Designing Environments for Memory Care Residents: Part 3
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woman in wheelchair looking at field and trees
Incorporating memory care gardens in retirement communities, adult day health, and rehabilitation facilities is an emerging trend seen throughout the United States, Canada, and the United Kingdom. These specialized gardens are purposefully designed to support the physical, psychological, and emotional well-being of residents and patients afflicted with various forms of dementia.
Large windows in the common spaces at Riverview Retirement’s memory care facility, people at tables by the windows
Large windows in the common spaces at Riverview Retirement’s memory care facility not only increase daylighting, but provide unobstructed views to an interior garden that both residents and staff regularly enjoy. - NAC Architecture
Across the country, memory care gardens are becoming an accepted industry standard when planning new retirement facilities or retrofitting existing ones. Some of this growth is driven by consumer demand, but more frequently the underlying reason for incorporating memory care gardens stems from empirical research that supports their inherent value. If designed correctly, these gardens can increase social interaction, enhance spatial orientation, and can help regulate the hormones that affect sleep patterns, while decreasing incidents of agitation, wandering, and aggression. The power of exposure to nature to affect both the physical and emotional wellbeing of an individual is immense.
Physical Wellbeing through Visual Exposure to Nature
Research repeatedly corroborates the benefit of exposing residents, patients, families, and staff to nature. Exposure can be as simple as a view through a window to a rolling, green hillside, or a small rooftop garden. It can be an interior gardenscape with a profusion of lush vegetation or immersion in an outdoor courtyard. In 1984, Dr. Roger Ulrich published the first empirical study in Science Magazine that demonstrated the value of access to nature. His study found that post-op surgical patients with views of nature from their hospital room had shorter inpatient stays and required less potent analgesics for pain control. Other empirical research reveals that people exposed to nature have lower blood pressure and heart rate responses, along with reduced levels of cortisol—a hormone released in stressful situations. More than three decades after Ulrich’s seminal work was published, studies continue to support his findings and build on this body of data.
Physical Wellbeing through Physical Exposure to Nature
Allowing residents to access healing gardens and engage in outdoor activities has proven to improve overall health, and can help balance hormones that produce better sleep. 1 According to The Alzheimer’s Society, gardening activities help improve bone density; decrease falls and injuries; and increase attention span, mobility, and dexterity. Outdoor gardens can provide that “never-ending walking path” which the resident can continue to walk to their heart's content, and it is a great source of exercise. The garden also offers passive engagement and access to natural distractions like lush plantings, fragrance, color, sound, and tactile experiences.
Outdoor seating, walking paths, raised planter beds, and birdhouses provide a variety of passive and active ways for residents at the Providence Adult Day Health Memory Garden to enjoy nature.
Outdoor seating, walking paths, raised planter beds, and birdhouses provide a variety of passive and active ways for clients at the Providence Adult Day Health Memory Garden to enjoy nature. Image courtesy of SPVV Landscape Architects
Being outdoors engages all the senses and provides the vitamin D and melatonin needed for a good night’s rest; there is growing evidence that exposure to bright light may improve circadian rhythms, which are signaled by melatonin. 2 Daylight is known to enhance melatonin levels, which decrease with age. Numerous studies suggest a 1-2 hour daily exposure to bright light results in improved sleep.
Emotional Wellbeing: Reduced Agitation
Few people would dispute that memory care settings are some of the more stressful environments encountered within the retirement community structure. Residents often experience confusion, disorientation, and agitation that can manifest in a multitude of ways including: wandering, impulsive vocalization, combativeness, withdrawal, and isolation. The healing garden becomes a place of respite; where residents can immerse in a soothing, stress-free environment.
