‘Why aren’t care home gardens used more actively?’ by Step Change Design

17th February 2017

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In this series of five articles, Mark Rendell and Debbie Carroll, garden designers and consultants at Step Change Design Ltd., describe the research they carried out and its subsequent effects on their own practice as garden designers and on the way their findings are helping care settings and designers to engage residents more meaningfully and sustainably with their outside spaces.

This was the deceptively simple question that we asked ourselves back in 2013. We both have an interest in the therapeutic value of outside spaces and have created a number of gardens for health, care and educational settings before we joined forces four years ago to carry out a small scale, self-funded research project.

Little did we know then that the trail to answering this question would lead us deep into the care practices of the care homes in our research project and force us to confront some deeply held beliefs and assumptions about our work as designers. Let’s track back to the time when we realised that something might be amiss in the relationship between designer and care setting.

We had become aware that some newly designed gardens around care settings were no longer being used by the homes’ staff and residents, even when they met the latest design guidance. We wondered why, particularly as a brand new garden is likely to be a significant investment by the care setting. To end up with a new garden that is not used any more than the one it replaced could rightly be interpreted as a waste of money.

For us, this was an unacceptable situation and we wanted to find out why this was happening. We were concerned that we (and our peers in the design sector) were missing something important about our design practice that in some way affected the home’s ability to use the new features and layout in the garden. We began to wonder if the guidance we work to was overlooking a key insight or factor that related to the way residents (particularly those living with a dementia) actually engage with their outside spaces.

We turned to the most relevant and, for us, resonant, design thinking on this topic for guidance. Garuth Chalfont’s book ‘Design for Nature in Dementia Care’ (Chalfont, 2008, Bradford University) shared the insights of a designer who ensured the resident was kept at the heart of any changes to the garden. He also called for more research to really understand the underlying dynamics between the garden and the garden visitor living with a dementia.

We responded to this call and developed our research methodology along the lines of his suggestion to use Environment Behaviour Studies (EBS), a data gathering format that simply involves people observing people interacting in the space.  

Our modest aims to recruit six care homes grew into a much larger study. Helped by Sylvie Silver at NAPA, 24 care homes joined the project, with 17 remaining to the end. We collected 600 completed diary sheets from these homes and made another 874 observations of our own during visits to 7 of the homes. We had many inspiring and illuminating experiences during the research project and particularly during our site visits that led us from the garden areas (where we thought the answer to our question would lie) back inside the care settings themselves. We found ourselves drawing on our management backgrounds to look more closely at the care practices, procedures, attitudes and approaches in the settings themselves and discovered three key findings as a result:

  1. There is a correlation between advanced care culture practices (i.e relationship-centred care) and active engagement with the outside space, regardless of the condition or design of the space,
  2. Fearful attitudes towards Health and Safety effectively cap engagement levels with the outdoors,
  3. The support of an outside specialist (e.g. a garden designer) needs to match and support the current care culture of the care setting to avoid overdesigning the space or risking the investment becoming a waste of money.

To find out more about Step Change Design, visit their website. Keep an eye out for their next blog in the series.

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