How storey configuration and number of transition points shape opportunities for outdoor access in residential care facilities: implications for age-friendly environments

Journal article, 2026

Background Age-friendly environments are increasingly recognised as essential for supporting participation, autonomy, and healthy ageing. In residential care facilities (RCFs) for older adults, the built environment interacts with organisational practices to shape opportunities for person-centred care and rehabilitation. However, limited knowledge exists regarding how architectural configurations influence access to immediate outdoor environments.
Aim To examine how storey configuration (single- versus multi-storey) and number of transition points were associated with opportunities for immediate access to outdoor environments within and adjacent to RCFs.
Methods A multi-methods design was used, comprising national mapping of storey configuration of 1,603 Swedish RCFs, mapping of transition points at three RCFs, and walking interviews with twelve older adults and eleven care workers.
Results Single-storey RCFs involved fewer transition points between indoor and outdoor environments, shaping opportunities for immediate outdoor access. In contrast, multi-storey RCFs required additional transitions, including corridors, elevators, and stairs, which increased dependence on care workers and constrained opportunities for outdoor engagement. Architectural conditions interacted with organisational routines, shaping older adults' opportunities for outdoor access and the practical possibilities for outdoor person-centred care and rehabilitation.
Conclusions Storey configuration and number of transition points constitute structural conditions that shape outdoor access in RCFs. These findings have implications for age-friendly design and planning of RCFs as well as for person-centred care and rehabilitation.