The progress of the health among the elderly has a major meaning for the needs of care, nursing and social services. The health of the elderly has improved but fall and fall accidents are a major problem. Acute diseases, activities and environment risks are often related to fall accidents. The aim of the study was to describe health care staffs’ opinions about fall risk and fall prevention. The study had a qualitative approach with a descriptive design. Twelve persons from a primary healthcare centre, a hospital and a community elder care unit in the middle of Sweden were interviewed. The material was analyzed through qualitative content analysis and data from the interviews resulted in two categories; The category “Factors contributing to falls” was formulated from the subcategories; The older persons health status and their care needs, Physical environment, Lack of competence among staff, Lack of time, stress and insufficient staffing, Staffs’ responsibilities and not followed routines and Insufficient cooperation between professional groups. The category “Factors preventing falls” was formulated from the subcategories; Physical environment and physical aid, Competence and fall risk assessment instruments, Different professionals’ responsibilities and Cooperation between different professionals. The results showed that the health care staff viewed several factors, which according to them contributed to falls as well as prevented falls. Cooperation between different professionals, increased competence and use of systematic fall risk assessment instruments were mentioned resulting in advantages for the patient. / Utvecklingen av de äldres hälsa har stor betydelse för behoven av vård och omsorg. Hälsan för äldre har förbättrats men fall och fallskador är ett stort problem och akuta sjukdomar, aktiviteter och omgivningsfaktorer är ofta utösande orsaker till fall. Syftet med denna studie var att beskriva vårdgivares uppfattning om fallrisker och fallprevention. Metoden var en kvalitativ intervjustudie med en beskrivande design. Tolv personer har intervjuats från hälsocentral, sjukhus och kommunalt äldreboende i ett län i Mellansverige. Resultatet redovisas utifrån två kategorier. Kategorin ”Faktorer som kan bidra till fall” framkom ur subkategorierna; Patientens tillstånd och omvårdnadsbehov, Fysisk miljö, Brist på kunskaper hos vårdpersonalen, Tidsbrist, stress och otillräcklig bemanning, Personalens ansvar och att inte följa rutiner samt Otillräcklig samverkan mellan yrkesgrupper och vårdnivåer. Kategorin ”Faktorer som kan motverka fall/fallprevention” framkom ur subkategorierna; Fysisk miljö och hjälpmedel, Kunskaper och utveckling av ett systematiskt arbetssätt, Ansvaret hos olika yrkeskategorier samt Samverkan. Resultatet i studien visade att det finns flera olika faktorer kring en patient som kan bidra till fall och som kan motverka fall. Samverkan mellan olika vårdnivåer, kunskaper och utveckling av ett systematiskt arbetssätt framkom som viktiga faktorer till fördel för patienten.

