“Why aren’t care home gardens used more actively?”



“Why aren’t care home gardens used more actively?”

This was the deceptively simple question that we asked ourselves back in 2013. We both have an interest in the therapeutic value of outside spaces and have created a number of gardens for health, care and educational settings before we joined forces five years ago to carry out a small scale, self-funded research project.

Little did we know then that the trail to answering this question would lead us deep into the care practices of the care homes in our research project and force us to confront some deeply held beliefs and assumptions about our work as designers.

We had become aware that some newly designed gardens around care settings were no longer being used by the homes’ staff and residents, even when they met the latest design guidance. We wondered why, particularly as a brand new garden is likely to be a significant investment by the care setting. To end up with a new garden that is not used any more than the one it replaced could rightly be interpreted as a waste of money.

For us, this was an unacceptable situation and we wanted to find out why this was happening. We were concerned that we (and our peers in the design sector) were missing something important about our design practice that in some way affected the home’s ability to use the new features and layout in the garden. We began to wonder if the guidance we work to was overlooking a key insight or factor that related to the way residents (particularly those living with a dementia) actually engage with their outside spaces.

We decided to carry out a small scale research project together and so we first of all turned to the most relevant and, for us, resonant, design thinking on this topic for guidance. Garuth Chalfont’s book ‘Design for Nature in Dementia Care’ (Chalfont, 2008, Bradford University) shared the insights of a designer who ensured the resident was kept at the heart of any changes to the garden. He also called for more research to really understand the underlying dynamics between the garden and the garden visitor living with a dementia.

We responded to this call and developed our research methodology along the lines of his suggestion to use Environment Behaviour Studies (EBS), a data gathering format that simply involves people observing people interacting in the space.

Our modest aims to recruit six care homes grew into a much larger study. Helped by Sylvie Silver at NAPA, 24 care homes joined the project, with 17 remaining to the end. We collected 600 completed diary sheets from these homes and made another 874 observations of our own during visits to 7 of the homes. We had many inspiring and illuminating experiences during the research project and particularly during our site visits that led us from the outside spaces (where we thought the answer to our question would lie) back inside the care settings themselves. We found ourselves drawing on our management backgrounds to look more closely at the care practices, procedures, attitudes and approaches in the settings themselves and discovered three key findings as a result:

  1. There is a correlation between advanced care culture practices (i.e relationship-centred care) and active engagement with the outside space, regardless of the condition or design of the space.

  2. Fearful attitudes towards Health and Safety effectively cap engagement levels with the outdoors.

  3. The support of an outside specialist (e.g. a garden designer) needs to match and support the current care culture of the care setting to avoid over designing the space or risking the investment becoming a waste of money.

Great News Announcement!

We're so pleased that Debbie and Mark from Step Change Design Ltd will be running a monthly series on our blog to help you to make the most of your care setting garden.

Make sure you subscribe to receive our blog in your inbox.

Intro to the series

In this monthly series we will be exploring ways to make the most of your care setting garden and help your residents benefit from stepping outside and enjoying meaningful activities there, as and when they choose. Step Change Design focuses on encouraging care settings to engage actively and meaningfully with their outside spaces with their residents. Our work is based on a large scale research project we carried out to understand why care setting gardens are not more actively used.


We have produced a poster-sized diagnostic tool, the Care Culture Map and Handbook, to help care settings review and improve on their activities and practices relating to the outdoors. Our Care Culture Map is a paper based tool, this is in this format deliberately to create conversation and action, this is for sale on the web shop. We provide a training, design and consultancy service to the care sector seeking support on creating actively used gardens and on making changes to their care culture.

Learn more about the Care Culture Map and Handbook download the.pdf HERE Purchase your copy from our shop HERE

For FREE downloads full of ideas click HERE



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#carehomes #Gardens #dementia #EnvironmentBehaviourStudies #EBS #StepChangeDesignLtd

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