Dirty Hands and Active Minds Part 2

In Part 1 we discussed the problems with a gardening program at the Three Hills Senior Center and explored some of the reasons these programs often fail.  In Part 2 we follow the folks at Three Hills as they discover was to use their garden area as a therapeutic resource.  Hope you enjoy the rest of this story.  I welcome your thoughts, ideas and comments.
Peace, Hank Bruce

Defining the program before you begin.


Dr. Bennett revived the horticultural therapy program at Three Hills by bringing Jessica, an experienced horticultural therapist, in for a training session for the staff. In two days she introduced everyone from the administrator to the maintenance crew to the field of horticultural therapy. She did this by engaging staff and residents in a little hands-on activity where they had fun learning the basic objectives for such a program, and how to implement them.

She explained that there are universal objectives, such as:
∙ Empowerment
∙ Increased socialization
∙ Sensory stimulation
∙ Physical activity
∙ Mental stimulation
∙ Increased participation

Then she discussed Individual Treatment Goals.
They reviewed the charts of five residents who had expressed interest in a gardening program. They discussed specific expectations, limitations and needs. Then they wrote a list of three objectives for each participant in the program, and several possible ways to achieve these. The residents selected a “JOB” from a list and this became the basis for their participation and evaluation.

∙ Gladys needed to work on her balance and proper body mechanics. She accepted the job of tying the vines to the trellis every three days.

∙ Jimmy was dealing with chronic depression and needed to work on awareness of his surroundings. He chose the responsibility for monitoring water needs with the moisture meter.

∙ Maureen needed to improve her confidence level and interpersonal skills. She was given the responsibility of deadheading the flowers in the entry way garden.

∙ Carl had some problems with attention span and details. But when he selected the job of tending the roses he became a rose expert.

∙ Bernie had been diagnosed with Alzheimer’s and displayed moments of anger and inability to follow directions. She worked with the “Reminisce Garden” planted with safe, non-toxic sensory plants. She spent a good deal of time talking to her “silent friends” and a few fellow gardeners as well.

Cultivating success
So often horticultural therapy programs that begin with a burst of enthusiasm and initial success falter and fail within months and many don’t survive to the second year. This can be prevented with a little planning ahead, and including the participants in the process from start to finish.

The site
Next Jessica walked through the courtyard discussing some of the elements that limited resident activity there. These included narrow walkways, little shade, limited access to the plants, little opportunity to be actively engaged. It was a beautiful landscape, but it was designed to be a passive rather than active experience. She suggested:
∙ The addition of a gazebo and a couple shade canopies
∙ Several vertical gardens and a “covered bridge” that provided easy access to plant material, an active experience and shade.
∙ Portable gardens that made gardening activities accessible for wheelchair users, and those who had mobility limitations.
∙ A whimsy pool with rubber ducky races, a potted cattail, a water lily, a real live turtle and several goldfish.
∙ A butterfly garden, created in cooperation with a local elementary school.
∙ Curbing on the walkways to help keep wheelchairs from tipping.
∙ Most popular was the Barefoot Park compete with bubbles and a beanbag court.

It should be noted that the residents made the bean bags and helped compile a list of features for the garden. They planted around the covered bridge with plants they selected by voting, and even painted rubber ducks as a part of an multi-generational program.

The gardening activities involved both indoor and outdoor projects, and not everyone was doing the same thing. Often they worked as teams, helping each other, sharing memories and new discoveries. Many of the projects involved starting plants from seeds or cuttings. These would become their individual “windowsill gardens.” Often they would make planters to give to friends, folks at the nearby hospital, and staff.

Evaluation
Bernie worked with the Reminisce Garden. Often she would sit on the ground and pet the leaves of the Lambs Ears or smell the mints, or pull the petals from the roses and throw them in the air.
Her treatment goals included:
Finding her way to the Reminisce Garden each day
Strolling the entire courtyard following the “Wandering Way Path, (painted pink)
Reducing anger and agitation
Sharing memories
Following simple directions in a 1-2 sequence
Engaging in meaningful shared activities

With most forms of dementia the goal is not to follow a treatment plan leading to healing, but it is a matter improving the quality of life for the individual and the family. This can involve sensory and mental stimulation, delaying decline, providing some positive moments, connecting with the person dwelling within, and engaging with the surroundings and other people. But most of all it requires us to accept the individual as a fellow human being and respect them as such.

