Healing Gardens for Assisted Living: An Interdisciplinary Approach to Health Education

Introduction

Assisted Living facilities are a relatively new and growing elder-housing phenomenon that gives seniors a way to maintain their independence and functionality. These life-transition facilities require major adjustments for older adults, creating a unique teaching opportunity for health education.

The Silver Sky project in Las Vegas addresses this emerging wellness issue. It is Nevada's first affordable, nonprofit assisted living center with 90 accessible/adaptable apartments. University of Nevada Cooperative Extension (UNCE) faculty collaborated to create Silver Sky by developing a public/private partnership to provide these services for low-income Nevada elderly. Silver Sky provides a venue to develop, pilot test, evaluate, and model research-based educational programming that includes the health promotion and quality-of-life benefits of a healing garden project.

Multi-Disciplinary Effort

Assisted Living provides supportive services, personalized assistance, and access to health care in addition to meeting seniors' housing needs. There is, however, a serious lack of health promotion programs specific to those elderly transitioning from living in their own homes to Assisted Living.

Research has demonstrated that horticulture and gardening can benefit people who are institutionalized. Gardening, even passive exposure to living plants or flowers, helps to improve health outcomes of seriously ill hospital patients and activity levels of infirm elderly. Over the past several years, facilities that work with such populations have begun integrating garden sites into their landscapes and in some cases into their therapeutic modalities (Barnicle & Midden, 2003; Bassen & Baltazar, 1997; Rappe & Kivela, 2005).

These efforts may take the form of aromatherapy gardens, meditative labyrinths, atria with growing plants, or community plots where individuals or groups are responsible for planning, growing, maintaining, and harvesting garden produce. These team efforts encourage leadership and participant involvement (Browne, 1992; Kweon, Sullivan, & Riley, 1998; Predney & Relf, 2004).

It is a logical next step to theorize that residents of assisted living, at a higher functional level than those in the above listed institutions, would benefit by participating in a healing garden program. This healing garden project represents collaboration between a UNCE aging issues specialist and a social horticulture specialist. It merges the unique expertise of each discipline.

Project Development

Early in the Silver Sky design process, a garden was envisioned. Each of the 16 planter beds was to be 2-feet high and 8-feet long. While this formation is appropriate for many types of gardens, it was not visually interesting (an important feature of healing gardens), nor would it address the requirements posed by senior citizens with differing levels of mobility, not to mention a wide range of gardening interests and skills.

Meeting this variety of needs required changing the overall approach to the horticulture of Silver Sky. First, rather than having all plant-related activity centered exclusively on community garden beds, it was determined that a more positive approach would be to include all the facility's landscape ornamentals as part of the garden project. This meant labeling all plants in the landscape with names (binomial and common) as well as their origins. By doing so, the development becomes more park-like, and plants are no longer merely passive decoration.

The community plots were also redesigned, with the physical abilities of the participants paramount. Rather than a uniform height, solid box, different shapes were constructed to maximize the accessibility and attractiveness of the garden areas. Several were set higher to ease bending, and others were built open at the bottom for wheelchair accessibility. Some of these followed designs that can be found at <http://www.infinitec.org>. Other considerations included the range of reach from wheelchair or walker to determine the width of plots for maximum usable space.

Resident Input and Collaborations

A number of factors determined the physical design of these community plots: type of plants to be grown; size of the gardeners themselves; physical ability and dexterity of gardeners; and the local climate and soil types. Focus groups conducted with the first Silver Sky residents determined that both flowers (ornamentals) and food (edibles) be grown. As a result of their input, emphasis was placed on selecting a variety of plants that would alternately flower in all seasons.

The healing garden is located in the rear of the facility in a place that is visible from the dining area and many of the apartments. The planting beds create opportunities for residents to see flowers they have grown displayed on their dining tables. They also experience opportunities to eat the vegetables they have grown in the garden. Residents also had concerns about the ability to garden in the Las Vegas summer heat. As a result, shade trees were added to the plans as well as benches for the enjoyment of all non-gardening residents, visitors and staff.

In order to evaluate the impact of the healing gardens on the residents of this new assisted living facility, quantitative life satisfaction scales are being administered. Qualitative evaluation measures include longitudinal one-on-one interviews at 8-week intervals with resident project participants, other residents, family members, and Silver Sky staff. They are asked about improvements/changes in their lives or what they have observed in others. This ongoing process evaluation allows them to suggest improvements to the garden project.

Silver Sky is truly a collaborative effort. The design, construction, and initial planting provided an applied educational experience for landscape architecture graduate students in the University of Nevada Las Vegas (UNLV) Environmental Studies program under UNCE faculty supervision. Silver Sky residents who have had experience in gardening are being recruited and trained to teach the basics of horticulture to their neighbors. UNCE Master Gardeners are involved in the training of both new teachers and other residents.

Conclusions

It is expected that ongoing curriculum development, testing, and evaluation will lead to creation of a health promotion program that could be utilized/ adapted at any assisted living facility worldwide. As the aging population grows, so also does the need for such facilities to help residents maintain independence. Health promotion should be an integral part of these life-transition residences.

It is also expected that this project will add to the body of knowledge on the impact of healing gardens in residential facilities for the senior population. The Silver Sky project presents a way for Extension to provide educational, life-enhancing services to the community. At the same time, it demonstrates that flexible integration of inter-disciplinary areas of Extension can expand the scope and reach of Extension programs into previously un-reached sectors of the community to a much larger and more diverse audience.

References

Barnicle, T., & Midden, K. S. (2003). The effects of a horticulture activity program on the psychological well-being of older people in a long-term care facility. HortTechnology, 13 (1), 81—85.

Bassen, S., & Baltazar, V. (1997). Flowers, flowers everywhere: Creative horticulture programming at the Hebrew Home for the Aged at Riverdale. Geriatric Nursing, 18 (2), 53 — 56.

Browne, C. A. (1992). The role of nature for the promotion of well-being of the elderly. In D. Relf, (Ed.), The role of horticulture in human well-being and social development (pp. 75-79). Portland OR: Timber Press.

Kweon, B., Sullivan, W. C., & Riley, A. R. (1998). Green common spaces and the social integration of inner-city older adults. Environment and Behavior, 30 (6), 832—858.

Predny, M. L., & Relf, D. (2004). Horticulture therapy activities for preschool children, elderly adults and intergenerational groups. Activities, Adaptation & Aging, 28 (3), 1 - 18. Available at: http://www.haworthpress.com/web/AAA

Rappe, E., & Kivela, S. L. (2005). Effects of garden visits on long-term care residents as related to depression. HortTechnology, 15 (2), 298—303.