The bioethics research by Dr. Anderson and her team has highlighted the need for policymakers to address long-term care (LTC) issues around the built environment, currently without clinical oversight. Growing knowledge of how architecture affects behavior, well-being, and health outcomes demands that concerns about evaluating benefits and harms, freedom, and consent be thoroughly vetted. Their novel and pioneering Bioethics Peer Review (BPR) model is currently being implemented to highlight bioethical issues across multiple dimensions of the building and its operations. The team's campaign with federal policymakers will aim to make them aware and consider these bioethical concerns, as new knowledge engenders new responsibilities.
Our Grants
Improving Long-Term Care Facility Design through Bioethical Peer Review
Diana Anderson, MD
Boston University
Boston University
Grant Type
Bridging Bioethics Research & Policymaking
Grant Cycle
2024
Duration
12 months
Amount
$48,902
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Diana C. Anderson et al., Bioethics Peer Review: A Structured Evaluation Framework for Long-Term Care Environments, The Journal of the Post-Acute and Long-Term Care Medical Association, Jan 2026
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Grantee Q&A
We ask Bridging Bioethics Research & Policymaking grantees about lessons learned for increasing bioethics’ impact on policymaking.
Who was the intended audience for your project?
Our interdisciplinary research and consultancy team (www.bprlab.org) had genuine entry points across the professional communities we sought to engage in academic medicine, clinical ethics, long-term care operations, and federal policy. We engaged both the staff of the U.S. Senate Special Committee on Aging and the constituent services of member senators serving the districts of our team members. These connections led to two formal briefings with the Committee and subsequent written testimony and public-facing materials submitted upon request. We also disseminated our framework to a national network of long-term care (LTC) providers and operational leaders, following several strategy meetings with the Senior Advisor for Aging at the Institute for Healthcare Improvement (IHI).
What message did you seek to deliver and how?
Our core message was that architectural decisions in long-term care facilities function like medical interventions — shaping fall rates, delirium incidence, infection transmission, dementia-related behavioral symptoms, and avoidable hospitalization — yet they are made without any of the clinical oversight, ethical review, or accountability structures we apply to care itself. We delivered this message to two audiences, focusing on the terms most relevant to their authority. For federal policymakers, we framed bioethics peer review (BPR) as a structured, replicable mechanism to integrate ethical and clinical evidence into LTC design decisions — a process analogous to clinical ethics consultation, already familiar to healthcare audiences, and scalable to regulatory guidance. For LTC providers and operators, the emphasis was practical: BPR offers a common vocabulary for design teams and clinical leaders to identify competing values and trade-offs during planning, before they become structural.
How did you involve collaborators outside of bioethics research in your project?
Our most important collaborators were the facilities where we piloted the framework and our partner at IHI. The two pilot facilities contributed access and substance by participating in the BPR process and surfacing unanticipated concerns. Their feedback shaped the structure and the optimal timeline for the framework's implementation phases. Collaborating with the Senior Advisor for Aging at IHI allowed us to reach medical, geriatric, and post-acute care communities with the credibility that comes from a trusted national organization vouching for the work's clinical relevance.
What lessons did you learn about translating bioethics research to policymaking?
First: Have a demonstrable solution and deliverables ready before asking for policy support to establish credibility. Real-world proof of concept is persuasive in ways that theoretical frameworks are not. Second: Our most productive engagements resulted from personal connections between team members and Congressional staff, which were decisive in the project’s success. Leveraging established national networks (e.g., reputable professional societies) and mapping relevant relationships before beginning outreach was foundational. Third: Tailor materials for your audience. Our journal article (https://linkinghub.elsevier.com/retrieve/pii/S152586102500605X) was impactful for some audiences, whereas the concise, plain-language policy brief focused on constituent relevance was more effective for others. We encourage parallel development of scholarly and policy-facing materials to maximize impact and efficiency. Finally: Plan for disruptions and delays when engaging with policymakers (e.g., the effects of a national election cycle) and build timeline flexibility into your project design to account for them.
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