Each day her activities were briefly noted in each of the treatment goals, and a weekly summary was prepared. At the end of the three month program overall response was reviewed with staff and a new set of treatment goals and activities was prepared. It should be noted that her anger outbursts began to decline within the first week and were rare by the end of the first three months.

For others the Individual Treatment Goals included:
∙ Improved range of motion
∙ Reduced need for anti-depressive medications
∙ Engaging in group activities
∙ Successful problem solving
∙ Accepting responsibilities

Soon the residents formed a Green Thumb Club that included many gardeners who did not have Individual Treatment Goals. All the residents engaged in the decision making process, and had the freedom to do individual projects as well as the group activities.

Investing in a Professional

Gardening activities and horticultural therapy programs can function best, and be most productive, when a professional horticultural therapist is active in the design, implementation and progress of the program. If there is not funding available to hire a horticultural therapist, have one conduct a staff training program for your facility. This is a good investment.

For more information on this contact Hank Bruce & Tomi Jill Folk at Petals & Pages Press. They also have a list of books on the field of horticultural therapy that provide a wealth of projects and activities for your clients.

Dirty Hands & Active Minds, part 1

Gardening Programs for Seniors,

Why some are successful and others aren't

The following is part 1 of a true story about a horticultural therapy program in central Florida a few years ago that almost failed.  This is adapted from Dirty Hands and Active Minds, a horticultural therapy course Hank Bruce offers for activity professionals and senior care communties.

Conversation in the courtyard
Dr. Bennett was reviewing the activities program with the Three Hills Senior Center when they walked out onto the patio. The landscaping crew was busy trimming the shrubs and cleaning the flower beds while maintenance was cleaning the fountain. There wasn’t a resident in sight.

“I thought you had a horticultural therapy program here,” Dr Bennett commented as he walked over to a raised bed with a few withered plants crying for a drink.

“Oh, we tried it,” Betty responded, but there was little interest. “We brought in a series of speakers, but few attended the lectures.”

Dr. Bennett sat down at the concrete table, almost too hot to touch in the blistering hot afternoon sun. “Did you contact the horticultural therapist I recommended? Did you get the project books on the list?”

“Well, NO.” Betty responded with a touch of pride in her voice, “We found a master gardener who volunteered. Didn’t cost us a penny.”

“Do you have a list of goals and objectives for your program?” he continued.

“Why, the objective was to get them off their duffs and out here with the flowers. Maintenance has gone to a lot of effort to clean this place up for them.” After a pause, she continued, “I have a lot of work to do and I don’t think this is working.”

“I see,” he was now frowning, “But, I sent you the program outline from Sterling Oaks. Didn’t you follow that?”

"Naw. The master gardener said that they might not take proper care of the plants, and they would die.”

A Dozen reasons why this program died:
1. There were no stated goals. Why are we doing this?

2. The residents were treated as spectators rather than active participants. It never became their program.

3. Few on the staff were aware of the existence of the program, and didn’t have a clue as to why they were doing it. It just looked like more work to them.

4. The courtyard area where the program was to take place had no shade, and the gardens were not accessible. The location for the activities, indoors and out must be comfortable, safe and convenient.

5. Failure to understand that IT’S ABOUT THE PEOPLE, NOT THE PLANTS.

6. The master gardener had received no training in horticultural therapy theory or practice.

7. There was no mechanism in place to evaluate the program and individual participation or progress.

8. Activities and projects were not appropriate for clients age, ability, culture, education, seasonal flow.

9. There was no follow through and follow up of projects. Show off time.

10. Physical, emotional, and social factors were not integrated into the activities.

11. Failure to include the clients in the decision making process.

12. Facility failure to understand the value of such a program.

People grow in the garden too

But, most important was the failure to accept the client’s potential as well as the limitations. So often we focus on the “Can’t do’s that we constrain the participant. This is true of children with special needs as well as seniors. Sp often, when we give the freedom to try we discover that both people and plants can grow in the garden. It’s called the People-Plant Connection.

In Part 2 we will discuss some special ways to make the experience more enjoyable fo all.