DESIGN INFORMATION What were the goals for the therapeutic garden design?

“The area outside of the nursing and assistant living units was a brown rubber roof. To convert that area into something that enticed residents to go outside or enjoy nature from their patios and windows and provide a safe, accessible and beautiful area which involved all their senses. To also use flowers, plants and vegetables to stir up memories since many of our residents had been farmers.” Future site of the Back

Garden. - Gerry Stride The staff at Medford Leas is very involved with the residents. They have initiated many excellent programs throughout the community. One of the areas within the community that was in need of improvement was the courtyard garden in the healthcare area of the community. The residents living within the Estaugh and Assisted Living Residences had little opportunity to venture outside due to the existing conditions of the courtyard garden. The goals for the courtyard were to improve the overall conditions within the courtyard by hiding and/or camouflaging the existing utilities, creating areas for programming and make the plantings more relevant for the residents’ interests and activities. The main goal, as stated by Gerry Stride, was to entice the residents’ to use the courtyard.

Future site of the Back Garden.

Were these goals achieved? If so, what evidence do you believe suggests their achievement? For those goals which you do not believe were achieved, what evidence suggests this assessment?

These goals have been achieved. There has been a significant increase in resident use of the courtyard garden as part of programs initiated by staff or using the garden area on their own. The residents with dementia participate in a greater number of programs throughout the year as a result of the improvements to the Back Porch Garden. The conditions of the courtyard garden have been improved and residents and staff have commented on the improved conditions. The roof top utilities have been screened from view and a ‘secret garden’ was created by staff for residents living on the upper floors of the assisted living unit. Programs have been developed for the

A fountain, bench, andthe Back Porch Garde

Porch

Porch

plants inn.

residents with dementia as well as residents living in assisted and independent living residences. The main goal – enticing the residents outside – has been accomplished as evidenced by the concerts, special events and other daily events that take place within the Back Porch Garden.

Take a copy of the plan and note the features that you believe help achieve these goals and how they do so. Also annotate what you believe the innovations were (if any) in the design.

Please see the location map and site plan at the end of the “Design Information” section.

• Constructing a porch off of the Recreation/Activities Room

• Repainting the surface of the roof membrane with one color for the walk and another color for the ‘room’ areas Containers of plants in the

garden. • Reducing the glare and noise

• Adding planters to the roof top area

• Screening the HVAC equipment

• Replacing the existing plant materials with more relevant plantings

• Adding a water feature and fountains

• Awnings over the windows What do you believe are the essential elements of the design that makes it a success and why?

“It is totally handicap accessible; it has shady areas as well as sun lit areas. We provide cushions, umbrellas, and various seating designs including rockers, picnic tables, benches and lounge chairs. The harshness of a brick building wall was softened by awnings; a porch is part of the design as well as two water features, the residents with the designer to include flowers they loved. Painting the roof green with trails turned the ugly brown roof into a garden path.” – Gerry Stride

A view along the garden walk.

The basic elements have been identified by Gerry Stride. These elements have been a catalyst in instilling a new energy and increased enthusiasm for the use of the Back Porch Garden. Staff has been motivated to provide more programs and activities. I believe that one of the most significant signs of the success of the garden has been the removal of imaginary barriers. The independent living residents have been leery of participating in activities within this area of the community. They are faced with aging and illness and do not want to venture in this area. The concerts, special events and other activities have encouraged all residents to come together to enjoy the various activities. The garden not only serves the needs of people with dementia, it meets the needs of people living in Assisted Living as well as the independent residences.

A concert in the garden.

What were the challenges faced in developing the design?

The courtyard garden area is situated between the Estaugh and Assisted Living wings of the healthcare buildings. At the bottom of the configuration lies the Recreation Room. In addition are one-half roof top and one-half on-grade garden areas. Access and visibility were two key issues. The garden area was not very usable because of the heat and glare from the roof surface materials, the noise and intrusion from the air handling equipment, the lack of usable furnishings and the over grown plant materials in the planting beds.

The “porch” in the garden.

What do you believe are the least positive features of the garden and why?

Access for the dementia residents is the least positive feature of the garden. The main access to the courtyard is through the Recreation Room, which leads directly onto the porch itself. Assisted Living enters the garden through the porch. The residents of the Nursing Unit enter the garden from the back of the courtyard, through a door leading from the staff time clock area. The Skilled Nursing residence should have access to the garden from the Back Porch.

