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Landscape Architect: A.Stevenson / dsb Landscape Architects
Location: Goodwin House, Ainslie ACT.
Introduction
The Design of a Dementia Care Garden: Goodwin House, Ainslie ACT.
The population is ageing. As Landscape Architects many of us are involved in the design of new aged care facilities from low care environments to very high care such as dementia care facilities. dsb Landscape Architects has completed the construction of a new garden devoted to the care of dementia residents at Goodwin House Ainslie, Canberra.
Research for this project included a visit to Adards Nursing Home, Hobart, Tasmania, a pioneering home for dementia care sufferers. The ideas and design solutions we took from this research, and further reading were combined to create two gardens that would address client needs; to enable the continuation of daily activities of residents in an attractive, safe, secure, stimulating and happy environment and therefore reduce the need for medications or restraints.
The key principle conveyed to me by Allan Bester, then Director of Nursing during my visit to Adards was to ‘design to treat residents as normal and fully functioning people’. If you design a padded cell they will panic and try to get out.
This is normal behavior for anyone. Design a comfortable living environment and they will be happier and will not wish to leave. Within this principle we still need to consider security and safety. However, there are design solutions that still create a ‘normal’ living space but help to minimise activities that are unsafe and encourage desired activities. For example, at Adards the gardens around each of the four ‘wings’ are divided by a wooden fence. Some residents do try and climb this. To minimise this activity the horizontal timbers were cut at an angle removing a ‘foothold’ which helps to prevent climbing. It was these simple but clever design ideas that I took away with me and resolved to incorporate into the new gardens at Goodwin House.
This article outlines design ideas specifically for dementia care gardens; however, many can also be applied to the design of nursing home landscapes in general.
Setout & Orientation:
Garden Number:
At Goodwin, as at Adards, the internal dementia living spaces are divided into two wings. The external space has therefore been divided into two gardens, providing intimate spaces for a limited number that reflect the internal living environment. However to cater for larger gatherings and / or a policy change in the operation of the gardens two ‘gates’ have been installed along the dividing fence line. Gates are discussed further under Safety and Security: Entries and Exits.
Garden rooms:
At home the environment around our house is divided into different use areas. Normally we have the aesthetically pleasing front and rear gardens, a driveway and carport and utility area. Sometimes there are separate play areas for children, vegetable gardens etc. Therefore we should try dividing the space to reflect the home so appropriate activities may be carried out in a suitable location and setting. At Goodwin each garden has an aesthetic area and utility area. One utility area has an old car and carport. The other has a bus stop with views over the road. Both have specially designed and constructed workbenches and cupboards for potting-up, working and storage of ‘safe’ tools such as brooms and watering cans. The two areas are separated from the garden by an archway. This is to enforce the sense of moving from one space to another and thus minimise the feeling of being trapped. Given a larger space, a games area or small area where children could play and relatives sit may be included. This may encourage relatives to visit.
Footpaths:
Residents may easily become lost in a small space and therefore confused and frightened. A main circular path leading around the garden and back to the entry provides a wandering route for residents, one on which they cannot get lost. In addition there are brick paved secondary paths for an alternative route. More able residents can use these.
Of vital importance to note is the way in which edging and lines may be read as boundaries. It is advantageous to edge a path to direct residents along it. A paving detail across a path, a dark construction joint or even shadow line may present a barrier over which a resident feels unable to move. Such lines should be eliminated from the design to minimise problems.
Familiarity:
Every day activities:
Residents should be able to carry out as far as possible every day activities that they used to do. In the external environment, this includes posting a letter, making a telephone call, waiting for a bus, gardening, hanging out washing, sweeping the patio. With forethought on suitable siting and some time spent on the phone sourcing old Australia Post post boxes these items can be incorporated into the garden.
Appropriate aesthetics:
For familiarity aesthetics on the whole should be appropriate to the preferred aesthetic and culture of the target group.
Plant selection:
Plant selection should include species known to the residents and probably grown in their own gardens. Currently this often means primarily exotics. Careful selection can meet this aim and provide water wise plants. Scent can help people to remember the past.
The gender difference:
The home and its everyday activities are most familiar to women. Therefore many of the everyday activities such as hanging out the washing will be pursued by the female residents. For the men who spent more time away from the home providing activities is more difficult. Ideas include installing an old car and providing workbenches and some simple tools. Male residents at Adards regularly wash the car and sit inside it to go for a drive. Ideally for safety the car and its dangerous moving parts would be immobilised, but less dangerous parts, radio, windscreen wipers and head lights connected to the building’s electricity supply would still function.
Stimulation:
Sensory stimulation:
Plant selection should include aromatic flowers and leaves and provide year round interest. Flower colour is bright to aid failing eyesight. Beds can be raised where possible to wheelchair level and a person standing and bending. Pots are placed around the garden to raise planting and ensure all year round colour by choosing a colourful glaze.
