Spending time outside provides important physical and mental benefits for older adults. However, accessing these benefits can be difficult for nursing home residents. There are often several barriers to spending time outdoors while living in nursing home facilities, with one study showing that of residents who were physically able to go outside, only 22% went outside daily, and as many as 32% went outside less than once a month.
Intentional design and policy can enable residents to get the most out of the natural areas surrounding their facilities. In 2019, Australian researchers completed a systematic review of the research on the use of outdoor spaces by nursing home residents. They identified ways that nursing homes can remove barriers to outdoor access and components of natural spaces that can encourage residents to increase their time spent outdoors.
Garden Design and Features
Encouraging residents to spend more time outside requires the inclusion of garden features that provide an interesting sensory experience—in other words, the outdoor design shouldn’t be boring. Researchers noted that outdoor spaces should house many different types of greenery, seasonal plants that change throughout the year, trees to provide shaded areas, and raised garden beds that allow residents to interact directly with the plants. Some residents noted a fondness for watching wildlife like birds and butterflies, meaning it is beneficial to include bird and insect feeders and to prioritize plants that attract these pollinators. Water features like fountains and small ponds can also add interest to the overall design and increase the serenity of the built outdoor landscape.
Pathways and Surfaces
Decreased mobility is a huge barrier keeping many nursing home residents from enjoying outdoor spaces. Pathways should be walkable and navigable by wheelchairs and other walking aids. Flat, wide surfaces are crucial for accessibility. That being said, some nursing home residents noted that an overabundance of concrete can reduce the beauty of natural areas. Researchers note the inclusion of flat and well-maintained grassy areas and dirt pathways can help keep the landscape interesting.
Shade and Shelter
Changes in weather conditions throughout the year affect how much time nursing home residents spend outside. Heavy rain, overbearing sun, or colder weather can make it harder for residents to enjoy nature unless proper shelters and shade are present. Gardens should include opportunities to experience full sun and partial to full shade for enjoyment throughout the year. Built structures like gazebos, decks, and shaded or heated patios allow residents to enjoy the outdoors regardless of the weather. Screened in patios can be beneficial in areas that deal with mosquitos or other pests.
Seating
With age and decreased mobility comes a need for plenty of places to rest. Outdoor areas should include ample places to sit in both the sun and shade that are easily reachable from pathways. A good rule of thumb is that the next place to rest should always be visible along a given path. Similarly, seating should be available within all built structures that protect from the elements. The inclusion of seating allows for passive enjoyment of the outdoors and provides a place for residents to enjoy nature independently or socialize with their friends and family.
Proximity and Access from Facility
One major deterrent to nursing home residents going outside is their inability to easily access outdoor spaces. Ideally, residents should be able to enter gardens and other natural areas directly from the facility, with automatic doors that allow residents with mobility issues to pass through easily. This allows residents the ability to choose to spend time in nature at their leisure. In cases where this is not feasible, facilities should provide frequent structured outings to nearby natural spaces and implement policies that encourage residents to spend time outdoors when possible.
Staffing and Resident Safety
It is important to emphasize safety in the planning of outdoor areas. Providing a locked fence surrounding these spaces can prevent residents from wandering, which is particularly important for those that experience memory issues, and keeps unwanted visitors out of the area. The layout of outdoor spaces should allows caregivers to easily monitor the area and quickly provide assistance if needed, while still giving residents the autonomy to roam around and enjoy the greenery. Hiring staff that specifically monitor outdoor areas greatly increases the sense of safety and can encourage residents to spend more time outdoors.
Social Activities
Planned social activities encourage residents to go outside. Whether it’s gardening, aerobics, meditation, picnics, or bird watching, having structured activities available on the facility calendar gives residents an incentive to spend time outdoors where they benefit from both exposure to nature and socializing with other residents.
Nursing homes and caregivers can take simple actions to help remove barriers of access to the outdoors and enable residents to spend more time in nature. Urban parks like Portland Memory Garden offer expanded opportunities to experience green spaces in a safe environment. In addition, Portland Memory Garden offers free activities for seniors every summer led by individuals trained in therapeutic horticulture. Visit our events page to learn more about summer programs and other events for nursing home residents and staff to enjoy.