In 2012, the Japanese government revised the Child Welfare Act to improve support for children with severe disabilities. Previously, inpatient facilities were classified according to type of disability. However, after the law’s revision, these facilities were merged into the category of “medical-type facilities for children with disabilities”. Such facilities must adhere to standards for number of staff, room types, and room sizes, but not for floor plan or layout. Further, the facilities have not performed adequate verification for changes in facility usage and requirements.
This study aimed to verify the usefulness of the new layout at Center K after its transition from a facility for children with motional disabilities to a medical-type facility for children with disabilities. We investigated the following four aspects:
1) Children’s attributes in both facility types.
2) Children’s usage rate of locations by day (weekday vs. weekend), season, and unit.
3) Nurses’ and nursing teachers’ nursing actions and usage rate of locations.
4) Behavioral changes in children who were transferred from the old to the new facility type.
We selected Center K as the site for this case study. At the center, a new medical-type facility for children with disabilities was built in 2016 near the older facility for children with motional disabilities. We performed field research at the center before and after the transition in 2015 and 2016, respectively.
1) We recorded the size, position, and orientation of furniture and beds in each facility type.
2) We collected resident demographics such as age, gender, and primary diagnosis and severity.
3) We observed and recorded locations, behaviors, and postures of nurses, doctors, nursery teachers, children, and families on a floor map by using a tablet computer.
We evaluated the usefulness of three planning proposals by analyzing four items: children’s attributes, children’s usage rate of locations, nurses’ and nursing teachers’ nursing actions and usage rate of locations, and behavioral changes of residents who were transferred from the old to the new facility type.
1) Unit configuration
A 3-unit configuration based on severity was proposed for the new facility. However, this was modified to the following 3 units based on severity and gender: highest severity, boys, and girls. Although this differs from the proposal, it shows the usefulness of a 3-unit configuration. Staff members belonged to a single team for all units and were not divided by unit. It will be necessary to reconsider the location of the staff stations and dispersed functions.
2) Room configuration
As the children had more severe conditions and an increased prevalence of severe motor and intellectual disabilities in the new facility compared with the old facility, bedroom occupancy in the new facility was higher. In addition, the number of children with infectious diseases increased, so bedroom occupancy increased significantly in order to protect children with a high risk of infection in common spaces. This increasing bedroom occupancy in the new facility shows the usefulness of the proposed room configuration and room facilities. However, no children’s activities used the living space in the quad room.
3) Community space configuration
The usage rate of the dining space in the new facility was higher than before. It seems to be the reason that it is located inside the ward, rather than outside as it had been in the old facility. One child with less severe mobility disabilities could walk over a wider area in the new facility, assisted by the distributed layout of the day space, dining space, and play spaces. This case serves as an example of the usefulness of integrated community space.