Table 3.

Scoring options during observations.

Aspects of MEDLO-Tool	Operationalization	Scoring Options
Engagement in activity	Five category options	Yes, active engagement (participating in activity) Yes, passive engagement (focus on activity) Yes, engagement with something else No, not engaged (gazing without focus) No, not engaged (sleeping)
Location	Five category options	Communal area on the ward Own room Communal area off the ward Outside
Level of social interaction	Five category options	No social interaction No social interaction, resident attempts to interact, gets no response No social interaction, environment attempts to interact, but resident does not respond Yes, interaction with someone else Yes, interaction with two or more people
Type of social interaction of environment towards resident	Five category options	Negative restrictive (interaction that oppose or resist resident’s freedom of action without good reason, or ignore resident as a person) Negative protective (providing care, keeping safe or removing from danger in a restrictive manner without explanation or reassurance) Neutral (brief, indifferent interactions) Positive care (interactions during the appropriate delivery of care) Positive social (interactions principally involving “good, constructive, beneficial” conversation and companionship)
Social interaction with whom	Five category options	Staff Other residents Family and/or friends Others Combination of the above