A planter - an Eagle Scout project.

One other feature that has its drawbacks is the presence of the HVAC equipment. It is in the center of the courtyard. (Debbie Lux, the grounds person who has shepherded the growth of the garden created a ‘secret garden’ within the utility enclosure for the residents living on the 2nd and 3rd floors of the assisted living residence.)

Describe the design process and the degree to which others participated?

Ceremony for Justin Dewitt. The design of the garden has been a collaborative process. An

initial meeting was held with staff and administration to discuss the ways in which the courtyard could be improved to benefit the residents. Meetings were held with the residents to discuss the plans and get their ideas on ways to improve the garden area. Staff was involved in the implementation of various improvements. The community was involved, soliciting the help of an Eagle Scout to lead the installation of many of the plantings and construction of the raised planters. Staff have contributed improvements, in addition to the original elements proposed. The garden has evolved since its original construction. The plans were the impetus for the original changes and the garden has continued to evolve in subsequent seasons.

Screen detail in the garden.

Design Information: Jack Carman, FASLA Design for Generations, LLC92 Tallowood Drive Medford, NJ 08055 609-953-5881 609-953-1625 jpcarman1@comcast.net

Location Map

Site Plan

USER INFORMATION – QUESTIONS FOR CARE PROFESSIONALS Describe the resident/participant profile of the population served by the garden.

Medford Leas is a Continue Care Retirement Community. The Back Porch Garden is used by residents living in the independent dwellings as well as residents in Assisted Living and the Nursing units. The residents with dementia live in the Nursing unit. There are residents who are in the middle stages of dementia living within the Assisted Living residence. They are able to live in the Assisted Living apartments up until the time that they pose as a wander risk. Many of the residents in Assisted Living were inspired by the garden to have mini gardens on their patio which they tend to and maintain.

What are the garden’s best and worst features? The garden is colorful, has flowers the residents requested, is wheelchair accessible, attracts birds, has features which include reminiscing items such as old tools and an old fashioned pump, water features, places for shade and sun, and is spacious. Part of it is on a rubber roof and when it rains it can be slick and must be “squeegeed.” But, many residents enjoy being able to sit on a porch once again.

What works about the garden?

It has doors that can be opened by a button to allow people in wheelchairs access, the furniture can be moved for picnics or concerts, there is a variety of colors in the plantings, and there is shade and sunshine for the tastes of all. The residents can view it from their rooms and can sit out on their patio at their own will. Residents in the Nursing unit have their own patio area so they can participate in general activities on the back porch or in special activities on their own patio. There are seasonally related activities held on the patio, such as potting plants for the spring, singing holiday songs (starting with St. Patrick’s Day in March), barbeques, picnics, and many other events.

What doesn't work?

After a rain we have to squeegee the deck because of poor drainage.

What maintenance issues are there?

Keeping the teak furniture oiled properly and redoing the roof to keep the paint fresh.

How do you feel the garden addresses the medical issues associated with dementia?

Davina Cornish who works with the residents on the skilled nursing unit states “Residents are calmer when they are outside on the porch. They are away from the noises of the nursing unit such as ringing buzzers, nurse chatter and pill crushing.” People who do not often speak verbalize (i.e. ‘that was a nice breeze’), or look at a butterfly. They seem more content on the porch. It is also a calmer place for the staff to do programming. Programming need not be as intense since nature is displaying her own program. Often we take residents out to the garden area and put on music. They can listen and relax or sing along if they wish. The program sometimes creates itself. We also use this time for hydration, such as sipping cool lemonade or iced tea as we enjoy nature. Residents have the opportunity to plant the plantings in containers and reminisce about the gardens they remember, they get to see beautiful flowers and sit on the porch, feel the breeze on their face, breathe fresh air in a lovely setting. Those who want to can help deadhead flowers in their containers. For those who were gardeners, this is a treat. It is a peaceful place where they can relax with nature. One gentleman was known for his politics, having taught at Tufts in Political Science for 40 yrs. Once the garden was completed he would go each morning and sit at the patio doors looking out at the new gardens. We also put a tomato plant in a pot outside his assisted living apartment, which he oversaw the watering and care of. His walking was not great, but each day he struggled to get to his spot at the window. In talking to his son I discovered he grew up on a farm and loved nature. It was his joy to see the birds and flowers each day and finally have a tomato sandwich from his own mini garden. He also had us

