Bioethics Peer Review: A Structured Evaluation Framework for Long-Term Care Environments

Health care environments-particularly the built environment-can function like health care interventions, achieving medicine-like effects that shape the lived experience of persons in long-term care (LTC). Despite a growing body of evidence-based design research illustrating the clinical and behavioral influence of environmental conditions, these findings are not consistently incorporated into new LTC construction and renovation. This reflects divergent trajectories of knowledge development across medicine, architecture, and LTC operations. Because shortcomings in environmental design fall outside medical oversight, research protections, and enforceable architectural standards, opportunities to support safety, well-being, and autonomy often remain unrecognized. To address this gap, we developed the Bioethics Peer Review for Long-Term Care Design, a multidisciplinary evaluative process grounded in clinical ethics consultation and aligned with the 5M geriatric framework. We describe the model, its rationale, and lessons learned from pilot applications in 2 LTC facilities.