Brukare och brukarinflytande har på senare tid, blivit allt mer uppmärksammat inom den offentliga sektorn i socialt arbete (Svensson., Johansson & Laanemets, 2008, sid. 133-136). Frågan är huruvida brukare inom äldreomsorgen, kan göra sina röster hörda och vilka möjligheter till inflytande det finns för äldre i samhället? Det övergripande syftet med denna studie är att söka kunskap om äldres möjligheter till brukarinflytande, inom äldreomsorgen i Kumla kommun. Ett delsyfte är att undersöka vilka former av brukarinflytande som tillvaratas i Kumla kommun, efter genomförandet av projektet ”Vägar till ökat brukarinflytande och medborgerligt inflytande över kvaliteten i äldreomsorgen”. Frågan om på vilket sätt brukarinflytande kan ske i det praktiska arbetet med äldre med demenssjukdom, utgör även det fokus för denna studie. Genom en kvalitativ forskningsansats, har intervjuer genomförts med tre respondenter; en tidigare projektledare, en representant från Väntjänsten i kommunen samt med nuvarande äldreomsorgschefen i kommunen. Kvalitativ data har därefter analyserats genom meningskoncentrering, i syftet att utmynna i tematiseringar. Resultaten av studien påvisar att det i Kumla kommun, finns flera olika möjligheter till inflytande för brukare inom äldreomsorgen. Bland annat kan äldre ges inflytande över sitt eget ärende genom talesombud eller så kan de äldre genom att ingå i brukarråd, ges möjligheter till inflytande mellan omsorgsgivare och omsorgstagare. Brukarinflytande bland äldre med demenssjukdom, innebar vanligen att vårdpersonal förde de äldres talan och att anhörigas önskemål för den äldre prioriterades sekundärt. / Users and user influence has in recent years, become more noticed in the public sector in social work (Svensson., Johansson & Laanemets, 2008, p. 133-136). The question is whether users of the elderly care, can make their voices heard and what possibilities there is for older people to influence in society? The overall aim of this study is to learn about older people´s opportunities to user influence, in elderly care in Kumla community (in Sweden). A second aim is to examine which forms of user influence that are procured in Kumla, after the implementation of the project "Vägar till ökat brukarinflytande och medborgerligt inflytande över kvaliteten i äldreomsorgen ". The question of how user involvement can occur in the practical work with older people with dementia is also the focus of this study. Through a qualitative research approach, interviews were conducted with three respondents; a previous project manager, a representative from Väntjänst in the municipality and with the current elder care manager in the municipality. Qualitative data were then analyzed by sentence concentrator, with the purpose to culminate in themes. The results of the study indicate that in Kumla community, there are several possibilities to influence by patients in nursing homes. One example is that elderly people are given control over their own case through spokespersons or by the elderly thought participating in user councils, and thereby be provided opportunities for influences between caregivers and care recipients. User influence among elderly with dementia usually meant that health workers helped the elderly with their claims and that relatives requests for the elderly where prioritized secondary.

Titel: Ledarskap i krissituationer – att vara chef inom den privata äldreomsorgen 2011-2013. Huvudsyfte: Syftet med studien är att undersöka hur chefer inom den privata äldreomsorgen ser på sitt ledarskap i krissituationer. Huvudfrågan för undersökningen har varit: förändrar chefer i den privata äldreomsorgen sitt ledarskap vid krissituationer, och i så fall hur? Huvudsaklig metod: Semistrukturerade intervjuer har genomförts med fem chefer från tre olika organisationer inom den privata äldreomsorgen. Huvudsakliga resultat: Det råder delade meningar bland de undersökta cheferna om huruvida branschkrisen 2011 innebar förändringar av ledarskapet. Överlag visar mitt resultat att de flesta av cheferna kan peka på faktorer i sitt ledarskap som förändrats i krissituationer. Vidare visar de exempel som angavs att de chefer som ansåg att krisen hade medfört förändringar i deras ledarskap hade gjort det på olika sätt. De chefer som uppgav att de inte gjort förändringar i sitt ledarskap under krisen 2011 motiverade också sina svar på sinsemellan olika sätt. När cheferna tillfrågades mer allmänt om huruvida de upplevt andra kriser under sitt ledarskap angav samtliga att så var fallet och de flesta menade också att dessa kriser hade medfört förändringar i ledarskapet. En av de undersökta cheferna uttryckte att hon inte förändrar sitt ledarskap i egenupplevda kriser. Att några av cheferna uttryckte att de inte upplevde att de förändrat sitt ledarskap i krissituationer förklaras bland annat med att kontexten av ökat tryck inte är obekant för chefer inom den privata äldreomsorgen och att det därmed inte ses som en kris och heller inte påverkar ledarskapet. En annan tänkbar förklaring är att det finns ett strategiskt tänkande kring handlandet i organisationerna som gör att krisen inte påverkar ledarskapet. Studiens nytta: Att bidra