plant red flowers which attracted hummingbirds and butterflies. Another 100-year-old woman goes into the garden every day, weather permitting, and reads. Still, another woman with Parkinson’s sits outside daily and deadheads flowers and just enjoys nature. She asked to move from the second floor to the first so she could more readily access this garden as she had been a member of several garden clubs but could no longer attend because of the ravages of her disease.

How do you feel the garden addresses the concomitant issues of aging?

There is something spiritual that happens when people communicate with nature. The business of the day is removed as a breeze blows in your face and you enjoy the colors of nature. It is a time of refreshment. People who may feel alone in their room can enjoy the “spirit” of the garden. Since people may walk their dog or just wander through, there is also a time to chat with people passing by.

In a typical week, how many times is the garden used and by how many people?

There are approximately two to three programs and/or activities for the residents living in the Nursing and Assisted Living residences. These events include picnics, intergenerational activities, and concerts. We had a 9-11 remembrance together with independent residents. The flowers from the Back Porch Garden are used for the annual flower show entries.

Residents read in the garden, sometimes bring their lunch out, may host parties, or just stroll around. We also run planned programming. A lot depends on the weather, but we have concerts outdoors once a week from the end of June to the beginning of September. We also have picnics, parades, small group gatherings and cocktail parties once a week. The concerts attract 70-100 people, the small groups 6-20, picnics 50-70, parades which include children about 50-70. When the weather is nice 4 -5 programs a day could be held outdoors by nursing and assisted living staff.

What types of activities occur there? Rank in order of most common to least common.

The more common activities occur within small groups participating in activities such as crafts, reading aloud, reminiscing, music appreciation, cognitive fitness. Happy hours, concerts, horticulture therapy, picnics, parades are activities participated in by residents in the Nursing Unit as well as within the Assisted Living residence. Concerts and happy hours are attended by independent residents as well. We also do a lot of intergenerational programming on the porch. Day care children parade, play games, and picnic with us. A local middle school performs a band concert each year out back as does a community band. We also have fall events such as a petting zoo for day care children and residents, scarecrow making in which a local middle school and day care center participates, and a mum festival. We try to keep activities going from spring to frost until weather ends our programs outdoors.

If the garden is not used, why not?

Weather conditions such as excessive heat or rain keep us out of the garden, when these are not factors it is used daily for formal programming.

Is the garden used for therapy? If so, describe the therapies that occur there and how often.

It is therapeutic for institutionalized residents to be outside. We do horticultural therapy, such as repotting plants, taking cuttings for new plants, plant seeds, and making flower arrangements. Residents got to watch robins hatch from eggs that were laid in a hanging basket. The residents became the ‘mother protectors’ of the birds. There is a chipmunk that lives under the patio and the residents like to watch for his/her appearance. Many of the people in assisted living have started gardens on their patios. Some put out bird feeders. Many residents take it upon themselves to dead head flowers on their own. These are all activities that the residents from the Nursing unit can watch and enjoy as a way of socializing with their ‘neighbors.’

Horticulture Therapy occurs, formally, once a week. However, it occurs informally everyday. The individual efforts are hard to measure, but occur, for many, daily.

How does the staff encourage garden use?

Staff encourages the use of the garden through programming and transportation of those who cannot get there by themselves. Debbie Lux works with residents taking geranium cuttings, planting seeds, pruning, and then using these things in the garden. She’ll start these projects in late winter where they grow in the greenhouse until it’s time to plant them outside in the garden.

Can residents access it freely, or is access restricted?

Residents in assisted living can access this freely. Residents in the Nursing Unit must be supervised due to wandering issues.

If the garden is restricted, when is it restricted?

The back of the garden leads to a walkway. Residents who wander must be supervised.

User Information: Gerry Stride, Director of Community Life Medford Leas Continue Care Retirement Community Medford Leas Way Medford, New Jersey 08055 609-654-3000 609-654-7894 GerryStride@medfordleas.org