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Our Interaction with Nature Doesn't End When We Age

Senior care facility, Phoenix, AZ / Dr. Lori Reynolds

When an older person loses their cognitive and motor functions, how do they maintain a connection to nature? This is the central question for Dr. Lori Reynolds, a clinical professor of occupational therapy, and landscape architect Brad Smith, ASLA. For a senior care facility in Phoenix, Arizona, with some 80 beds for assisted living and 30 for memory care, which involves helping those with advanced neuro-cognitive disorders, Reynolds and Smith together came up with new approaches to redo their courtyard in order to better maintain that connection. At the Environments for Aging conference in Las Vegas, they presented two options — one geared towards the assisted living residents and one for the memory care residents.

Reynolds made the case for investing in gardens in senior care facilities. "For 100 percent of older adults, nature is important." As Jack Carman, FASLA, a landscape architect who works on senior care facilities, said: "our interaction with nature doesn't end when we age."

Reynolds found studies that show "access to nature increases resident satisfaction. And residents are most satisfied when there is ample seating, a variety of nature elements, walking paths, and adequate shade."

Furthermore, the presence of a garden in a senior care facility influences those family members making the decision about where to put their parent or grandparent. "Nearly 50 percent report the availability of a garden influenced facility choice."

Other surveys show that "outdoor activity space is among the top desired features," and "the second-most-important feature after the location." So, if gardens make residents and families happy, and happy residents recommend a facility to others than functional garden spaces seem like a no-brainer.

After explaining the many physiological benefits of nature for all people, she focused in on the benefits for those in memory care, explaining how exposure to nature can "reduce agitation and aggression among Alzheimer's patients." For these patients, "plants can become like people." They are a presence that can take on "significant meaning," Reynolds explained. Plants can also represent a legacy: A plant that has been in someone's life for many years "is a past-life experience, and adds coherence." The plant of a loved-one who has passed away can help sustain the memory of that person.

Facilities can design ways to maintain this elemental connection — for both those who still have an active relationship with nature and those with a mostly passive relationship. For those able, an active relationship, which involves going out and spending time in the garden, is preferable. For those who cannot, a view out a window of a garden or even indoor potted plants are important. For some, "engagement outdoors may be too difficult — it may be too windy or too far from the bathroom." But still, this doesn't mean that accessible, aesthetically pleasing gardens should be jettisoned from budgets.

The current state of garden design for senior care facilities is more focused on the internal than the external, "despite the acknowledged value of these outdoor spaces," Reynolds said. If there are outdoor spaces, they are too often ornamental, not functional. More need to be accessible and provide healthy doses of nature.

To that end, Brad Smith worked with Reynolds and a senior care facility in Phoenix, Arizona, which they prefer to leave anonymous, to create garden designs that enable both more active and passive interactions with nature in an interior courtyard (see image at top). There are opportunities for transforming the space, which has a required access lane for a fire truck, into a more dynamic, therapeutic place that enables "inside out and outside in" connections.

The option geared more towards assisted living patients, offers a meandering path, an expanded covered patio and outdoor seating areas with rocking chairs, and a water feature surrounded by trees and plants. There are also bird and butterfly feeders patients can bring nectar and seeds to. For this option, Smith envisions caregivers bringing out wheelchair-bound residents so they can enjoy classes in the morning or early evening when it's cooler.

For the variation designed for memory care residents, there are "vignettes designed to spark connections to the past." Smith proposes making the space "as familiar as a backyard," by designing a space for clothes lines and a gardening shed. "Women of a certain generation spent much of their time drying clothes; just letting memory care patients hang stuff up may make them feel better." There's already an old 1940s-era car parked in the courtyard, which he imagines male residents enjoy seeing and exploring. A loop walking path, like the one in the memory garden in Portland, Oregon, would enable a safe place for pacing. And the space is also designed to provide pleasing views from inside the memory care residences of soothing water features.

With memory care, Reynolds said facility owners should use light furniture that's easy for caregivers to move around. Also, pergolas should be avoided, as they throw shadows that will "wig out" residents. In Phoenix, the gardens will be really hot much of the day with lots of glare, so use would be limited to mornings or evenings.

Smith and Reynolds estimated the senior care residence had spent about $57,000 on what they have now, which doesn't do much. For $155,000 they could have the assisted living landscape, or for $96,000, the one for memory care. For just a little bit more, "they could have a killer garden space that boost marketing, creates positive first impressions and a sense of perceived value," Smith explained, while also providing many of the health benefits of nature. Bringing in volunteers — local Habitat for Humanity or other groups — to help plant could further reduce the costs. But they also noted a need for a maintenance budget up front.