Redesigning Rooms of Clients With Intellectual Disabilities and Severe Behavioral Problems in a Long-term Care Facility: Three Case Studies

Abstract To observe changes in three clients with intellectual disabilities and severe behavioral problems and staff in a long-term care residential facility after redesigning the clients’ rooms by making them more personal and homely, adjusting the amount of stimuli, changing the layout, connecting to the outdoor area, and using high-quality natural materials. Relatively many clients with intellectual disabilities exhibit severe problem behaviors, including self-harm, aggression toward others, and repeated destruction of their own rooms, which can eventually result in a barren, inhumane living environment. Research on these clients is limited. Data were collected in a mixed methods study in which quantitative and qualitative data were analyzed. After the redesigns, positive changes were observed in the well-being and behavior of all three clients, for example, with respect to quality of life, privacy, freedom of choice, problem behavior, mood, cognition, activities of daily living, leisure activities, social behavior, self-harm, and constraints. There were no changes in the use of psychotropic medication. Quality of life scores increased in two cases, but were significant in only one. Emotional and behavioral problem scores decreased significantly in two cases, but in only one case these results were maintained at follow-up. Staff experienced a more pleasant, safe, and functional work environment, with improved provision of indicated care and interaction. Absenteeism decreased significantly in two of the three cases. Redesigning clients’ rooms could potentially be a promising intervention for clients with intellectual disabilities and severe chronic behavioral problems.