Appendix B:  Current Trends and Best Practices

The following is a brief summary of the current trends and best practices: [26]

• Residential care for individuals with intellectual and developmental disabilities has shifted toward person-directed planning, community integration, independence, self-determination, and housing individuals in the least restrictive environment possible.
• Across the United States, there has been a concerted effort, beginning in the late 1970s, to transition individuals with IDD from large state-run institutions into smaller community group homes. States have been working to downsize large institutional campuses, replacing aging infrastructure with smaller, more dispersed community homes. This shift is supported by an increase in community-based programs and supportive housing to ensure successful transitions into de-institutionalized community homes.
• A key trend in non-institutional therapeutic environments is the concept of the building and site working together to form a “therapeutic platform” in which the interior space and exterior landscape are viewed as equal contributors to a healthy living environment.
• Evidence-based design supports the importance of physical and visual connections to the landscape as a means to reduce stress, anxiety, and agitation, and to provide a positive outlet for energy. In addition to improving well-being, outdoor spaces should be active participants in therapy. Outdoor spaces can be developed as restorative gardens for sensory stimulation, horticulture therapies, and recreational therapy. Outdoor spaces that are both passive and active should be provided to accommodate the variety of resident needs. Active spaces improve fitness and provide positive outlets for energy. Studies have shown the importance of physical activity for individuals with developmental disabilities as it affects balance, muscle strength, and quality of life.
• Natural daylight and views, shown to reduce stress, anxiety, and depression, should be provided in not only the residential areas, but also in staff work areas. Natural daylight and views to the landscape assist in intuitive wayfinding. Signage should be a last resort for wayfinding. Views to the landscape can create landmarks for individuals that help one navigate through a facility. The ability to see outside, to see what the weather is like, or what time of day it is creates a “grounding effect” for residents and staff. This is of particular importance for residents who may not be able to physically go outside, and for staff who may work long shifts indoors throughout the day.
• In addition to views to the landscape, additional interior devices beyond signage should be provided to assist in wayfinding. Landmarks and reference points should be provided throughout main circulation paths and the use of color and personalization of spaces can help residents of all different cognitive functioning levels navigate throughout a facility. Double-loaded corridors with no views to landmarks or the landscape have been shown to be disorienting for people to navigate.
• The trend toward deinstitutionalization of the residential care environment is being supported by smaller resident groupings and households. The national average for small group homes for individuals with intellectual and developmental disabilities is six residents per household. In addition to smaller households, facilities are being built with residential materials, such as wood and carpet, and with better acoustics to mitigate noise. All resident daily living activities occur within the resident households, such as dining.
• Facilities for individuals with developmental disabilities should be accessible throughout for mobility and varying cognitive functioning. Flooring transitions should be seamless throughout and technology, such as automatic door openers, should be leveraged to provide further assistance. Ample space should be provided for turning radiuses of wheelchairs and other larger assistive devices. Material selection and lighting should be cognizant of individuals with visual impairments through contrast between flooring and wall materials, non-glare surfaces and lighting, avoiding high contrast patterning that can be visually disorienting to individuals.
• Trends in resident bedrooms emphasize resident dignity and privacy through providing private bedrooms or semi-private bedrooms that offer a full height wall partition for separation. In both options, private ensuite bathrooms should be provided. Private bedrooms have been shown to improve resident sleep through fewer disruptions; increase occupancy rates through fewer roommate issues; and to lower infection rates. Some senior residents and residents with intellectual and developmental disabilities benefit from having a roommate. A combination of single rooms and double rooms should be considered for this resident population.  For residents with complex behavioral needs and/or who have court-commitments, private bedrooms are considered best practice.
• Evidence-based studies indicate that environmental factors positively affect resident participation.  Environmental factors such as opportunities to make choices, environmental variety and stimulation, family involvement, assistive technologies, and positive staff attitudes have all shown to improve resident participation in activities and therapies. It is important to note that studies have also shown that smaller residential environments also improved resident participation, but larger residential environments with the appropriate amount of variety and choice showed similar positive results.

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Footnotes

26. Ten-Year Plan for the Provision of Services to Individuals Served by State Supported Living Centers, CannonDesign, September 2014, pg. 75.

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Updated: August 16, 2017