Outside Space
factors at work very clearly now: fearful attitudes towards health and safety effectively ‘capped’ engagement levels with the outside space; care home cultures that were lower on this care culture spectrum tended to use garden features to help activate the outside space, whereas those homes further up, practising a more relationship-centred form of care, were using their staff to engage residents with the garden.
THE CARE CULTURE MAP In basic terms, we didn’t want to be yet another set of researchers saying ‘what’ needed to be done (to activate care setting gardens), but more importantly to show ‘how’ it could be too. We rejected the usual route of writing a report, and deployed our graphic and visualisation skills to create an easy-to-use, poster-sized, practical diagnostic tool, the Care Culture Map – based on our findings and the care culture spectrum we had plotted.
This aims to help the care setting locate its current care culture practices along this spectrum of care. Interestingly, it wasn’t until the final stages of the Map’s development that we were able to add the final piece of the jigsaw: how outside specialists such as garden designers, gardeners, horticultural therapists, and architects, might fit in to support care setting residents in engaging more meaningfully with their outside spaces. We added an extra column to the Map to help the garden designer and other outside specialist work out how best to support their care setting client at the point on the care culture spectrum where they are currently positioned. If this is not done, the danger is that the designer can end up providing support at a higher level than the care setting’s actual position on the spectrum – resulting in the garden not being used as intended, because the actual cultural practices lag significantly behind its new functionality and design attributes.
CARE CULTURE DRIVES OUTSIDE SPECIALISTS’ INVOLVEMENT We had followed the evidence across the whole of the care setting, and, with the help of the 17 care homes in our project, had emerged out the other side with this clear finding: care culture should drive involvement of the garden designer and other specialists if the intervention (and investment) is to be embedded and owned by the care home longer term. In other words, design support needs to match the current abilities of the home and where they are located culturally, and not go too far beyond this. We began this journey by questioning why care setting gardens that had been designed,
About the authors
Debbie Carroll and Mark Rendell, from Step Change Design, are garden designers with a background in creating therapeutic, sensory, and care gardens. Having worked together on community outdoor projects in the past, they came together again in 2013 to undertake a self-funded research project to answer a question, particularly in relation to people living with dementia, ‘Why aren’t gardens around care homes used more?’ They set up Step Change Design in 2014 to provide a focus for their work with care settings and specialists who work with them. ‘Passionate about unlocking the potential of outside space to help residents live the lives they choose, inside and outside the care setting’, they have produced a poster-sized diagnostic tool, The Care Culture Map and accompanying Handbook, ‘to help care settings practically and clearly identify ways to use their gardens more’.
and had had a lot of money spent on them, were not more actively used by their residents, even if the garden had met current design guidance. The answer related to information about how the care setting was using its garden already. It became clear that if the care setting didn’t use its current outside space regularly, then a new garden was unlikely to make the facility use it more, especially after the initial novelty value had worn off.
In other words, if the use of the current
garden isn’t embedded in the routine habits and practices of the care setting before the garden designer arrives, then it is not likely that making it prettier, redesigning it, and introducing new materials, features, planting, and colour, are going to make it any more integrated into the care culture in the long term. In fact, it could be a waste of money.
RELATIONSHIP-CENTRED DESIGN So how do we ensure that investment in our work as designers and specialists results in good value for money for the care setting, and a positive reflection on our reputations? It is clear that we need to get to know our care setting clients much more deeply than we perhaps
currently do. We also need to reflect on the way we traditionally deliver our design work. We are here to support the care setting on its culture change journey. For this to happen, we need to build a relationship with the care setting, and support its forward progress up the Map and along this care culture spectrum towards greater relationship-centred care. The care setting needs also to articulate its care culture practices so that the designer can match their services to this position. We call this approach ‘relationship-centred design’. However, what do we mean by this? As a result of our research, we advocate a new approach to working with our care sector clients that starts from where the care setting’s culture currently is, not from where we (or the care setting) think it should be, or hope to take them. We are talking about a major shift in garden design and outside specialist practice: from a one-off, product- driven approach, to a more sensitive, ongoing approach entailing possibly smaller commissions, but over a longer timespan with the care setting – matching interventions to their evolving care culture practices and engagement levels with their outside spaces, and effectively building a mutually supportive relationship with our clients.
OBSERVING PRACTICES AND BEHAVIOURS
A selection of images taken during the pair’s research into gardens used by care home residents, particularly with dementia, during 2013.
26 THE NETWORK Ap r i l 2 0 16
This also requires the designer to build in time to establish the cultural position of the home in practice, if not in aspiration. Consequently, we advise designers to understand the cultural practices at work, and to build in time at the care setting as a part of the site survey and analysis phase, observing behaviour and practices, inside and out, to establish the reality of the care culture at work. The Map tool can help with this. We also found that, although we are seen as garden designers, these skills may not be what is required of us, at least initially, when we work for a care setting. We also have an important role as advocates for the therapeutic value of the outdoors in the overall care provided at the home. Our enthusiasm for, familiarity with, and championing of, the outdoors can be enough to help a cautious care culture to shift significantly in its attitudes towards this valuable resource, paving the way for more investment and design support in the future, aligned carefully with our knowledge of where the organisation is on the care culture spectrum.
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