med ökad förståelse kring hur chefers ledarskap omformas och påverkas i krissituationer. Att kunna ge en bild av ledarskap och förutsättningarna därikring samt omständigheter knutna till den privata sektorn inom äldreomsorg. / Title: Leadership in crisis situations - being a manager in the private eldercare 2011-2013. Main purpose: The study aims to examine how managers in the private eldercare sees their leadership in crisis situations. The main question for the study was: does managers in the private eldercare make adjustments in their leadership in crisis situations, and if so, how? Methodology: Semi-structured interviews were conducted with five executives from three different organizations in the private eldercare. Main findings: Opinion is divided among the surveyed managers on whether the industry crisis in 2011 resulted in adjustments to the leadership. Overall, my results show that most of the managers can point to factors in their leadership that adapted in crises. Furthermore, the examples stated shows that the managers that felt that the crisis had led to changes in their leadership had done so differently. The executives who said they did not make adjustments in their leadership during the crisis in 2011 also motivated their responses to each other differently. When the managers were asked more generally about whether they had experienced other crises under his leadership all stated that so was the case, and most also felt that these crises had led to adjustments in leadership. One of the surveyed managers expressed that she did not adapt her leadership in own perceived crises. That some of the managers said that they did not feel they adapted their leadership in crisis situations is partly explained by the assumption that a context of increasing pressure is not unfamiliar to managers in the private elderly care and is therefore not seen as a crisis, and do not affect the leadership. Another possible explanation is that there is a strategic thinking about the conduct of the organizations that prevents the crisis from affecting the leadership. Contribution: To contribute to a better understanding of how managerial leadership reshapes and is influenced in crisis situations. To provide a picture of leadership and the conditions therein and circumstances connected with the private sector in the elder care.

Syfte: Syftet med studien var att beskriva sjuksköterskans upplevelser av att använda sig av hundassisterad omvårdnad i svensk äldreomsorg. Metod: Intervjuer gjordes med legitimerade sjuksköterskor som hade erfarenhet av sällskapshundar och utbildade hundar inom äldreomsorgen. Resultat: Sjuksköterskorna upplevde att hundassisterad äldreomsorg inverkade positivt på flera plan, både bland de äldre och för personalen. Sjuksköterskorna upplevde att en hund berikade vardagen på äldreboendet och att hunden var till praktisk nytta i sjuksköterskans omvårdnadsarbete, framförallt i arbetet med patienter drabbade av demens. Hundassisterad omvårdnad upplevdes medföra ett ökat välbefinnande, minska stress och aggression, ge ökad glädje och matlust samt stimulera aktivitet, både fysiskt, mentalt och verbalt. Det förekom knappt några allergier bland de äldre, kanske för att deras miljö tidigare inneburit en mer djurnära kontakt. Sjuksköterskorna upplevde att nuvarande antal hundar var för få i förhållande till efterfrågan, och att användandet av hundassisterad äldreomsorg kunde göras mer effektiv, om det upprättades en bättre struktur för mål och uppföljning av gjorda insatser. Slutsats: Den legitimerade sjuksköterskan ser mycket praktisk nytta i sitt omvårdnadsarbete med att använda sig av hundassisterad äldreomsorg, då hunden underlättar arbetssituationen och inverkar lugnande. / Aim: The aim of this study was to describe nurses' experiences of dog- assisted elderly care and how nurses perceive that the dog contributes to the care in Swedish nursing homes. Method: Interviews were conducted with registered nurses who had experience of pet dogs and care- dogs in elderly care. Results: The nurses experienced that dog- assisted care had a positive impact in several levels, both for the elderly and the staff. The nurses experienced that a dog fortified the everyday life in the nursing homes and the dog could be put to practical use in the elderly nursing care, particularly in working with patients suffering from dementia. Dog- assisted care was perceived lead to increased well- being, reduce stress and aggression, provide increased pleasure and appetite. The interaction with the dog stimulated activity, both physically mentally and verbally. There were hardly any allergies among the elderly, perhaps because their environment previously consisted in a close animal contact. The nurses experienced that the current number of dogs were too few in relation to demand, and that the dog- assisted care of elderly could be made more effective, if a better structure were to be put up, for goals and the monitoring of the actions taken. Conclusion: The nurses' experienced that dog- assisted care of elderly also contributed to the nurses' care, because the dog made the work- situation easier and had a calming influence on the patients.

