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Promising Practices in Dining and the Environment

The CMS Interpretive Guidelines and Creating Home



Adequate and Comfortable Lighting

Below is the full text of the CMS Interpretive Guidelines changes for the tags related to dining.

The CMS Tag Revisions are in red italics.
 Portions of new text related to Promising Practices in Dining and Environment are bookended by these symbols. 

The CMS interpretive Guidelines beyond dining can be accessed at: 
June 12 2009 CMS Interpretive Guidelines.

§483.15(h) (5) F 256 – Adequate and comfortable lighting levels in all areas;
The facility must provide –

§483.15(h)(5) Adequate and comfortable lighting levels in all areas;
Interpretive Guidelines §483.15(h)(5)

Interpretive Guidelines: §483.15(e) (1)

"Adequate lighting" means levels of illumination suitable to tasks the resident chooses to perform or the facility staff must perform.

"Comfortable lighting" means lighting that minimizes glare and provides maximum resident control, where feasible, over the intensity, location, and direction of illumination so that visually impaired residents can maintain or enhance independent functioning.

As a person ages, their eyes usually change so that they require more light to see what they are doing and where they are going. An adequate lighting design has these features:

  • Sufficient lighting with minimum glare in areas frequented by residents;

  • Even light levels in common areas and hallways, avoiding patches of low light caused by too much space between light fixtures, within limits of building design constraints;

  • Use of daylight as much as possible;

  • Elimination of high levels of glare produced by shiny flooring and from unshielded window openings (no-shine floor waxes and light filtering curtains help to alleviate these sources of glare);

  • Extra lighting, such as table and floor lamps to provide sufficient light to assist residents with tasks such as reading;

  • Lighting for residents who need to find their way from bed to bathroom at night (e.g., red colored night lights preserve night vision); and

  • Dimming switches in resident rooms (where possible and when desired by the resident) so that staff can tend to a resident at night with limited disturbances to them or a roommate. If dimming is not feasible, another option may be for staff to use flashlights/pen lights when they provide night care.
Some facilities may not be able to make some of these changes due to voltage or wiring issues. For more information about adequate lighting design for long term care facilities, a facility may consult the lighting guidance available from the Illuminating Engineering Society of North America, which provides authoritative minimum lighting guidance.

The following are additional visual enhancements a facility should consider making as fiscal constraints permit in order to make it easier for residents with impaired vision to see and use their environment:
  • Use of contrasting color between flooring and baseboard to enable residents with impaired vision to determine the horizontal plane of the floor;

  • Use of contrast painting of bathroom walls and/or contrasting colored toilet seats so that residents with impaired vision can distinguish the toilet fixture from the wall; and

  • Use of dishware that contrasts with the table or tablecloth color to aid residents with impaired vision to see their food.
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