Additional visual interest is derived from paving, boundary and archway details. ‘Features’, for example a wall mounted water feature and birdbaths, are placed at the end of axis to be viewed within the garden and from internal living spaces. The internal / external link between the garden and shared and private rooms is very important to encourage use of the outdoor space and provide a visual amenity for those who cannot venture outside.
The water feature will provide the sound of running water. An external power socket located in the wall of a shelter allows radios and CD players to be used outside. Perhaps even a television for the cricket!
Animals in the garden:
It is universally understood that animals, dogs and cats particularly can bring comfort to humans. Animals are now incorporated into the daily life of many nursing homes. When I visited Adards there was a rather spoilt but loving Collie happily wandering around accepting many treats from the residents. They also had hens and an aviary. At Goodwin ACT local restrictions prevent hens; however we have an aviary, custom built and situated between the two gardens, for universal observation. In addition birdbaths and tables are located outside communal living spaces.
Comfort & Relaxation:
Sunlight:
As we age the eyes become more sensitive to the sun and glare reflecting off surfaces. Medications can increase sensitivity. Canopies at doors allow time for eyes to adjust to the heightened light level. Concrete footpaths are coloured to reduce reflective glare and many shaded seating areas are placed around the garden.
Seating Areas:
Seating is varied and numerous, providing many options and frequent ‘rest stops’. Comfortably shaped sturdy benches with arms are chosen, adequate space for wheelchairs provided and seating positioned to encourage socialising. Seating is provided in both the sun and shade for year round use.
Safety & Security:
Entries and Exits:
Entries and exits to be used by residents are marked clearly and should always be open. Entrances into the garden from the car park though the external boundary fence, for example, should be disguised as aesthetically part of the fence line with no obvious handle or lock that would cause distress when it will not open.
Boundaries:
The debate over the most suitable secure boundary continues. The boundary fence should not easily be climbed. This requires height and no, or minimal, footholds. However, a high visually impermeable boundary may provoke a wish to ‘get out’ and so encourage climbing. There are a few options, the preferred depends upon the site and the client’s experience. At Adards they were lucky to have a sloping site.
The garden was raised and then sloped down towards a simple two-meter high wire mesh fence with shrubs in between the raised garden and the fence. The visually permeable fence and the elevated garden allowed residents to look though and over the fence. If they walk down to the fence they are confronted by a two-meter high fence line which is difficult to climb, but because they could easily see the outside world there were very few reported instances of residents trying to escape.
At Goodwin House the primary boundary fence is solid and two meters high. Opposite the garden ‘bus stop’ the solid fence is reduced and a trellis makes up the two meters, so residents can see the road and believe they are waiting for the bus. Between the two gardens the garden wall is much reduced in height, using a decorative brick wall with angled bricks to minimise climbing and topped with trellis and climbing plants. Given space a further possibility is a lower ‘false fence’ situated in front of the main boundary fence with the space between densely planted with shrubs. This idea is yet to be tested.
Structures:
Structures in the garden include archways, gazebos, washing lines and an aviary. Each element needed to be sturdy, of sound construction, with minimal climbing opportunities and elements that may harm the residents, for example sharp edges. As a result many items are custom made; commercially available archways were found not to be strong enough to take the weight of a person should it be climbed or wide enough to cross over a path designed for wheelchairs. Others are ‘off the shelf’ items that have been altered in some way. For example the decorative trellis along the base of the gazebos is replaced by vertical uprights, thus minimising footholds for climbing.
Paving:
Paving should be level, a concrete base ensures a long term level and even surface. Reflective glare should be minimised.
Lighting:
Security lighting is essential. Lighting levels otherwise depend upon its anticipated after dark use. At Goodwin House after dark use will be minimal, lighting is therefore primarily decorative, designed to highlight the garden so it may be viewed from inside after dark.
Plant Selection:
Residents may ingest plants, therefore non-toxic plants should used.
Staff:
The garden’s success is very much dependent upon their understanding of the design. Recognition of the different elements and their function and use can help staff to develop activities and encourage the safe use of the gardens.
Staff must also be able to easily observe all activities within the garden. This means minimising hiding places. Key seating areas can be sited opposite windows for continual observation from inside. Staff should feel relaxed enough to allow unrestricted access to the gardens. If this is not possible then residents will not gain the maximum benefit from the gardens.
Finally, I would suggest that it is important that the client and contractor understand the aim of the design and the reasons for such a high level of detailing and the science behind it. In this way we might hope to gain a higher level of design content and construction.
Reference:
American Society of Landscape Architects (ASLA): LATIS Forum on Therapeutic Design: Part One Therapeutic Design in Healthcare Settings. November 2005
Landscape Architecture (Magazine) August 2006 (ASLA):
- How gardens benefit Alzheimer’s patients by Jean Marie Cackowski- Campbell and Sally Augustin.
- Use of gardens by people with dementia.
ADARDS Nursing Home Tasmanian
www.adardsnursinghome.com.au
overview / images / Project
2008