The purpose of this study was to understand how the concept of quality as an idea was spread to and translated in municipal elderly care. A central question was: How does literature, policy documents and key people describe the function and meaning of the concept of quality? The method of analysis was a qualitative case study with a critical discourse. The theoretical framework of the study is mainly what is known as institutional theory and a line of thought describing how ideas are transferred and spread. The theoretical focus is on how original ideas are interpreted and why they gain a foothold in new contexts. With the help of empirical material in the form of literature, documents and interviews the study shows how the idea of quality was spread from industry to elderly care.   An essential discovery is that the concept of quality has uncritically been implemented to the municipal care of the elderly, correlating to organizational changes, limited resources and the concept of quality becoming a part of the Social Services Act. The municipal care of the elderly tried to apply a quality control system not designed for a human service organization. In order to succeed it tried to make the idea concrete and intelligible by using various system and manuals. The results show that the process has created conservation rather than a change. There is a paradox between quality as a subjectively created value and quality as a quantitative instrument used to create efficiency.

Arbetsplatsen är en arena där det finns goda möjligheter att arbeta hälsofrämjande. Inom äldreomsorgen finns det både utmaningar och möjligheter när det gäller att förändra arbetssituationen och på så vis förbättra de anställdas hälsa. För att underlätta detta arbete kan arbetsplatsen ta hjälp av externa samarbetspartners, till exempel företagshälsovården. Syftet med studien var att ta reda på hur de anställda inom äldreomsorgen i en kommun i södra Sverige uppfattar att samarbetet kring hälsofrämjande insatser mellan deras arbetsplats och företagshälsovården fungerar. Datainsamlingsmetoden som användes i denna studie var enkäter utdelade till alla 345 fast anställda. Svarsfrekvensen blev 49 procent. Resultatet visade att personalen uppfattade samarbete mellan chefen och företagshälsovården som bra men att det var obefintligt mellan dem själva och företagshälsovården. De anställda anser att samarbetet kan utvecklas genom bättre kommunikation och information. Slutsatsen som dras i denna studie är att cheferna bör tydligöra företagshälsovårdens roll i det hälsofrämjande arbetet. Genom välfungerande kommunikation och bra informationsspridning kan samarbetet mellan cheferna, de anställda och företagshälsovården förbättras. / The workplace is an arena where there are good opportunities to work health promotive. In the elderly care, there are both challenges and opportunities when it comes to changing the work situation and thereby improve the employees’ health. To facilitate this work, the workplace can take the help of external partners, such as the occupational health service. The purpose of this study was to find out how the employees of the elderly care in a municipality in southern Sweden perceive the cooperation between their workplace and the occupational health service when it comes to working health promotive. The data collection method used in this study was questionnaires distributed to all 345 of the permanently employed. The response rate was 49 percent. The results showed that the employees perceived that the cooperation between managers and the occupational health service was good, but that it was non-existent between themselves and the occupational health service. The staff has the opinion that the cooperation can be developed through better communication and information. The conclusion of this study is that managers should clarify the occupational health service´s role in the health promotive work. Through effective communication and good methods of spreading information, the cooperation between managers, employees and the occupational health service can be improved.

