'Ty Enfys', Merthyr Tydfil. Photo courtesy of @robmrichards
I thought it was high time that we had a blog section dedicated to sensory approaches for people with more advanced dementia. Having been involved in helping to design some dementia friendly outdoor spaces in my professional life, I thought that 'Sensory Gardens' would be a good place to start.
Before I continue, I would like to invite you to share your photos and stories about sensory approaches for people with advanced dementia and I will include them as best practice exemplars in later articles.
To begin with, take a look at the 'Ty Enfys' sensory garden above. Note the points of interest, especially the 'yellow brick road' and the old 'phone box. The raised beds and safe seating areas are also impressive, especially as they are constructed out of attractive natural materials - slate and wood.
Here are some points to consider when involved in designing outdoor sensory garden spaces (please let me me know if you have others to add):
Making a safe space
Dementia friendly gardens need to be safe in terms of being somewhat enclosed, preventing disorientated people from being at risk if they managed to leave the premises. But this needs to be done in a non-threatening way. The wood and slate walls above are a good height and not at all intimidating. They are also broken up by trees and shrubs, to avoid any feeling of being 'held'.
Safety in walking is also a concern to pay attention to, not just in terms of trip hazards, but also colour and texture of flooring. Some colour changes can be perceived by some people with specific areas of brain damage as changes in height or as drops and are to be avoided wherever possible. Having said that, the 'yellow brick road' design above makes for a great route to follow and is provided with lots of points of interest along the way.
Safe seating can be enhanced, as above, by wide walls at sitting level, so anyone can 'take a break' when they fancy it. The areas of shaded seating are also important, especially in this weather.
Connecting with nature
'MHSOP Unit' gardens, Llandough Hospital, Cardiff. Photo courtesy of Tim Nichols
In this example, you can see the raised flower beds are full of herbs and colourful flowers, to stimulate sight and smell. Also, patients at these units have planted sun flowers and tomato plants, so they watch their efforts at gardening bloom and grow. Also, having a product to taste and display later on is very rewarding.
You can see some tall shrubs and trees have been planted to break up the built features. Shrubs have been carefully selected to attract butterflies and bees etc, e.g. buddleia and lavender. Many sensory gardens will have a bird feeder corner and/or a goldfish pond, so that people can observe small animals and help feed and encourage them. Unfortunately, in our unit these were discouraged by our colleagues in estates due to the risk of attracting rats and dirty water causing a listeria risk.
There is also the issue of maintenance and gardening support. This was one that took a while to crack, simply because across our health board such workers were in great demand. One note of caution, if you are going to install artificial grass, be aware that weeds will always find a way. Safely maintaining gardens to keep down weeds and slugs and snails and so on, means that is probably best to avoid having toxic substances about and go for plants which little critters don't enjoy..
Connecting with art
In this photo of the same gardens, you can see that the top wall has been an art project, to create an interesting and attractive birds and butterflies design. It's great to engage people with dementia directly in such arts projects.
You can also see the wind chimes, which add another sensory experience - hearing - to the garden experience. Colourful pots and lighting complete the garden.
In the Lys Enfys photo above, you can also see that elements of reminiscence have also been considered - the garden gnomes, the Judy Garland plaque and of course to 'phone box. There is also a wishing well, if you look closely.
Our Llandough Hospital gardens are shared between two day hospitals downstairs and five wards upstairs. This was the configuration we were 'given', but what we managed to achieve with our design team was every upstairs ward having access to a safe sun balcony, with a therapy room opening onto it via patio doors. We also managed to have dedicated lifts built in to each balcony to allow access to the gardens downstairs. All that was then needed were staff to accompany patient groups and ensure people got back safely to the right setting.
Photo courtesy of @PlaylistforLife
There is nothing better, for me anyway, to be in the garden listening to music. Especially, if it a personally curated playlist of YOUR favourite music. We'll come back to this in a later article, but just to say for now having a decent speaker and a few age appropriate and garden, season or weather focused playlists ready to go, for some group singalongs and dances, is a lovely way to spend an hour or two outside.
Having a few outdoors games ready to hand to play is a good idea. Boules, or beach balls are a great start. Large dominoes and a hopscotch template are also good to have on stand by. Eventually, a library of resources can soon be amassed.
Sheds & Garden Rooms:
'Holme Manor' in Lancashire
Having a garden shed for individual and group activities, such as potting on, fixing things, model making and generally fiddling, can be the focus of some wonderful outdoors activities, especially if the garden as previously been a big part of the person's life.
Having a safe non glass treehouse can encourage more focused gardening activities. Or having a garden room for comfortable shaded seating can be a lovely and relaxing escape, of individual time or visiting.
My late Mum's care home had wonderful outdoors facilities. ('Capel Grange' in Newport). It was a fully accessible space, even for her in her specialist chair and she loved to sit out there and do the crossword and have a glass or two of red.
The other benefit was the garden was off an open plan conservatory dedicated for family visits, group activities and individual time. A free drinks station was also on hand.
Final notes of caution
Remember the factor 50 and remember that some medicines result in sun sensitivity, so it's best to check that out before enjoying outdoors activities.
Be mindful of your group and notice when individuals have had enough and want to go back inside, or if they are becoming overheated or chilled.
Built environments and garden furniture obviously require capital funding and have some staffing implications regarding maintenance and cleaning. However, much can also be achieved via charitable fundraising and contributions.
In the next article we will focus on more 'low teach' outdoors approaches, so let me know if you have any models of best practice to share.
Also, don't forget to share your own dementia friendly garden photos and I'll make a gallery up below. (Just bear in mind photos will need to follow your organisation's consent policy.)
Some useful resources for further more detailed exploration