Today's healing gardens: more than shrubs and flowers; The many considerations that go planning healing gardens that work.into.

Recent research in healthcare design has identified an important positive link between the well-being of people in residential healthcare settings and exposure to nature. Residents with access to outdoor environments are more aware of their surroundings and of time of day and seasonal changes, are more engaged in activities, and benefit from fresh air, exercise, and sunlight. Moreover, the design may incorporate features that support therapeutic treatment programs, including physical, recreational, occupational, and horticultural therapy.

In her book The Healing Landscape: Therapeutic Outdoor Environments, landscape architect Martha Tyson describes the philosophy, benefits, and characteristics of healing gardens. According to Tyson, the project's overall design philosophy should be holistic, providing a living environment for residents that will allow them to nourish their minds, spirits, and bodies. A therapeutic outdoor environment provides places that support outdoor activities that allow residents to engage in familiar tasks that they can accomplish with limited assistance; e.g., gardening and other light chores, as well as walking, standing, or just sitting and observing nature.

In effect, outdoor spaces extend the living/activity areas of the building into the landscape. They provide places for large group gatherings, small seating areas for visiting, pathways and benches allowing enjoyment of solitude, and a variety of natural colors, forms, textures, and sounds to create an ambience that helps to reduce stress.

At their best, therapeutic outdoor environments are designed based on a master plan that integrates the built environment with the landscape--from the perimeter of the property to the residence itself. Landscape elements within the master plan include:

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* perimeter landscape

* site entry and arrival

* parking lot layout and plantings

* building-entry gardens

* building-edge plantings

* walkways

* garden views

* patios and courtyards

* working gardens

* water elements

Here is how these elements figure into planning for today's healing gardens.

Defining Boundaries

The perimeter landscape defines the overall boundaries of the project as they relate to the surrounding neighborhood, anchors structures to the property, and creates a sense of environmental closure for residents. The specific landscape plan and choice of plant materials for this are guided by the existing characteristics of the site, including topography, vegetation, and nearby structures. Ideally, the perimeter should consist of both formal and natural elements, with the more formal elements along edges facing public streets and the structures on or adjacent to the property. Consideration also should be given to screening the residence from the surrounding neighborhood for enhanced privacy and security.

Cars and Gardens Don't Mix

The residence arrival and entry area should be designed to minimize intrusion by the sight and sound of motor vehicles into the gardens; ideally, the parking should be located on the side of the building that provides the most effective separation of parking and gardens. At the same time, the building lobby and other public spaces in the residence should provide views of the gardens that can be enjoyed from indoor seating areas and draw residents and their guests outside.

Similarly, the parking lot should be situated at the rear of the building, with islands of low plantings and small trees providing a screening and softening effect, especially for those residents whose apartments or rooms unavoidably overlook the parking lot.

A Pleasant Transition

Building-edge garden beds with small trees, shrubs, and flowering plants soften the transition from the landscape to the building and provide focal points at windows, as well as improve the view from residents' rooms overlooking the parking lot.

Building-entry gardens at the vehicular drop-off point and other exterior doors should create a sense of welcome and a natural transition between the building and the larger gardens. Plants in entry gardens, as well as in building-edge and parking lot beds, should be chosen based on relative scale, appealing color and texture, tolerance of paved areas, and sun/shade requirements.

From a Stroll to a Long Walk

Walkways should provide opportunities for walks in various directions and of varying distances. To meet the requirements of the Americans with Disabilities Act (ADA), walkways should be level to gently sloped and wide enough to allow two wheelchairs to pass one another. Careful consideration should also be given to providing good drainage and to choosing paving materials that minimize the potential for slips and falls. Bollard-type lighting fixtures, two- to three-feet high, should be provided to light walkways without eye glare.

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Focal Points

The landscape design should provide opportunities to view the gardens from various distances, perspectives, and heights. These viewing areas should be distinguished by small structures of various sizes and types--for example, small trellised structures, gazebos, or tree-shaded areas, with seating for individuals and small groups. These structures can also serve as landmarks along the walkways.

A patio and courtyards just outside the residence's public spaces provide a central focal point for the healing gardens and define outdoor spaces to accommodate gatherings of residents and guests. The garden beds surrounding the patio are the ideal location for low flowering shrubs and colorful annuals and perennials, punctuated with a few small trees. Beyond the patio, yet visible from it, lawn courtyards surrounded and crossed by walkways provide further space for gatherings. Functional lighting should be provided at the patio and courtyard perimeter for evening enjoyment and safety. Decorative lighting may be used here and elsewhere in edge gardens to accent particular specimens of plants and trees.

Water elements enhance healing gardens with soothing sounds and a cooling effect, and serve as an attraction for wildlife. Options for these elements include ponds, fountains, containers with floating water plants, and birdbaths.

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Rolling Up Their Sleeves

Working gardens allow residents to grow their own vegetables and flowers. These gardens must be level, with a southern exposure, sufficient water and electricity sources, and a small structure for tools and supplies. The working gardens should be close to the residence, but not at a focal point, since they will not be planned or maintained by professionals.

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Considerations for Upkeep

Overall, the landscape design must balance the goal of providing a comfortable home environment that enhances residents' quality of life but includes practical consideration of implementation and maintenance costs. One of the worst things that can happen to a healing garden is for it to look neglected because of a lack of proper maintenance. A landscape must be designed for durability and ease of maintenance, as well as beauty. A good irrigation system is essential. Finally, adequate funds must be provided for periodic professional tree and landscape maintenance, even if residents are actively involved in planting and routine upkeep.

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Providers can consider multiple project examples in planning their healing gardens (see figures 1-6).

These project examples represent current trends in the design of healing gardens for assisted living--among them, offering residents a series of walks or paths that connect a garden's distinct settings, each distinguished by degrees of sensory interest and a range of activities and materials. The distinct settings include: (1) the covered porch; (2) small, formal lawns, vine-covered trellises, and gazebos, creating recognizable landmarks; and (3) gardening for active interaction by residents with an agrarian theme. By incorporating gardens in residential healthcare facilities, providers can significantly enhance the care of the body, mind, and spirit for each resident they serve.

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Ron Reid, AIA, is President of Ron Reid Associates, PC, Architects. For further information, phone [phone] or visit www.rra-a.com. To send your comments to the author and editors, please e-mail [e-mail].

BY RON REID, AIA