Step Change Design focuses on encouraging care settings to take a fresh look at their care culture
and care practices in order to engage actively and meaningfully with their outside spaces with their residents.
In this monthly series we explore ways to make the most of the outside spaces around your care setting to help your residents benefit from stepping outside and enjoying meaningful activities there, as and when they choose.
The Open Door Policy explored
‘Does your home have an open door policy?’ This is often one of our first questions when visiting a care setting to which most reply ‘yes’ or at least that they aim to give residents the freedom and support to go outside when they wish. How often are doors that overlook and conveniently access the garden locked or alarmed? When challenged about this, it is often followed by a range of reasons for not allowing access to what is usually a perfectly normal and secure outside space.
On the face of it many of the reasons given seem reasonable but when we dig a little deeper we often uncover the fact that these are really excuses hiding a range of more subtle fears or unwritten policies that are being applied to avoid letting residents step out as freely as should be expected.
We’ve witnessed deliberate avoidance of unlocking doors because it is clear to us that the outside is seen as more dangerous than inside. We have even been told the reason one particular door is locked was because the person with the key wasn’t on shift! We’ve also been told the reason the door is locked is because no-one uses that door to go outside, while watching a resident attempt to use the very door in question. We observed that this door being locked clearly contributed to the increased level of anxiety caused by the confusion this resulted in for the resident.
In a care setting where we were running a workshop, and where the home had a lovely , safe garden with gardeners on hand to support residents, we were shocked to hear a member of staff ask us, ‘So are we allowed to let them out then?’ We had to wonder, is this a care ‘home’ or little more than a prison?
This home had all the resources it needed, fully trained staff inside and out and yet the doors remained firmly locked. This member of staff had worked there for 3 months and had not been given any indication it was acceptable to support residents to step outside. In fact, her impression was that this was to be avoided. In addition, there was an overly complicated locking system at the doors that made it difficult for both staff and residents to venture out easily without fear of an alarm going off elsewhere in the home.
In this setting a simple starting point to address a complicated Open Door policy was to ensure everyone knew it was simply ‘OK to go outside’ and then to ensure that doors were unlocked to avoid the fear of setting off invisible alarms. Communicating, and expecting everyone to play their part, in applying an Open Door policy is essential if it is not to be simply given lip service.
More often than not, where an Open Door policy is not applied faithfully it may be a way of avoiding dealing with bigger fears and perceptions around the outside as a whole, most often around Health and Safety concerns. If these are not addressed, this issue will always hold a care setting back in engaging with the garden more. By sense checking these fears, talking about them, understanding what the reality of a risk may be for the resident and what could reduce it can be an important and major step forward.
In contrast to the homes struggling to achieve a straightforward Open Door policy, we witnessed in our study homes that showed how, once you unpick the fears and apply the knowledge about your residents as individuals, that you can open up the home not just to the garden but to the wider community too. In one home we saw lovely examples of a front garden space used, apparently freely, by residents, including those living with dementia. They liked to sit by the main entrance, watching people come and go, and could see across the car park out the open gateway to the nearby housing estate. This pushed even our open-minded approach around secure boundaries, as garden designers, into new territory on what a safe place should look like.
On investigating further, we discovered the care culture of this home was to risk assess their residents as individuals and so they knew who was safe to sit outside unsupported compared to those who needed to be more subtly supervised with their cuppa out front at the end of a meal.
So, we’ll end as we began with our question: ‘Do you have an Open Door policy (or at least state that residents are free to go out)?’ If you answered yes, now go and test the policy in reality. Step into a new resident’s shoes who spots the garden for the first time, and just as they would have done almost daily at home, check how easy it is to step outside: the route to the door, the ‘invitation’ and encouragement that you give to visit the outside space, how uncluttered the door and view to the outside is. What may be stopping your residents from going outside? What can you and your colleagues do to make this a simple and natural part of daily life for your residents? On the other hand, if you answered no to the question, what is behind not feeling able to let residents have this natural freedom of movement? Remember, it has been proven scientifically to be good for us all to go outside, and even prisoners are entitled to an hour outside by law. What needs to happen to create and apply a straightforward Open Door policy in your home?
Connect with Step Change Design on Twitter Debbie Carroll @stepchgdesign