1. H | D | R | C
Housing and Dementia Research Consortium
Annual Knowledge and Learning Exchange Event 10th Nov 2016
Green Dementia Care in Extra Care and Residential Care Settings
Dr Julie Barrett, HDRC Research Coordinator
Julie Barrett
Research Coordinator for HDRC
Going to talk about what’s going on in the UK in terms of green dementia care and a pilot study that we have just started.

2. What is “Green Care”?
The term “Green Care” refers to a range of health-promoting interventions encompassing living organisms (plants and animals) and natural elements (e.g. the weather).
Green Care links traditional health care to:
Gardening (horticultural therapy)
Agriculture (green care farming)
Animals (animal assisted interventions)
Exercise in the natural environment.

3. Green Dementia Care
There is growing interest in the physical, mental, social and spiritual impacts of green care for people living with dementia.
There is some evidence to suggest that engagement with the outdoors and nature is important for people with dementia and can be beneficial to their health and wellbeing.
However, overall the evidence base is very limited and fragmented and often anecdotal or based on individual case studies.
Despite growing interest in the subject of connection with nature for people living with dementia, and the potential benefits for health and wellbeing, the existing evidence tends to be anecdotal and/or based on small studies that provide limited insight into what works and for whom. In addition, the participants have mainly been people living in their own homes in the local community.

4. Green Dementia Care in accommodation and care settings
Research that focuses on green dementia care in care homes and extra care housing is very limited.
There is a need for large scale, multi-site, multi provider research to better understand the effects of interaction with the natural environment on people living with dementia in such settings.
To lay the foundations for such research we are carrying out a pilot study…..
There is a dearth of research on the impacts of interaction with the natural environment on people with dementia living in residential care and extra care housing.

5. Pilot study: Green Dementia Care in Extra Care and Residential Care
I year pilot study funded by the Abbeyfield Society. Began 1st Nov 2016.
Gather existing evidence on the impacts of interaction with nature for people with dementia (literature review).
Identify opportunities available in UK to people living with dementia in extra care and residential care settings to engage with nature (survey)
Explore the barriers and enablers to engagement (interviews with residents with dementia and staff in case study schemes).
We will be looking at:
1. Existing evidence for the impacts of interaction with nature on health and wellbeing outcomes for people living with dementia, e.g. behaviours that challenge, cognitive function, social interaction, eating and sleeping patterns.
We will also look at:
2. Examples of successful approaches to providing nature-based activities for people living with dementia.
Using an online survey, we will gather info on:
3. What facilities, programmes and activities currently exist in terms of interaction with nature for people living with dementia and to what extent the residents with dementia engage with these activities.
We will then carry out interviews at case study sites to examine:
4. Management and staff perceptions of: the benefits, enablers and barriers to engagement with the natural environment for residents with dementia and the contextual factors that facilitate or hinder engagement, such as policy or design.
5. The individual characteristics and factors that enable or hinder involvement in nature for residents living with dementia, such as perceived difficulty, fear of falls, previous involvement in nature activities such as gardening.

6. Current programmes
The main purpose of this presentation is to give you some examples of current activities and programmes in the UK that connect people with dementia to the natural environment.

7. Dementia Adventure Organises dementia friendly
Holidays
Short breaks
Walks in local parks, woodlands and nature reserves.
Runs workshops for those who want to start up walking in nature groups.
Mainly aimed at people living in their own homes.
Help people with dementia to get outdoors and connect with nature by organising dementia friendly holidays, short breaks and walks in local parks, woodlands and nature reserves and other activities such as cycling and gardening.
Workshops have begun to instruct those who would like to start up walking in nature groups for people living with dementia.

8. Eden Alternative Used in Accord Group care homes.
Life revolves around close and continuing contact with plants, animals and children.
One of the principles of this approach is creating a human habitat where life revolves around close and continuing contact with plants, animals, and children.
Research in the US has shown health and wellbeing benefits for older people in general (Eden Alternative brochure), however, green care is just one of a range of person centred principles in this approach and its contribution to the benefits seen is not known.

