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In Japan, improvement in the care for institutionalized patients with severe motor and intellectual disabilities (SMID) has resulted in improved prognosis compared with previous decades, leading to difficulty in entering institutions because of the limited capacity. In recent years, new SMID patients discharged mostly from neonatal intensive care units receive care in their parents' homes rather than in institutions. In order to effect this change, an assessment of patient care in both an institutional and home environment is of utmost importance.We performed a minute-by-minute time study of the work of staff members (n = 31) in a ward in an institution for SMID (31 patients with no ventilators) over 48 h in order to reconstruct patient care.Significant differences were found between the entirely immobile group (n = 15) and semi-mobile group (n = 13) in the area of total care time (124.6 vs 83.4 min/day, respectively, P = 0.003) and non-medical care time (99.1 vs 69.0 min/day, P = 0.003). Nurses (16 in total) did twice as many tasks as other staff members in the areas of medical care and general care management. The number of tasks was the same for nurses and other staff members in the areas of non-medical care and social participation/others.Patient care undertaken by medical professionals in the areas of both ordinary care as well as medical care seemed to have contributed to improved prognosis in SMID patients. This study demonstrates the essential nature of nursing care for SMID patients living in institutions and at home.