Imagine the garden as a sanctuary created for restoration. Each interaction with nature holds the power to evoke long-term memories stored in the cortex and hippocampus areas of the brain. At The Village at Orchard Ridge, an assisted living and memory care community located in Coeur d’Alene Idaho, two such examples occurred shortly after the dedication of the facility’s Serenity Garden in 2007. Staff shared the experience of one of their residents who only uttered the words “Ba! Ba!” for the past two years. When she wandered the new garden, she suddenly began pointing at flowers and reminiscing about tending the garden with her mother when she was a little girl. Another example resulted in de-escalation of aggression when two ladies were combative, literally coming to blows with one another. Staff escorted both ladies into the garden. By the time they had traversed the looping path, they were holding hands. Clearly the garden was instrumental in tapping long-term memories for one resident; while de-escalating aggression and potential violence for the other two residents.
Emotional Wellbeing: Social Interaction
A well-designed memory care garden provides opportunities for safe, supportive movement, as well as social interaction with family, staff, or other residents. People generally experience greater happiness and a deeper sense of belonging on days when they interact with others. Memory care gardens can provide that, since these gardens offer many topics for residents to start up conversations as they see flowers or hear birds.
Women in wheelchair accompanied by a man in the Orchard Ridge Serenity Garden
A successful memory care garden should feature an appropriate balance of hardscape and vegetation that provides opportunities for movement, encourages social interaction, and engages the senses. The Village at Orchard Ridge Serenity Garden; image courtesy of SPVV Landscape Architects
Whether as a safe place for personal respite or as a setting for social support, memory care gardens foster a sense of self worth and involvement. We know residents, families, and staff report a greater perceived sense of satisfaction when offered access to healing and therapeutic gardens. This data should be of particular interest to caregivers, administrators and CFO’s. When residents maintain a higher level of comfort, satisfaction, and require less medication—and when nursing staff is content and deliver better quality care with less staff turnover—this translates to real monetary savings.
Designing the Garden
An effective memory care garden does not have to be elaborate, large, or expensive. A successful garden will provide opportunities for movement, exercise, social interaction, programmed activities, and even therapeutic treatment. This may take the form of looping pathways, purposely designed ramps, larger spaces for gathering, and fully accessible vertical and raised bed planters for residents requiring the use of wheelchairs and walkers. Water features provide a beautiful visual distraction and can be as simple as a small bubbler fountain, or as elaborate as stream beds and cascading waterfalls. For safety, it is best to provide views to a water feature rather than direct physical access in memory care environments.
Most importantly, an effective garden consists of approximately 25 percent hardscape and 75 percent abundant vegetation designed to engage the senses. Plant material should be non-poisonous/non-toxic, colorful, seasonal, have texture and form. The plant palette should provide visual and tactile interest that compels people to touch and engage. It should provide soothing sounds as leaves and ornamental grasses rustle in the breeze, and fragrances that remind residents of a distant memory.
Three decades of research support the value of healing gardens to a person’s physical, emotional and cognitive well-being. Memory care gardens are relatively new to the Inland Northwest, but they are found in abundance nationwide in all types of retirement, adult day health, and rehabilitative settings. Purposely designed memory care gardens in our region include: Rockwood Retirement South Hill, Riverview Retirement Community, The Village at Orchard Ridge, Providence Adult Day Health, and the Walla Walla Veterans Home.
Successful healing gardens result from a collaborative design effort between the architect, a landscape architect with healthcare experience, clinical, and facilities staff. Only then can we realize the fullest potential for the garden to meet the needs of people struggling with dementia.
Stay tuned for her next installment where Jill explores more ways architecture can provide a meaningful impact on the lives of individuals suffering from dementia. If you missed her previous articles, you can read them here:
Designing for Memory Care: Part 1
Designing for Memory Care: Part 2
1 Wolf, K.L., S. Krueger, and K. Flora. 2014. Healing and Therapy - A Literature Review. In: Green Cities: Good Health ( School of Environmental and Forest Resources, College of the Environment, University of Washington.
2 Margaret Calkins PhD, Joseph G. Szmerekovsky PhD & Stacey Biddle COTA/L (2007) Effect of Increased Time Spent Outdoors on Individuals with Dementia Residing in Nursing Homes, Journal of Housing For the Elderly, 21:3-4, 211-228, DOI: 10.1300/J081v21n03_11