Sammanfattning  För att förhålla sig till en modern och föränderlig omgivning genomgår idag många offentliga  verksamheter stora förändringar i sina sätt att styra organisationen. En av de största förändringar  som skett är möjligheten för privata aktörer att köpa upp och bedriva verksamheter, något som  tidigare bedrivits i kommunal regi. Äldreomsorgen är en av de sektorer som idag står inför stora  organisatoriska utmaningar där omsorg ska kombineras med strategier som tidigare främst tillhörde  marknaden.  Den forskning som har gjorts på området är tvetydig och ger inga klara besked om de effekter som  privatiseringen har för varesig personal eller vårdtagare. Vi ville därför undersöka ett privatiserat  äldreboende för att studera vilka marknadsmässiga tendenser det kan uppvisa samt hur personalen  upplever sin arbetssituation.  Uppsatsens resultat visar att äldreboendet har flera marknadsmässiga inslag och att personalen i det  stora hela verkar mycket nöjda med sin arbetssituation. Vidare framgår de fördelar en privatisering  kan innebära för både anställda och vårdtagare beträffande kvalitet och utbud, men även de  svårigheter som uppstår i omsorgsarbetet då omsorg som en relativt oförutsägbar verksamhet inte  tillfullo kan anpassas till företagsmässiga visioner och strategier.  Nyckelord: Äldreomsorg, privatiseringens effekter, standardisering, individuell omsorg,  omsorgspersonal. / Abstract  To respond to a changing and contemporary environment many organisations in the public sector  changes in their way of controlling the organisation. One of the biggest changes is the ability of  private actors to buy and practice care, which were previously conducted by the municipality.  Elderly care is one of the sectors which are currently facing major organisational challenges where  care will be combined with strategies that previously belonged to the market sector.  The research that has been done in this area is ambiguous and gives no clear answer about the  effects that privatisation has. Therefore we wanted to investigate a privatised home for the elderly to  study the market trends that can exhibit and how staff perceives their work situation.  The result shows that the home for the elderly has market elements and their staff seems very  pleased with their work situation. The study shows that there are benefits of privatisation for both  employees and patients regarding quality and supplies, but the study also shows the difficulties that  occur in the care work when care, which is an unpredictable activity, not fully can be adapted to  market visions and strategies.  Keywords: Elderly care, effects of privatisation, standardisation, individual care, care workers.

When the population is getting older, the need for complex care and nursing interventions in elderly care increases. To create a holistic view of the elder and their life situation, interprofessional team collaboration is often desirable and necessary. Teamwork is often described in positive terms, but previous research has shown that this work method is complicated and requires constant reflection and development. The purpose of this study was to investigate how elderly care teamwork is formed in the interaction between representatives of different professionals. To accomplish this purpose, we have studied how the team members define a well-functioning teamwork and difficulties, and how consensus is achieved in the team. This qualitative case-study combines observation and semi-structured interviews with five informants from different professions working together in an elderly care team: one manager, one assistance case worker, one nurse, one physiotherapist and one of the nursing staff. The results of the study were then analyzed with the terms domain consensus and domain conflict taken from the new institutionalism. The study shows that the informants define a well-functioning teamwork as a work method where openness and mutual respect towards each other’s competence, creates a better holistic view of the elder and their needs. The informants also present teamwork difficulties as disagreements and gabble. The study finally suggests that there is a consensus regarding teamwork goals, and regarding who is entitled to claim knowledge in the different fields of the working area. / I takt med en åldrande befolkning ökar också behovet av komplexa vård- och omsorgsinsatser inom äldreomsorgen. Detta leder till att interprofessionell teamsamverkan i många fall är önskvärd och nödvändig för att skapa en helhetssyn över den äldre och dennes livssituation. Teamarbete beskrivs ofta i positiva ordalag, men tidigare forskning har visat att detta arbetssätt är komplicerat och kräver ständig reflektion och utveckling. Vårt syfte med denna studie har varit att studera hur teamarbete i äldreomsorgen formas i samspelet mellan representanter av olika yrkesgrupper. För att uppnå detta syfte har vi studerat hur teamets aktörer definierar ett väl fungerande teamarbete och svårigheter, samt på vilket sätt det råder samförstånd i teamet. Vi har genomfört en kvalitativ fallstudie där vi genom observation och fem intervjuer med yrkesgrupperna enhetschef, biståndshandläggare, sjuksköterska, sjukgymnast och undersköterska har studerat ett team inom äldreomsorgen. Studiens resultat analyserades sedan utifrån begreppen domänkonsensus och domänkonflikt hämtade ur den nyinstitutionella teorin. Studien visar att informanterna definierar ett väl fungerande teamarbete som ett arbetssätt där öppenhet och respekt gentemot varandras kompetenser bidrar till en ökad helhetssyn över den äldre och dennes behov. Informanterna beskrev i sina intervjuer även att svårigheter i form av meningsskiljaktigheter och ”kackel” kan förekomma. Studien visar slutligen att det råder samförstånd gällande teamarbetets mål, samt gällande vem som har rätt att göra anspråk på de olika kunskaperna inom verksamhetsområdet.

