Care-Roadshow

‘Don’t let a beautiful day go to waste’: spending more time outside by Step Change Design

8th May 2017

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In this final article in the series, Debbie and Mark from Step Change Design Ltd. share some ideas and insights they gained from their large-scale, self-funded research project to help residents and staff quickly and easily tap into the amazing resource that is the outside space around most care settings.

We have been on an amazing journey. As designers with little prior experience of care settings before we set out on our research project, we now have a whole range of insights that help us to assess where the care settings we work with might be located on the care culture spectrum we created and how to help them move forward on their culture change journey and so increase engagement with the outside.  Let’s take a look at a few tips and insights from our research that can result in significant shifts in how often and how well you use your outside space with your residents.

If your residents can’t see the garden, how do they know it is there?

Room layouts can be a helpful clue about the type of care culture in operation and can reveal a lot of information about the subconscious attitudes and practices of the staff and residents, particularly in relation to the outdoors. For example, chairs facing away from or blocking an exit into the garden suggests a care setting that has turned its back on the outside space. An activities manager told us during a site visit that the garden was always well looked after and there was much to see and do outside and yet, despite her encouragement to staff to go outdoors with residents, the garden was rarely used.

The dining table was placed across the French windows and the other chairs were arranged inwards facing the large screen TV. We felt there was no connection to the views outside from this ground floor household and so we proposed a small experiment: to move the dining table to the back of the room and arrange a number of chairs to look out of the French windows towards the garden. Within 48 hours we learned that this had resulted in more spontaneous engagement with the outdoors by residents, most of whom were living with dementia. Some went outside unprompted, others were talking to each other, there were also positive examples of improved eating, sleeping and preparation for bed.

‘Activity breeds activity’

One easy way to activate the outside space for residents is to simply do more in the garden. During our research visits, we were often joined in the garden by residents who had seen us from indoors. We also noticed one member of staff who understood the power of drawing residents outside if he went outside first. He would often complete his notes at the end of his shift on the patio outside. On the day we visited his care setting, he was quickly joined by residents who wanted to find out what he was doing or to simply keep him company. He acted as an invitation to go outside, and consequently drew many residents outdoors that day.

Grasp the moment: open the doors and go outside!

Care cultures are made up of the many procedures and policies that describe how something should be done, why it needs to be done and by whom. These may have been in place for a long time and may never have been reviewed. Addressing culture change in any organisation will require revisiting what you do, and what you say you do, and ensuring this is in line with best practice.  

One area we encountered that differed widely between policy and practice was the Open Door Policy. In homes with an Open Door policy, we came across elaborate alarm systems, a single key holder, painted over door frames (so they could no longer be opened) and some staff who didn’t know which doors were open (or could be) and which were not.

This Policy affects the ability of the residents and staff to be able to easily access their garden. How straightforward is your Open Door Policy? How well is it followed by staff? Test it out. If you don’t know, then chances are that residents and staff don’t either. The aim should be to keep the Open Door Policy simple and easy to follow making it as easy as possible to respond to spontaneous visits to the outside. Have coats and hats handy, cushions and umbrellas if necessary, all to help enable and extend a visit to the garden.

A Handy Checklist

We created a Checklist Tool to help care settings and designers ‘sense check’ new features, activities and objects being considered for the garden. We wanted to remind both parties not to be ‘blinded by the bling’: filling the outside space with lots of features and objects in the hope that they will stimulate the garden visitor but that can actually end up confusing or disturbing the residents’ understanding and interpretation of the garden.

The Checklist is made up of four questions to ensure that what is planned for the garden will be of relevance and meaning to the current residents, will avoid introducing ‘gimmicks’ and infantilising them or their experiences in the garden, and will not hinder future development of the space:

  1. Is it purposeful? By this, we mean, is there a point to doing the task? Does it aid the wider community or home in some positive way? Is it something that needs to be done? Will it make a difference to the space or people’s enjoyment in it?
  2. Is it realistic and in context? By this we mean, is this activity or feature likely to take place or be found here? Are you using the actual or appropriate items for the task (including tools and equipment)? Do they look like the real thing? Are they actual items that an adult would use in this space?
  3. Is it meaningful or relevant (to the resident and locality)? Based on what you know about the resident, will this be an enjoyable task for them? Will it bring them pleasure, accomplishment or meaning? Is it something that would be familiar to residents in this region or neighbourhood? Will it aid a sense of connection or identity for the resident?
  4. How can this activity/feature be sequenced (built on)? What spin-off activities might this lead to (for the resident or the wider home)? How can this task lead to other related activities? What might lead up to or lead from this activity that prolongs and deepens the meaningful occupation of it for that individual or for others?

Looking back, we were fortunate in our research to have worked with a very diverse range of care settings. This led us on a powerfully transformational journey as designers and forced us to look afresh at our practices. Our work at Step Change Design aims to help the care setting look with fresh eyes at their subconscious attitudes and beliefs and subtle habits and practices to overcome the hindrances and obstacles that may be preventing your residents from engaging with their garden as and when they wish to.

We include many more handy tips and insights into using the outdoors more actively on our website: www.stepchange-design.co.uk

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