspectives of cognitively intact residents. Methods A meta-synthesis was conducted, involving the search of eight databases, comprehensively searched through 10 December 2024, to identify studies exploring residents’ perceptions of home-like environments in nursing homes. Inclusion criteria focused on qualitative studies with residents aged 50 and above. Thematic synthesis identified recurring themes across studies. Results Nineteen studies published between 2002 and 2024, which encapsulated the 1368 residents’ perspectives, met the inclusion criteria and were included in the review. Four key themes developed through thematic analysis: (i) Psychological: sense of recognition, autonomy and control, coping and adaptation, emotional comfort; (ii) Social: interaction with staff, relationship with residents, family connectedness and social activities; (iii) Built environment: private space, communal spaces, personalisation, aesthetic and ambience and outdoor spaces; (iv) Organisational: staffing challenges, respectful care practices, scheduled activities and dining and food choices. Discussion Findings highlighted that autonomy, meaningful social connections and personalised environments are essential for fostering a home-like setting for long-term residents. Institutional constraints hinder this, highlighting the need for policies embedding autonomy into routines, staff training and design, with flexible, personalised and culturally attuned care practices that respect residents’ preferences.