Denna studies Syfte var att beskriva hur omvårdnadspersonal och sjuksköterskor på två särskilda boenden i en kommun i Mellansverige uppfattar sin egen och varandras yrkesroll, däribland uppfattningen av sjuksköterskors ledarskap. Detta syfte har speglats utifrån designen kvalitativ ansats där resultatet är övergripande beskrivande och Metoden för studien var halvstrukturerade, ämnesfokuserade intervjuer som analyserats genom kvalitativ innehållsanalys. Resultatet som framkommer i studien var att rollerna är svåra att definiera, de generella beskrivningarna är att sjuksköterskans ansvar ligger i det sjuka och förebygga ohälsa samt att omvårdnadspersonalens huvudansvar vilar i den basala omvårdnaden men båda yrkesgrupperna anser sig dela det preventiva arbetet, omvårdnadsteknik är omvårdnadspersonalens arbetsuppgift - men anses valbar och förväntningarna på respektive yrkesgrupp skiljer sig. Varken sjuksköterska eller omvårdnadspersonal anser att sjuksköterskan har några specifika uppgifter som ledare utöver att de ska fungera som handledare och stå för kompetenshöjning på avdelningen, däremot framkommer åsikter om att det finns en naturlig ledarroll inom den medicinska vården vid specifika situationer. Slutsatser i studien var att sjuksköterskorna uppvisar bredare kunskap om arbetsuppgifterna inom yrkesrollerna än vad omvårdnadspersonalen gör, förväntningarna på varandras ansvarsområden skiljer sig och båda grupperna verkar ovetandes om ansvaret sjuksköterskor har i ledanderollen. / The aim of this study was to describe how health care assistants and registered nurses perceive their own and each other’s work roles and also how they perceived registered nurses role as a leader. A qualitative descriptive design was used. The used method was semi-structured, topic-focused interviews that were analyzed through qualitative content analysis. The result of the study shows that it was difficult to define respectively work role, the general description is that the registered nurses responsibility lies within the area of diseases and prevention of illness. The health care assistant’s main responsibility is in the area of basic nursing care and also technical care, but both occupational groups considered preventive work as a shared responsibility and the expectations on respectively occupational group differ. Neither the registered nurses nor the healthcare assistants considered registered nurses as a leader, except in the role of a mentor and the responsibility to increase competence within the healthcare assistants group when needed. But it was found that registered nurse have a natural role as a leader regarding the medical care in specific situations. The conclusions of the study was that the registered nurses has a broader knowledge of the work tasks within the work role of the two professions compared to the health care assistants, the expectations of each other’s responsibilities differ and both groups seem unaware of the leading role that is incorporated in registered nurses responsibility.

