A lovely bouquet goes a long way.

Digging through our Piedmont, North Carolina, clay soil in late fall to drop an unattractive bulb into a hole, only to cover it up and conceal backbreaking labor, is just not fun. But, oh, the fun comes later. Enjoying the bounty derived from the ungratifying task of fall bulb planting is one of my favorite springtime delights. Dozens and dozens of scented hyacinths, daffodils of varying yellows, and vibrant, perky tulips will announce that winter is behind us!

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Bulb planting days are upon us. As a horticultural therapist at Hospice and Palliative Care of Greensboro, it is my role to enable patients at our 14-bed residential facility to be as involved in gardening as their conditions allow. In addition to working with people who are hospice-appropriate, my services have been contracted to involve residents in two local long-term care facilities. Living at both of these locations are residents receiving hospice services and support, and residents with varying abilities and limitations who are not faced with a terminal diagnosis.

Whether the residents live at our hospice facility, are hospice-appropriate in a long-term care setting, or are not within the final days of their lives, the goals for activities are the same: improving quality of life, offering opportunities for regaining control, transferring roles from care receiver to caregiver (of plants), and enabling those with limitations to continue to participate in worthwhile activities. Since bulb planting is a strenuous task, even for an able-bodied, healthy person, how does this fit into a facility's programming?

Begin with a planning session with the residents. Catalogs boasting cheery springtime daffodils, tulips, and the like are a good place to start. During the planning session, you will need a poster board with a stand, brightly colored markers, and as many catalogs and books of bulbs available in your area as you can collect. Allowing the residents to thumb through the pages will stir up memories of the flowers they planted with their families in their own yards.

A discussion of the flowers in the catalogs, with vivid descriptions for those who have limited eyesight, may create a pleasant mental image of something they can no longer see. On the poster board make a list of bulbs that the group would like to see planted. Attach the catalog picture beside its name and leave that posted. When the ordered bulbs arrive, it will be encouraging to look from the actual bulbs to the poster to remind everyone of the miracle of their transformations.

Now let's plant! If you have access to raised beds at your facility, the residents can easily bury the bulbs. If you do not, in an article in your facility's newsletter, invite the families of the residents to join in a bulb-planting day. Depending on the quantity of bulbs, you may want to approach local businesses to see if they would allow their employees to become involved in your project. In Greensboro, during our Days of Caring, local businesses offer their employees an opportunity to help a nonprofit organization by letting them choose to take a half-day, or sometimes a full day, to help us. Residents appreciate help from the community and can work alongside their families or community volunteers as they open packages of bulbs, hand them out, or simply sit in the midst of the activity.

Fresh flowers bring life into a facility where some of the residents have little chance to experience it otherwise. In the spring there will be plenty of blooms to pick and bring inside. Until then, purchasing cut flowers can provide programming on many different levels. I interact with residents who are physically and mentally healthy enough to carry out most gardening tasks. Also present within most facilities are those less fortunate who are not able to participate in an organized activity. How can all residents, regardless of their limitations, be included?

We begin by placing arrangements of greenery and colorful, cut flowers in vases. Evergreen sprigs will provide a contrasting backdrop that will showcase white, yellow, or other colored flowers. Try to keep those with limited eyesight in mind by choosing colors that are easier for them to see and by including flowers with a pleasant scent. Each participant is encouraged to give a completed vase to a bedridden resident who is unable to journey outside. Smaller vases are provided if residents would like to take a vase to their own rooms. The focus of the activity is empowering the residents to create a gift that can be shared with a neighbor. During delivery of the bouquet, allow time for interaction between the creator of the gift and the recipient, using the flowers themselves to break the ice. For those who have limited or no sight, we describe the color and shapes of the flowers. The sense of smell is awakened as they inhale the sweet fragrance.

Living within most facilities are many whose abilities fall in between the independent gardeners and those who are unable to participate in creating a bouquet. There are also residents who are able to venture outside their rooms but choose not to, as well as those who may be confined to a bed but have the use of their hands. Instead of presenting them with a vase, already arranged, they may choose to participate if I carry a bucket of loose flowers and greenery, an empty vase, pruners, and a plastic measuring cup into their rooms and invite them to put together their own creation.

By carrying all of the individual components that comprise the bouquet into residents' rooms, the control is transferred to them. They may only want to fill the vase with water, using the manageable measuring cup. Or maybe they'll say, "You do it." If they don't want to participate physically, I ask them questions that will allow them to guide me in putting the bouquet together.

At one facility, a family member donated funds to provide flowers weekly so that the residents could always have fresh bouquets on their dining room tables. The icing on the cake is that the residents are responsible for arranging and filling each vase through a weekly flower arranging class. Increased socialization, a sense of purpose, and improved fine-motor coordination are the gifts the flowers have to give.

After a stroke, one of the gentlemen who was using the pruners to remove the wrapper from the bound flowers and then cutting them to more manageable lengths commented, "This is really good therapy for me, using my weak hand to open and cut the bundles."

Another participant brings a small pair of scissors, enabling her to successfully arrange the flowers. The first time she came to class she quietly said, more to herself than to the rest of us, "Flowers add so much to the tables."

In Memory Care, in addition to the flower arranging for the tables, we encourage one-on-one participation. Holding a bright orange Shasta daisy with its boldness of color, smelling a sprig of fresh eucalyptus, or feeling the smoothness of a soft rose petal can possibly speak to a mind that no longer processes human conversation.

Using flowers at any time of year offers an invitation to socialize, the opportunity for control in a restricted setting, sensory awareness, and perhaps, most importantly, a chance to experience pleasure and joy in the reality of severe limitations.

Sally Cobb is a Horticultural Therapist at Hospice and Palliative Care of Greensboro in Greensboro, North Carolina. Her goal is to create healing gardens around the three buildings that make up the facility, involving as many patients, family members, and community volunteers and donors as possible. For more information, call [phone]. To send your comments to the author and editors, e-mail [e-mail].

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