What makes a healing garden? A tour of three facilities' gardens that nurture residents' well-being.

Unfortunately, many gardens for the long-term care setting are poorly designed. For example, I recently toured a garden for residents with Alzheimer's disease in a very hot and dry area of California and learned what had not worked in its original design. The fix involved adding a canopy (for much-needed shade) and vinyl fences to keep residents on the raised sidewalk from falling into the rosebushes. So clearly sponsors of such projects need to fully understand the benefits of a well-designed healing garden and not inadvertently create an outdoor environment strewn with obstacles, hazards, and potential liabilities.

In appropriately designing a long-term care garden, we need to consider the theme of "wellness" and approach the design holistically. Positive outcomes for residents, family, and staff can be achieved by creating an outdoor environment that capitalizes on an individual's strengths and compensates for his or her weaknesses. The focus should encompass the resident's physical, psychological, social, and spiritual needs--and the following three examples describe this holistic approach to landscape design and its positive outcomes.

A Garden Symbolic of Life's Journey

In 1964, Father Gordon Mycue recruited some local businesspeople to approach the Archdiocese of Minneapolis and St. Paul to gain support for constructing a freestanding, Catholic-based campus.

Since 1968, St. Therese Home, Inc., has served the senior population in a variety of settings. Located in New Hope, a suburb of Minneapolis, the organization manages a 298-bed nursing home and 220 senior apartments both for independent and assisted living, and provides home healthcare, rehabilitation, and pharmacy services, as well. The campus includes a convent that provides housing for the Sisters of St. Benedict and a resident priest who lives on-site and provides spiritual support to residents and conducts daily Mass. The campus also has a healing garden; landscape architect Gary Fishbeck says, "The garden at St. Therese is both a 'prayer garden' for those residents whose faith is central to their lives, and a beautiful, nurturing environment. It serves as a 'healing garden' in that it brings a deep sense of calm and joy to the lives of those who immerse themselves in this place."

The garden, called The Way of the Cross (Figures 1 and 2), was designed to allow one to "walk with Christ" in prayer. The pathway, stone stations, and plantings each symbolize various aspects of Jesus's life and journey. Besides being a spiritual place, the garden serves as a venue for social gatherings and exercise. (Indeed, anyone who enjoys the entire walk and visits all of the 14 formal stops along the way certainly gets a physical workout, along with the other benefits.) The garden can also serve as an outdoor chapel for devotions involving large numbers of people, with a semicircle of spruce trees providing a sense of enclosure.

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The final improvement for this campus was the creation of a new landscaped plaza. Located just north of the main lobby, this patio will have comfortable areas in which to sit, bubbling water in a small pond, and carefully selected plants, trees, and flowers to provide pleasant fragrances, colorful blooms, and lush textures.

"Backyard" Design for a Rooftop Garden

Another sponsor, with a similar name but separate ownership, is St. Therese--Southwest, located in Hopkins, Minnesota. The organization offers a range of retirement living options in a high-rise building on a suburban campus--a high-rise that is, in fact, pastoral in some aspects. Specifically, it offers a rooftop "Midwestern backyard" garden, along with an outdoor deck with grill area, screened gazebo, and numerous flowering planters.

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Opening off the main dining room is a 2,000 square-foot circular patio allowing residents--even those who require walkers, canes, or wheelchairs--easy access to the outdoors. Checkerboard-patterned patio blocks articulate the space, which includes a shuffleboard court and areas covered with synthetic turf to provide sure footing and a splash of color in the winter.

The 500-square-foot screened gazebo provides a shaded, bug-free alternative to the sunny deck. A sandbox is available for visiting grandchildren, and large, 3-foot-high terra-cotta pots allow residents the opportunity to "work in the dirt" and enjoy horticultural therapy. Hanging pots of annual flowers are suspended from the screened roof overhang, providing draping colors and fragrances for residents to enjoy.

The rooftop garden was inspired by elements found in typical backyards in the area and is well maintained by the residents. In fact, Wanda R., a new resident in the independent living facility, says she enjoys all the activity that the rooftop garden provides, noting, "You can see the screen house as soon as you get off the elevator and, whenever we eat in the dining room, there is something delightful to look at. I not only enjoy the changing colors of the blooming potted patio plants, but also love the long-range vistas of sky and woodlands beyond."

Evoking Memories and Keeping Safe

Through their research for a new one-story, 20-bed facility for Alzheimer's residents in Yubba City, California, the architectural design team discovered behavioral patterns among residents that shaped the backbone of their landscape design. Since residents were rarely in their rooms and often wandered, the design took on a diamond shape with a continuous interior corridor, resulting in a secure outdoor "wandering garden" featuring nontoxic plants, a vine-covered trellis for shade, a circular-pattern sidewalk, soothing sounds from a small fountain, comfortable seating, and ample lighting for safety during nighttime use (Figures 5-8).

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At each corner of the building the interior corridor system opens up with large glass windows and doors looking on unique courtyard gardens. Featuring a different wall mural in each "knuckle" (or corner where corridors intersect), these areas become warm living areas that are flooded with sunshine and have intimate views of the outdoors. A high, secure garden wall provides a barrier to elopement, and each courtyard gate is programmable to provide for safely delayed exiting in case of an emergency.

With ample opportunities to view and visit the courtyards and central garden, residents are aided in their orientation to the world while they witness physical cues evoking pleasant memories of past experiences with plants, insects, and birds. This healing garden was so successful that the sponsor named the facility itself "The Gardens."

Conclusion

These three examples exemplify successful, comprehensive garden designs that are appropriate to the long-term care setting. After viewing them, one has to conclude that it's a shame that sponsors often stop short of achieving the full benefits of their outdoor amenities. A holistic approach to landscape design can improve the journey as we age by introducing garden environments that engage all of our senses while promoting wellness and healing and providing quiet fun.

Peter Rauma, AIA, NCARB, is an architect with Hammel, Green and Abrahamson, Inc., a full-service architecture, engineering, and interior design firm with offices in Minneapolis, Rochester (Minn.), Milwaukee, Sacramento, San Francisco, and Los Angeles. He specializes in the design of residential environments for aging throughout the United States. He can be reached at [phone] or at [e-mail]. For more on healing gardens in Long-term care, see Nursing Homes/ Long Term Care Management, June 2002, p. 22. To comment on this article, please send e-mail to rauma1003@nursinghomesmagazine. com.