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 internet has been an amazing thing: it’s allowed us to find out so much more about the world we live in, to connect with people far away and to make a great deal of our lives easier. The internet has also allowed people to share ideas, opinions, thoughts and solutions to a wide range of practical problems. But the internet can also be troublesome; it can sometimes be hard to distinguish between what is true and what is not. It can help us find the ‘answer’ to a question but without our ability to necessarily understand the workings out behind the answer. The internet can also create fads and five-minute wonders, ideas and solutions that become retweeted or shared around the world in record time, losing the important aspect of the cultural context for these ideas (i.e. their appropriateness for a particular place and time) or the problem that they intended to solve in the first place, which may not be the one you were actually trying to solve!
And the care sector is not immune from this. We saw a particular internet ‘fad’ take hold like a forest fire during the time we were carrying out our research project. When we traced its origins, we saw that it came out of Australia. This was the bus stop in care setting gardens. Never mind that no actual bus would ever come past, the bus stop was seen variously as a means to provide a seating area (with covered canopy in some instances) or as a means to calm, deflect or distract residents for a period of time. We need to challenge the ethics of the way this feature has been used. Is it respectful to encourage someone to sit and wait at a bus stop when you know that no bus will ever arrive? Why is there a need to provide a ‘real’ life feature in a back garden when no ordinary back garden would contain a bus stop?
We have also seen phone and post boxes, taxis and tractors appearing in care home gardens as well. Why is this? What does the setting hope that these features will achieve? We can understand the motivation to recreate a sense of local or national identity through these iconic and uniquely British features but how appropriate are they to put up, in what is often intended to be the typical front or back garden of a care setting. And how relevant would they be to the lives of the residents currently living at the care setting anyway?
Designers have some responsibility here for the proliferation of features such as these in care settings. In one rural care setting in southern England there is a tractor feature in the garden. The reasoning behind the inclusion of this feature could be related to the rural context of the setting but a little further investigation about the lives lived by the residents at that care setting would have revealed that they were more oriented towards the City professions and suburban life than that of farming or the land. In effect, this tractor (and the other street features we describe above) risks becoming a ‘gimmick’ – an expensive and short-lived feature that becomes irrelevant and pointless to the residents within a matter of weeks (if not sooner!) and in some cases adding a degree of confusion to those living with dementia.
We were acutely concerned about this and the impact not just on care setting budgets but on the reputations of designers and outside specialists who were promoting these types of installations and features. We aren’t saying that in a particular home, a post box (for example) in the grounds would not be appropriate but simply want to make sure that these decisions are taken in a conscious and considered way, and that the staff (and outside specialist, where necessary) are able to justify how it relates to their particular outside space (including the locality), the current mix of residents or in the care culture practices of the setting to engage their residents meaningfully and authentically with these features.
It is also worth exploring the motivation behind wanting a typical street feature in a domestic garden when there may well be a real one a very short distance away from the care setting itself. What is stopping staff accompanying residents to post letters in the post box that is just along the street? Answering this question may reveal deeply held attitudes towards Health and Safety, the relationship to the world beyond the care setting or even to the assumptions made about where staff and residents are ‘allowed’ to go.
Is it possible to install any of these features in a care setting garden so that it does not become a gimmick? Yes, it is. For example, we supported a care setting to install a post box in a wall near the entrance to the home where the housing estate beyond was clearly visible and the pavement and road entered the setting. The location was therefore realistic, as it appeared to be part of the wider street rather than the garden, and in keeping with where you would likely see a post box.
This is one of the four key ‘checks’ we propose you make before you choose garden features. The checks we have come up with are part of a Checklist Tool for care settings. It is our response to try to interrupt the gathering momentum of these one-size-fits-all fads that proliferate on the internet.
The Checklist tool is designed to help the care setting review planned or new activities, events or garden features to ensure you can provide the maximum benefit for your residents and help create an increasingly active use of their outside spaces. It also helps sense-check new approaches to avoid introducing gimmicks (features that have little value or meaning to your residents) or infantilising residents (engaging with them in a non-adult way) which may add to, rather than reduce, confusion for residents living with dementia.
To use this Checklist, we pose four questions. The more questions you can answer with a ‘YES’, the less likely it is to become a gimmick or risk infantilising residents. Let’s take a look at the questions:
1. ‘Is it purposeful?’
2. ‘Is it realistic and in context?’
3. ‘Is it relevant and/or meaningful?’
4. ‘Can the feature be included in wider activities at the setting?’
So, it’s possible to see that the risk of a feature becoming a gimmick or infantilising the resident is higher for those homes that are unable to answer the questions in the Checklist Tool affirmatively. The more questions that can be answered positively, the more the feature or activity is likely to be valuable and meaningful to the residents in your particular setting and the wiser and more cost-effective the decision to purchase the feature or intervention. So why not apply the checklist to your outside space and let the world know just how well-used and well-loved the features are in your garden!
For more information about our Checklist Tool, go to: http://www.stepchange-design.co.uk/wp-content/uploads/2016/07/napa-living-live-spring2015.pdf
Connect with Step Change Design on Twitter Debbie Carroll @stepchgdesign
About Care Culture Map and Handbook