LJN Blog Posts

 "Why don't we go into the garden?"

(3 November 2014)

Our reseach into why care homes don't use their gardens more, even when designed to latest guidance, for people with dementia was at last completed last summer and our findings have now been completed and a diagnostic tool to support both the Care industry and Design sector has been developed.

The original intention was to identify what design aspects were not working and what was needed to ensure gardens were fully used and monies were well spent and most importantly that Residents who wished to could actively engage with the outdoors. Our journey took us on a completely unexpected route as we quickly realised that the design was not the key to the success but that it was about the people who made the interactions happen that mattered. We crossed the threshold into the care homes themselves to better understand what was at work.

We ended up with a large scale project and gathered nearly 1500 of interactions with the outside by residents with the outdoors. We identified that the most active gardens were directly correlated to how relationship-centred the care was and that the level of fear associated with Health and safety would also cap interactions.

Where gardens were designed beyond a homes cultural position on a spectrum towards relationship-centred care there was a greater likelihood that the garden would fall out of use after the initial novelty has worn off and that the level of use would return to that matching their cultural position before the new garden was installed. Our diagnostic tool can assist in understanding the cultural position of a home and understanding the type of support a designer can provide to ensure it is effective as a home grows in its use of the outdoors.

To find out more about our findings and intended work to share this as widely as we can to benefit people in care to access the outdoors more visit our new website. Our aim is to turn our original question "Why don't we go into the garden?" into an invite.  If you would be interested in future workshops on these findings then feel free to complete the contact form to join our mailing list. www.stepchange-design.co.uk

Government announce funding to enhance environments for those with demenita

(25 July 2013)

Governement support to improve environments for those with demenia has been announced following trial projects via the Kings Fund see https://www.gov.uk/government/news/launch-of-pioneering-dementia-care-pilot-projects . I am currently working on two hospital gardens benefiting from this funding. One of which was part of the original scheme and has redesigned thier main wards.

The Dementia research project currently being carried out by Mark Rendell and I is now half way through looking into understanging how to ensure gardens are an active space when the designer leaves. We have had over 400 interactions recorded so far and carried out 9 of the intended 21 detailed visits to care homes across the UK. Some funding from John Lewis has enabled the purchasing of some garden items to test some further theories unfolding from this work. The detailed data gathering phase will be complete by the middle of September with outcomes identified and shared later in the year.

(22 April 2013)

Following links made via NAPA (National association for Providers of Activities for Older People) we were inundated with 50 care homes enquiring about our study. From this 24 have been selected to take part in our study by compiling diaries through the summer on interactions with their outside space. 7 homes have been chosen to take part in detailed observational visits across the summer by the Designers and to test out which elements in a garden give the most positive benefits to those living with dementia.

The attached press release has been issued enabling those who want to know more to get in touch or to be kept informed as the project unfolds between May-September.

EffectiveGardensMEDIA%20RELEASE1Apr13.pdf

(17 January 2013)

We are now seeking Care homes or hospitals with a range of outdoor space to be part of our wider study to run from May to August this year. This builds on work trialled last year. An article will appear in the NAPA (National association for Providers of Activities for Older People) magazine issued to many Care homes across the UK to locate interested locations for two studies.

15+ homes are sought to carry out a simple diary/journal based study on how their outdoor space is currently used by those with dementia and the interactions identified. A further 6 homes are wanted for a more detailed observation based Environmental-behavioural study involving 3 visits by the Designers across the summer. 

Locations interested in taking part should contact either of the Designers for more details and detailed packs will be issued at the end of February for those taking part.

Debbie Carroll Garden Designs www.dcgardendesigns.co.uk

Mark Rendell, The Growing Company www.thegrowingcompany.co.uk

(16 December 2012)

In September I, Mark unfortunately got stranded behind floods, attended a workshop held by NAPA (National association for Providers of Activities for Older People). This small charity packs a mighty punch as it supports care home organisations and is currently advising Government on how activities form an integral part of the care package.

 Their whole ethos sits with the growing move to Person centred care and away from larger group activities to a more tailored, individual activity mix that also supports wider medical needs. This workshop sat well with the project we began this year and has focused our minds to developing our plans to take our project forward on a larger scale and ultimately share the results in 2013. 

 In particular we will be looking for Care homes who look after those with Dementia and have an outside space, designed or not, to help us progress the research part of our project. Attached is an introduction page covering the main aspects of our project and how you may be able to help or can pass to anyone you may know who may be interested.

Dementia gardens research Designer Intro Dec12

 Our focus has refined to the following three key aims:

1. To carry out a data gathering exercise with two strands that will use a variety of data capture approaches and will be used to inform best practice to share both with Garden designs but also with the Care industry and appropriate charitable support organisation.
   1. A wide scale gathering of information will be used to better understand how the outside space is used currently and how it can be enhanced further.
   2.  A smaller detailed study will be used to test assumptions on existing practice and aims to identify simple garden elements that give the greatest positive impact to the lives of those living with dementia.
2.  To provide a training package for Garden designers to bring them up to date with the latest guidance for garden users with dementia, understanding how care industry structures work to ensure finished gardens are used on completion and describing current good practice from our observations of what works best in designing gardens for people with dementia.
3. To offer training and support for key members of the care professions to provide practical and achievable actions for incorporating the outdoor environment more fully in their care regimes and practices. This will also enable them to get the best out of any garden designers employed so they can ensure their own expertise on their residents needs is fully considered from the outset.

 We have made contact with NAPA, CQC, HIW and The Alzheimer’s Society to raise the profile of our project and will keep them informed of progress.