9. Thrive This charity runs:
structured programmes of horticultural therapy activities for people with dementia which focus on positive reminiscence, re-connecting with others including friends and family and gentle appropriate exercise and cognitive stimulation.
workshops in dementia care homes to encourage more people to take part in gardening.
Offers gardening programmes (social and therapeutic horticulture) at four regional centres in Battersea, Birmingham, Reading and Gateshead.

10. Living through Landscapes
The charity ‘Learning through Landscapes’ has been awarded a £1.3 million Big Lottery Fund grant.
Make the gardens of 30 care homes in the UK dementia friendly.
Provide training to staff.
University of Kent to evaluate.
To address the issue of under usage of care home outdoor areas by residents with dementia, the National Lottery has provided a grant to ‘Learning Through Landscapes’ to make the gardens of 30 care homes in the UK dementia friendly.
The charity ‘Thrive’ will deliver the necessary training to staff.
The University of Kent will evaluate the impact of the transformed gardens on the lives of residents living with dementia.

11. Creative Spaces in the Community
Project run by the charity ‘Sensory Trust’.
Funded by the Big Lottery Fund.
Began in March 2014.
Uses nature-focused activities and creative community engagement to improve physical and mental wellbeing of people living with dementia in their own homes in rural communities in Cornwall.
Aims to: create a model to demonstrate the benefits of incorporating the outdoors in dementia-friendly rural communities, and showing how to achieve this.

12. Breath of Fresh Air
The Abbeyfield Society developed this in-house programme to encourage care home residents with dementia to connect with nature.
Consists of resources and training workshops to show carers the benefits of being outdoors.
Has been rolled out across Abbeyfield with over 60 Breath of Fresh Air Ambassadors .
April Dobson (Abbeyfield Head of Dementia Care), who developed the programme, is the winner of the 2016 Hennell Award for innovation and excellence in dementia care. 
Pic: ‘Breath of fresh air’ sensory garden for people with dementia exhibited at this year’s Hampton Court Flower show.

13. Dementia Care Farms
‘Down to Earth’ dementia care farm, Millbrook, Hampshire.
Care farms are becoming increasingly popular in the UK for their therapeutic farming practices designed for vulnerable groups of people, including those living with dementia.
This nature-based intervention, which originated in the Netherlands, specialises in providing a supervised, structured programme of farming-related and other activities, such as feeding and caring for animals, woodwork, gardening activities and crafts using natural materials – all supported by specialist staff in a safe setting.

14. HenPower Set up by the charity ‘Equal Arts’ in 2011 in the north-east.
Uses hen-keeping to promote health and wellbeing and reduce loneliness among care home residents, including those living with dementia.
12-month study of the project by Northumbria University in found that Henpower improves the health and wellbeing of older people, and reduces depression, loneliness and the need for antipsychotic medication in care homes.
Now in more than 40 care homes. Is extending to other areas of the UK and to include extra care settings.

15. Pet therapy
The Elisabeth Svendsen Trust, brings donkeys into care homes for residents’ enjoyment.
Guardian Homes (Scotland) – residents are encouraged to bring in pets. Individual homes have aviaries, chicken coops and sheep.
Sanctuary Care – homes have at least one pet, including cats, guinea pigs, rabbits, chickens, fish and birds. Residents also receive visits from a range of animals including owls, donkeys and giant snails.
Sanctuary’s Chadwell House (dementia specialist) is especially pet friendly. Pets include six rabbits, four guinea pigs, two budgies, two chickens and two cockatiels.
These are just some examples of what is going on around the country in terms of engaging older people, particularly those living with dementia, with the outdoors and with the natural environment => next slide

16. Do you have any examples?
I would like to conclude this presentation by asking the room if you have any examples of green dementia care that you could share with us.
Photo courtesy: Let Nature Feed Your Senses and Magdalen Environmental Trust-Somerset