We had a question that needed an answer: “Why don’t care homes use their gardens more?” As Garden Designers, we want to make sure that our Clients have a garden that they will cherish and use to the full. We felt it was important to find out why some designed outdoor spaces around care homes were still not being used, and after a lot of money had been spent on them and they had followed current design guidance.
This felt wrong to us so we set up a Dementia Gardens Research Project in 2013 to answer this question. We asked the care sector if they would like to help and 50 care homes across the UK responded. Seventeen of them across England and Wales participated in the project last year. We asked them to keep detailed diary records of the interactions their residents living with dementia made in the garden and we also made observations of our own during 20 site visits to a representative group of seven of the care homes.
In total, we collected almost 1500 pieces of information about the ways that care home staff and residents with dementia used their outdoor spaces.
We then spent three months analysing and reviewing all the data we had gathered. We not only found the answer we were looking for, we also put together a lot of information about what residents with dementia liked to do in the garden, the plants they like to interact with, a range of garden layouts and features that help or hinder getting outside easily, the techniques staff use to encourage meaningful interactions with the outside and the procedures that different homes have in place to help residents cross the threshold and spend quality time in their garden.
Early in the Research project, it became clear that the culture of the organisation was more important in determining the quality of the interactions with the outside than the design of the garden. We found that it was the people and not the garden itself that influenced how active and meaningful the garden would be for the residents. During our observational visits we spent as much time looking at the internal workings and practices of the home as we did outside.
Something else emerged too. Because we had a large sample of homes in our study, we could also see very different approaches to health and safety, activity provision and management culture. When we plotted our findings onto a Map, we started to see an important correlation. The homes that we identified as being further along the journey towards relationship-centred care (i.e. demonstrated that they understood and responded to the individual needs and abilities of their residents) had a much more integrated relationship with their outdoor spaces. The gardens were well used and regularly accessed, it was easier for residents to go outside, residents were actively encouraged to go outside spontaneously, carers and members of staff facilitated the visit outdoors well, and the homes were keen to experiment and try new approaches and features in the garden.
Those homes that had a fearful attitude towards Health & Safety tended not to be using their outdoor spaces to the optimal level for their residents. It was more difficult to spontaneously access the outdoors, staff lacked confidence in the outdoor environment and the homes were generally unprepared for interactions with the outdoor space.