Designing landscapes for dementia care

Turning an under-used outdoor space in a care home into a creative oasis for residents living with dementia brings benefits to them, their friends and families, staff and the wider community.

At the Sensory Trust we have spent many years getting to understand how we can design environments in ways that make them easier to use by older and disabled people, while keeping hold of the qualities that make them special, fun and engaging. In 2009 we put this learning into practice when we implemented a new garden design in a nursing home for people living with dementia.

We have identified some key design considerations to help with the new design or renovation of care home gardens:

Access – routes – journeys

The easier the garden is to get to, the more likely it is to be used and anything that acts as even a small obstacle may well deter people from making the effort to go out. This means thinking about the design of the building, not just the landscape – are there good views of the gardens from indoors, doors that give residents quick and easy access, and flush levels between indoors and outdoors so they work for everyone including wheelchairs and self-drive mobility vehicles?

Access within the garden relies on aspects like wide, firm, non-slip paths; choice of route lengths; plenty of seating; avoidance of obstacles and use of textural indicators to assist people with visual impairments. Also access to highlights, so for example residents can reach to dip their hands in the water feature or fill the bird feeder, including wheelchair users.

A choice of short and longer routes will enable residents to enjoy the landscape as they choose. These can be punctuated by features that serve as mini-destinations, in part to motivate people to be active and in part to add to interest and range of activities in the gardens. For example, seating areas, orchard, summerhouse, gathering point with seating and accessible gardening facilities.

The increased use of self-powered mobility vehicles means that power points may need to be included for recharging.

Seating – shelter – shade

Seats and tables are essential, along with shelter and shade. Some residents will only be able to go outdoors at all if there is a seat within close range, so seats just outside doors are important. Seats along paths will provide rest for people with limited stamina. Seats also give residents the chance to relax and spend time outdoors on their own or with others.

Back rests are needed to support people when seated, and arm rests to assist the action of getting up and sitting down. Low seats are difficult to get up from, and there should be space adjacent for wheelchair and self-powered vehicle users.

Indoor – outdoor connections

Good views from windows brings the gardens into the day to day lives of residents who can’t get outside and when the weather is poor, especially from late autumn to early spring. These can be enhanced by plants with winter flowers or berries or early spring blossom. Locating winter scent (eg winter honeysuckle) near the building will ensure the scent can be enjoyed by people indoors. Bird boxes, feeders and nectar-rich plants can be used to attract wildlife.

Windowsills can give residents the chance for light gardening, such as growing microgreens. For residents living in upper storey apartments they can still enjoy some plants even if they don’t have immediate access to a garden space.

The areas just outside the door are likely to be used most often so this is a good place to create attractive garden areas. These will ideally serve different uses, from sitting outside on a sunny day, having coffee or a meal outside, to gardening or taking stroll through the gardens.

Year-round interests, events and celebrations

As residents spend much of their time at home, the priority is to create a garden that is accessible and interesting throughout the whole year. This relies on the planting design and choosing displays for the different seasons, however interest can also come from art work and seasonal events and activities.

Celebrations can inspire residents to use the garden at different times of the year, and are a good way of linking with the wider community. For example, a Christmas tree can provide a focus for residents, staff, friends and family to decorate each year. Outdoor sockets, lights and decorations can inspire residents and staff to think of other inventive ways to enliven the landscape.

Providing space for gatherings, garden parties, film nights etc. will also encourage wider social use and again an outdoor power supply will make it easier to connect lights, projectors etc. A space for an outdoor fire or outdoor cooking area, will support barbecues and sharing food.

Containers, raised planters and gardening

While gardening is popular, not many residents are likely to want to do more than occasional activity, perhaps some light weeding or container growing. The challenge is to design to allow for people to engage as and when they want to, without this causing maintenance problems.

Raised planters are a good answer. They bring the soil and plants to a height where they can be reached and they can support light gardening, or larger-scale vegetable plot (or flowers, herbs etc). Including shelves for tools and a water butt makes it easier for people to join in.

Raised planters can also be integrated into the landscape as structural elements, adding enclosure to a space and backing to seating and positioning plants within easy reach of hands and noses.

Supporting creative activities

Other outdoor activities such as DIY and craft work need space and storage, sheds are useful for both.  This makes it easy to use things and put them away again, and this makes it more likely the garden will be used more widely. Craft work can be supported by growing relevant plant material – such as basket willow or flowers for drying – and can be extended to activities indoors.

An outdoor tap is essential if residents are going to garden, or do other activities that need water, even if it’s just to rinse their hands. Carrying heavy water containers from indoors makes it more likely that people won’t bother, or can’t without someone else’s help.

Plants

An ideal planting style evokes the feel of a domestic garden, reminiscent of residents’ previous homes, but without the associated high maintenance demands. It relies on long-lived shrubs and herbaceous perennials that are low maintenance but which provide high interest through their display (eg Crocosmia, ground-cover Geranium and Aster).

If you are investing in a new design it is a good idea to get professional help as you can waste money and get disappointing results by making poor choices. It is also an excellent opportunity to get residents involved, inviting them to identify their favourites and help research possibilities. Local garden centres can be a useful source of inspiration and are excellent for seeing what is looking good at different times of year.

Need more inspiration?

Read our case study of garden design at Trevarna care home