Environmental characteristics of nursing homes and community-based settings, and the well-being of adults with intellectual disability.
Adults with ID thrive in small, stimulating, choice-rich community homes.
01Research in Context
What this study did
The team visited the adults with intellectual disability. Half lived in nursing homes. Half lived in small community houses.
They counted how often staff let residents choose food, clothes, or activities. They noted how many pictures, plants, and games were in each place. They also checked health records and asked about community outings.
What they found
Community houses won on every score. Residents showed more daily living skills, like cooking and shopping. They visited parks, stores, and churches twice as often. Doctors saw fewer skin problems and colds.
The key drivers were size and stimulation. Community homes had six or fewer people. Staff invited residents to plan meals and pick radio stations. Walls had bright posters and calendars.
How this fits with other research
Hassin-Herman et al. (1992) saw the same lift in skills six years earlier. Their small homes also beat big institutions. The pattern repeats.
McSweeney et al. (1993) looked closer and found a bump in problem behavior right after the move. The gains still came, but only after extra support. The two studies do not clash; they simply warn you to watch the first months.
Young (2006) followed adults for years and confirmed: scattered community houses beat cluster units. The benefit lasts.
Why it matters
If you help place adults with ID, push for small, lively homes. Ask for six or fewer roommates. Ask if staff let residents vote on dinner and pick weekend plans. These cheap tweaks raise skills and health without raising cost.
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02At a glance
03Original abstract
The present study examined whether characteristics of the environment of nursing homes and community-based residential settings are associated with the adaptive behaviour, health and community integration of adults with intellectual disability living in those settings. The specific characteristics of the environment were type of facility, size, level of residential involvement in policy-making, and the degree of variety and stimulation of the physical environment. The study assessed 249 residents with intellectual disability over a 3-year period who lived in nursing homes at baseline. At follow-up, 50 of the residents had moved to community-based facilities while 199 of the residents remained in nursing homes. The results indicated that type, size and characteristics of the environment were related to the level of adaptive behaviour and community integration at follow-up. Residents living in community-based settings had better health and greater levels of community integration than residents living in nursing homes. Residents living in smaller facilities had greater adaptive behaviour at follow-up than residents living in larger facilities. More variety and stimulation in the residential physical environment was associated with greater adaptive behaviour among residents at follow-up. Residential facilities that permitted greater resident involvement in policy-making, and had greater variety and stimulation in their physical environment were associated with greater levels of community integration among their residents at follow-up.
Journal of intellectual disability research : JIDR, 1998 · doi:10.1046/j.1365-2788.1998.00155.x