LeadingAge Magazine · March/April 2015 • Volume 05 • Number 02

Gardens Enhance Quality of Life, Therapeutic Opportunities in Senior Communities

March 01, 2015 | by Larry Beresford

Therapeutic gardens can be great additions to long-term care communities. Here is a look at how three providers have transformed ordinary spaces into beautiful places for residents to congregate.

Everyone knows that gardens and proximity to nature can be beautiful, calming, brimming with pleasing sights and smells. But can gardens become important elements of health care delivery and contribute to therapeutic goals? Can they meaningfully enhance quality of life for residents of eldercare communities? Three LeadingAge members say their onsite gardens are integral to the experience they offer to residents—even to the marketing of their services.

At Friendship Village of Schaumburg, Schaumburg, IL, the “Secret Garden” was an underutilized, enclosed courtyard that earned its moniker because no one seemed to know how to find the entrance. But after building a new entrance from the Willows Assisted Living Unit and removing some overshadowing trees and iron-contaminated soil, this L-shaped patio was transformed into a life-enhancing, much-frequented garden oasis for the unit, says Friendship Senior Options Foundation Manager Kate Garbarek. “Over three years, we raised $500,000 to reconstruct the Secret Garden. Now it’s hard to imagine life here without it. It’s a central part of our campus and one of our favorite places to engage our residents.”

Staff representing maintenance, marketing, activities, dining and nursing participated in planning with the landscape architect to maximize the garden’s functionality, Garbarek says. She convened focus groups of residents to gather their input.

The new garden, completed in September 2013, includes raised beds for residents to touch, feel and smell the plants as well as a rose-colored walking labyrinth and a trickling water fountain. Everything from the color of the concrete to the selection of patio furniture was specifically chosen to engage seniors with the outdoors, she says. Now they use it as a meeting place and bring family visitors out to enjoy it.

The garden has hosted ice cream socials on sunny days, cookouts, and a men’s pizza lunch, says Judy Petersen, the assisted living unit’s director. It is regularly used for exercise classes, parties, family functions and concerts.

“If residents go out there alone, staff will notice and bring them a bowl of ice cream—or, in winter, a cup of hot chocolate,” Petersen says. Nature can have a big impact on people, physically, socially and spiritually, she adds. “They feel more connected with each other and with nature. I just had a conversation with a resident, and it went down a spiritual path. I don’t know how to quantify that, but sometimes when you’re out in nature, it’s just good for the soul.”

It also helps that one of the main dining rooms overlooks the garden, Garbarek adds. “Residents in our independent living area sit against the windows now to look out and enjoy the garden, sometimes carrying their coffee or dessert outside for socialization. Others go out to water using the rain barrels whenever they see a plant needing a little extra hydration.”

Although there are few quantitative studies documenting the impact of gardens and access to nature on residents in long-term care, a growing body of evidence suggests that exposure to gardens can improve sleep, reduce agitation and enhance cognition in the elderly and in people with dementia. Gardens can reduce stress, anxiety and the need for pain medications while improving memory, attention and self-esteem—with few or no adverse side effects.

The first challenge facing providers who want to add therapeutic gardens is to find accessible outdoor space and then make it easy to get to, safe and inviting. For such an investment to pay off, residents should want to use it. Evidence-based design characteristics of therapeutic gardens identified by the American Horticultural Therapy Association include space for presentation of scheduled and programmed activities, features to improve accessibility, well-defined perimeters and easily recognizable garden patterns, and a profusion of plants and people/plant interactions.

Other considerations include the importance of both sun and shade, space for groups and privacy, considerations of safety and security for the residents, and design for easy maintenance. In long-term care settings, gardens can enhance social interaction; promote activity, exercise and physical health; provide multi-sensory stimulation and engage the brain. But the garden should be planned based on the activities that are likely to take place in this outdoor space.

Jeanne Mulley, dementia service manager for residents in early stages of dementia at St. Ann's Community at Cherry Ridge in Webster, NY, says, “When I started, this unit had an activity room, and off that room was a garden, which was small and circular with non-skid pavement. We worked with our foundation to identify an anonymous donor who could support the expense of turning it into a real garden. We hired a local landscaper who has designed gardens for hospitals. He brought a great vision for what was possible.”

