The premise of the project is deceptively simple but far-reaching: the design of a long-term care facility is not neutral. Corridor layouts, shared versus private rooms, access to outdoor space, lighting, wayfinding cues, and the placement of nursing stations all shape how residents move, socialize, sleep, and maintain a sense of autonomy. Anderson’s research team has developed a bioethics-based evaluation tool that assesses whether built environments genuinely support dignity, safety, independence, social connection, and quality of life for older adults. Rather than treating these outcomes as incidental benefits of good design, the tool frames them as ethical obligations that facilities can be systematically measured against, giving designers, operators, and regulators a common vocabulary for judging whether a building helps or harms the people living inside it.

“Building on research findings, the project will work with the U.S. Department of Veterans Affairs to integrate ethical design considerations into long-term care planning and standards,” Anderson says. “The goal is to create healthier, more person-centered environments for older adults while providing a model that can be adapted across the broader healthcare system.” The partnership with the VA is significant because the department operates one of the largest networks of long-term care facilities in the United States, serving veterans with complex medical, cognitive, and psychiatric needs. Standards adopted or refined within that system could ripple outward, offering a template that private nursing homes, assisted living operators, and state regulators could adapt for their own purposes.

The new grant builds directly on a previous award Anderson and her team received from The Greenwall Foundation in 2024. That earlier work highlighted a striking regulatory gap: many long-term care issues tied to the built environment currently exist without clinical oversight. Decisions about square footage, room configuration, and shared spaces are typically made by architects, developers, and administrators operating under building codes and reimbursement rules, not by clinicians or ethicists trained to evaluate how environments affect health and human rights. As scientific knowledge has grown about how architecture influences behavior, well-being, and measurable health outcomes, Anderson argues, the ethical stakes of those decisions have grown as well. Questions about evaluating benefits and harms, preserving freedom, and obtaining meaningful consent from residents with cognitive impairment demand thorough vetting before design choices are locked into concrete and steel.

Anderson is unusually well equipped to make that argument. She is a board-certified healthcare architect and a geriatrician, holding credentials in both disciplines at a time when few researchers can claim even one. She earned her Master of Architecture degree from McGill University in Montreal and her MD from the University of Toronto, then completed a residency in internal medicine at New York-Presbyterian Hospital and Columbia University Irving Medical Center. She went on to complete a clinical geriatric fellowship at the University of California, San Francisco, and an advanced fellowship in geriatric neurology and research at the VA Boston Healthcare System, training under Andrew Budson, MD, professor of neurology at the school. That dual training allows her to read a floor plan the way a clinician reads a chart, spotting risks and opportunities that specialists in either field alone might miss.

Her professional record reflects that interdisciplinary reach. Anderson has worked on hospital design projects around the world and is widely published in both architectural and medical journals and books. She is a frequent speaker on the impacts of healthcare design on patient outcomes and care delivery, addressing audiences that span clinical medicine, architecture, and health policy. A past fellow at the Harvard Medical School Center for Bioethics, she has focused her scholarship on the intersection of space design and ethics, particularly in the context of nursing homes and institutional living for older adults. In those settings, the built environment can determine whether a resident with dementia can wander safely, whether families can visit comfortably, and whether staff can deliver care without eroding the dignity of the people they serve.

That commitment to bridging disciplines also led Anderson to co-found the MGB Health Design Lab, an initiative that unites clinical, architectural, and design professionals under a shared mission. The lab works to advance collaboration between healthcare and design across research, education, clinical practice and innovation, and bioethics and policy. Its creation reflects a growing recognition within medicine that the physical environment is a modifiable determinant of health, much like nutrition or medication management, and that improving it requires teams that speak both the language of clinical evidence and the language of spatial design. The new Greenwall-funded project extends that logic into the policy arena, where design standards are written and enforced.

Behind the award stands The Greenwall Foundation itself, a nationally recognized private foundation with assets of roughly $100 million. The foundation awards approximately $3 to $4 million annually in support of its mission to make bioethics integral to decisions in health care, policy, and research. Its funding strategy is aimed at expanding bioethics knowledge with the explicit goal of improving clinical, biomedical, and public health decision-making, policy, and practice. The Bridging Bioethics Research & Policymaking program, under which Anderson’s grant falls, is designed specifically to carry ethical analysis out of the seminar room and into the offices where real-world rules are drafted, a fit that matches Anderson’s ambition to influence federal practice through the VA.

The timing of the work is notable. Populations across the United States and much of the world are aging rapidly, and the demand for long-term care is projected to rise sharply in the coming decades. The COVID-19 pandemic exposed how profoundly facility design shapes infection risk, isolation, and mortality in congregate care settings, intensifying scrutiny of nursing home layouts, ventilation, and shared spaces. At the same time, research in environmental psychology and gerontology has accumulated evidence that surroundings influence cognition, mood, mobility, and social engagement among older adults, including those living with dementia. Against that backdrop, a framework for ethically evaluating care environments arrives at a moment when policymakers, providers, and families are all searching for better answers about how to house and care for a growing older population.

If the project succeeds, its impact could extend well beyond veterans’ facilities. A validated bioethical evaluation tool, embedded in federal planning and standards, would give every stakeholder in long-term care a structured way to ask whether a proposed building respects the people who will live in it. It would also establish a precedent: that architecture in healthcare is not merely a matter of cost, code compliance, or aesthetics, but a domain of ethical responsibility deserving the same rigor applied to drugs and devices. For Anderson, the work represents the convergence of her two professions into a single argument, one that insists the places where older adults spend their final years should be judged not only by how efficiently they operate, but by how faithfully they honor the dignity, freedom, and humanity of the people inside them.

Subject of Research: Bioethical evaluation of long-term care facility design and its integration into federal healthcare planning standards

Article Title: BU researcher receives bioethics grant for improving long-term care facility design

Article References: BU researcher receives bioethics grant for improving long-term care facility design. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: bioethics, long-term care, healthcare design, Diana Anderson, Greenwall Foundation, Department of Veterans Affairs, geriatrics, nursing homes, built environment, aging, architecture, health policy