 While this project began to support Garden designers it has been widened to include the Care industry themselves, who are the real experts in this field, and are essential to the successful use of their outsides space. Our various strands aim to ensure that where gardens are created, or existing spaces brought into use, they not only look good but are actually “switched on” as an active part of care.

We also hope to provide evidence of the elements that provide the most positive responses for memory jogging and activity avoiding out of context gimmicks that can add to frustration and confusion.

            Longer term the hope is to refine the most positive elements from our research that can be adapted to the domestic garden so enabling the garden to remain a valuable tool to support the care of those living with dementia while still at home.

(Photo:Sweetpeas, very familiar & can be cut to take to those with less mobility)

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(21 September 2012) 

It is Alzheimer’s awareness day reminded me to do an update on Mark Rendell's and my progress on investigating how gardens can support those suffering from dementia.

Since my last updates (see below) we have refined a series of tools to aid the early design stages this includes enhanced site analysis questionnaires. We have also developed an approach to assess the use of the garden once complete that can also be used to understand how well an existing space is utilised.

We have completed our first Environmental-behavioural study observation and identified elements that change in the way a garden is used and explored as the illness progresses.  We are developing a new activation layer to the traditional design process that ensure the Garden is "switched on" when completed and is treated as part of the care package and not just as a pretty place to look at.

We have been very fortunate to be supported by Hospital Management Trust at a local care home where the garden was redesigned (see photos)and have been permitted to visit to carry out our first observations. The Activity co-ordinator here is keeping an observational diary to continue this work over a longer period. This already is demonstrating some powerful examples of how even a short visit outdoors can benefit residents with greater alertness than when they do not go outside.

Next week Mark and I have been invited along to the HMT management conference and are looking forward to meeting a key speakers from NAPA, an organisation that arranges training for those who provide activities for older care home residents.

(Photo: Familiar feel to garden)

Our next steps is to plan how to gather observations from a much wider range of organisations that care for those with dementia.  This will help us build a wider set of data and better understand how gardens/outside space are used and responded to by residents themselves.

The information gathered will be used to create workshops, specifically aimed at Garden designers, to help them access the wider information available and support them in creating gardens that are used as part of the care package and that go beyond the often initial request for a pretty garden to look at.

It is also hoped we will gather enough information over the early part of next year that may be shared so as to benefit anyone supporting those living with dementia  whether they live in a care environment or are in thier own home.

(Photo: Original white door repainted to stand out and resemble a front door making it easier to locate way back inside)

Debbie Carroll Garden Designs www.dcgardendesigns.co.uk

Mark Rendell, The Growing Company www.thegrowingcompany.co.uk

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 (28 May 2012)

Last week was Dementia awareness week championed by the Alzheimer’s society. The following link emphasises seeing the person behind this dreadful disease bearing in mind 5 key points:

1. It’s not a natural part of growing old.
2. It’s caused by diseases of the brain. The most common of these is Alzheimer’s.
3. It’s not just about losing your memory – it can affect thinking, communicating and doing everyday tasks.
4. It’s possible to live well with it.
5. There’s more to a person than the dementia.

http://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=1816

Mark and I are preparing to carry out our first follow up analysis to a dementia designed garden (see earlier details of our research project below this update).  A post build survey has been developed, to dovetail to one used as part of the original site analysis and design brief, that will capture data on what aspects of the garden have made a difference, positive or negative. This will be complimented by a series of planned observations that will endeavour to capture a direct response from the sufferers themselves.

This aspect is a first step in trying to gather information on the Environmental-Behavioural study (EBS) for the key user. This information is much used in other design disciplines to understand how the environment affects behaviour so allowing design to be informed by this to create the desired and most positive response in the user.  Capturing the feedback from this user group is a challenge and one that we hope to share more of as we develop this further in the future, more updates to come.

Debbie Carroll Garden Designs www.dcgardendesigns.co.uk

Mark Rendell, The Growing Company www.thegrowingcompany.co.uk

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(27 March 2012) 

It was good to hear the Governments plans yesterday to increase funding for research into dementia in the UK. The care of those suffering with this awful range of diseases is an area where, along with fellow Garden Designer, Mark Rendell, we have begun work on how gardens can be used to support those suffering from dementia.

 My own interest in this area began while at college 7 years ago when I had to research the needs for an Alzheimer’s hospice as part of a final project. This work was then resurrected and brought up to date in 2011 when re-designing a garden at a Hampshire Dementia care unit on behalf of Hillier Landscapes. This garden been installed and will be planted with help from the residents this spring.

This Care home have been exceptionally supportive in helping me to develop various methods for gathering information on what to include, avoid in these gardens and to better understand the “why” elements of a garden may be important. They are also allowing follow up monitoring of the longer term changes of access to the new garden has on behaviour and physical abilities.

Some of this work has already been used for assessing the needs for a second Dementia care unit garden in Kent which I am in the process of designing on behalf of Hillier Landscapes.

The ongoing relationships with these homes to follow up once the gardens are established is such an exciting opportunity to find out how those suffering from dementia interact with their outside space and how this can be made to be both enjoyable, therapeutic and give a sense of self back through familiar activities and settings.

Mark Rendell and I plan to look into this further over the coming year with the hope to gather together the latest information for fellow Garden Designers. This along with our own research may provide additional data to support making the most of gardens for those who suffer both within care homes but also while still in their own home. More information will be provided later in the year both via this route and our websites.

Debbie Carroll Garden Designs www.dcgardendesigns.co.uk

Mark Rendell, The Growing Company www.thegrowingcompany.co.uk