The Rainier Grove Memory Garden is very pretty and used by residents year-round in pursuit of peace and tranquility, Mulley says. “Some residents play a role in the gardening, and our groundskeeper is very supportive of that. For things they make crafts-wise, like birdhouses or windsocks, residents can see the end product displayed in the garden. Families call our garden the dementia-free zone—you just go outside and enjoy some freedom. They are looking for plants that have fragrance and bloom at different times. We also have a bubbling boulder fountain surrounded by six river birch trees,” she says.

“In the springtime our first tulip blooms. After that, the garden has tomatoes, cucumbers, squash, and herbs, which we harvest in the fall. Some of the produce went into our Italian Week dishes this year,” Mulley says. The community’s activities therapist makes good use of the garden, which is visited every day by some residents. “It’s also one of the biggest factors when families are choosing a community for their loved one. It gives them peace of mind to know that the garden is secure. It enhances quality of life and allows residents to experience the same pleasures they had before they were institutionalized, offering healthy choices that don’t require the interventions of staff.”

The work of maintaining these gardens typically falls to the community’s maintenance or grounds staff, plus whatever help can be mobilized from residents or volunteers. Some residents who have fond memories of gardening may want to grab a shovel or a trowel and start digging, while beds raised to wheelchair level can enhance their participation. But more often residents just sit and enjoy the garden.

At Providence Benedictine Nursing Center in rural Mount Angel, OR, a grant from the Oregon Community Foundation supported a horticultural therapy intern to manage and maintain its therapeutic garden for 12 weeks last summer, but also to engage residents and their families in garden activities, events such as “Art in the Garden” and nature-based learning for staff on how to maximize use of the gardens.

The community hopes to establish a small endowment for a permanent horticultural therapy and garden maintenance program, says director of social services Melissa Kennelly, who is also a horticultural therapist. “The goal of horticultural therapy is to provide relevant, interesting, preferred activities for families and staff to use with residents that promote quality of life, well-being and socialization.”

Planning for the garden, in an under-utilized inner courtyard, dates back to 2004, recalls Polly Youngren, who was then assistant director of nurses and had recently completed a horticultural therapy course. “We hired a landscape architect and held three planning meetings, inviting residents, families and staff to participate.” The garden opened in 2006, designed with a continuous curving walkway, flowers planted for year-round blooming, birdfeeders and a roofed structure.

It has become a feature that gets used by the community a lot, says Susan Gallagher, director of the Providence Benedictine Nursing Center Foundation. “It has totally changed how we think of our community. We had a younger resident who was told that she needed to go to a nursing home because there could be no weight-bearing on her leg for ten weeks. ‘I was afraid to go to the nursing home,’ she said. ‘But I love your garden. It has kept me sane.’”

Plants can be a conversation starter, Gallagher adds. “Grandma can talk about her red tulips or tell her grandchildren, ‘I had Lamb’s Ears in my yard at home.’ We plant tomatoes, strawberries, blueberries. You can pick them off the vine. This is their home; residents should be able to take visitors into their back yard. Staff, too, have had a positive response to the garden, and the other units started saying, ‘We want our own garden.’”

Therapists use the garden when working with patients on the skilled unit, says Emily Dazey, the center’s director. “We specifically widened the walkways, added hand railings and put in a small gravel pathway so that physical therapists can walk with people on different kinds of surfaces. Occupational therapy can work with people digging in our raised beds,” she explains. “The senses are stimulated … touch, smell, the sound of the water feature. We do specific life enrichment programs in the garden, but lots of spontaneous things also go on there as well.”

Dazey says quantifiable outcomes for garden therapy would be hard to come by, “although we receive comment after comment on our satisfaction surveys about how important the garden was to people, for providing a quiet place alone, a beautiful place to connect with others, and many other reasons unique to each individual. We are a teaching nursing home, and we’d love to do research with our garden program. For example, we know that some activities or applications work better than others. We’d like to have a grant to study that,” she says.

“I don’t know how we managed to provide as meaningful an experience for our people without the gardens. The main garden has become so lush and beautiful. Each time I’m out there, I am reminded that this truly is a creation of our supportive community.”