The objective of this study is to test if the hypothesis of the environmental gerontology theory can be applied to a cross-cultural environment. This study examined the applicability and functionality of the Multiphasic Environmental Assessment Procedure (MEAP), a tool based on the environmental gerontology theory, and assessed the quality of elderly care facilities in Taiwan. Special emphasis was placed in examining the functionality of the MEAP from the cross-cultural standpoint and also in identifying the associations or potential impacting factors of care quality. This is the first study with the application of the MEAP to examine the quality of the two major care facilities in Taiwan. Results of this study provide not only an insight into the characteristics of the elderly care facilities ,and a reference for policy making and regulation, but also valuable data for cross-cultural comparisons. The study employed the MEAP to achieve the stated objectives and further evaluated the differences in the characteristics of the two major elderly care facilities, namely the nursing homes and assisted-living facilities in Kaohsiung city in Taiwan. This cross-sectional research was conducted with questionnaires by 687 employees (excluding foreign workers) and 429 residents in 35 nursing homes and 41 assisted living facilities in Kaohsiung city were interviewed. Participants were selected from residents who were conscious and without cognitive disorder for face-to-face questionnaire interviews. For facilities with ten or more residents, 50% of the eligible residents were selected for this interview. For facilities having less than ten residents, all those qualified residents were interviewed. Results were analyzed on the basis of institutional units rather than the individual basis. Results showed that the MEAP effectively evaluated the associations of the multiple environmental factors with the quality of life of the two major elderly care facilities in Kaohsiung city. Standardized multiple quality indexes mode showed that the assisted-living facilities have better overall quality than nursing homes do. The major findings are: 1.The major residents of elderly care facilities in Kaohsiung city were the socioeconomically less privileged residents, including house wifes, the disabled, and widowed. The service most needed was personal care such as bathing. 2.Based on the MEAP, a total of eight significant variables were compared between nursing homes and assisted living facilities. Among these variables, nursing homes were better in staff resource than that of the assisted living facilities. Assisted-living facilities were better in all other seven variables including functional abilities, activities in community, acceptance of problem behavior, physical amenities, social-recreational aids, and orientational aids and staff facilities. 3.The staff members of both nursing homes and assisted living facilities have better SCES than that of their residents. 4.Compared to assisted living facilities, the nursing homes were superior in staff level and staff resources but inferior in comfort, security, and control. No differences were observed in services, autonomy, rapport and morale. 5.The characteristics of organizational management, such as ownership, type and size, were important impacting factors of care quality. The nonprofit-nursing homes were better scored in six of the eight quality indexes than the ones owned by privately-for-profit. 6.Factors that influenced the quality of the nursing homes include number of workers, number of beds, number of residents, ownership, functional abilities, actively level, activities in community, occupancy rate and type of elderly care facility. 7.Factors that influenced the quality of assisted living facilities include occupancy rate, number of residents, number of workers, activity level and type of elderly care facility. 8.The regression model for the outcome of multiple environmental quality indexes with the structure and process indexes is related in nursing homes. The regression model indicates that the model significantly predicted outcome quality index (morale) (R2 = 49.4%). Both structure quality index (comfort and safety) and process quality index (autonomy and rapport) were significant predicting factors of outcome quality index (morale). Autonomy was a negative predicting factor. 9.Standardized multiple environmental quality index indicated that based on the MEAP, assisted living facilities had a little bit higher quality than that of nursing homes in Kaohsiung city. In conclusion, this study confirmed the hypothesis that the MEAP can be applied effectively to evaluate the quality of elderly care facilities in a cross-cultural environment. However, cultural differences do have an impact on the functionality of the tool. Results of this study indicate that the two major elderly care facilities in Kaohsiung city have relatively similar characteristics, but the assisted living facilities are slightly better in overall quality than that of nursing homes. The major factors that impact the quality of elderly care facilities are the operational characteristics and efficience. Results of this study indicate that the MEAP provides very useful indicators for assessing the quality of elderly care facilities in Taiwan, especially for nursing homes. The MEAP identified more structure and process-related impacting factors than outcome-related impacting factors in this study. Concerning cultural difference, the MEAP could be benefited from some modification in certain measurements, especially in facility atmosphere(SCES), when applied in Taiwan.