It seems self-evident that being around nature makes us feel calmer and more relaxed. In fact, numerous studies have shown the therapeutic benefits of spending time outdoors. For those with dementia, it would seem all the more important to have access to a calming outdoor space, and yet it rarely happens within hospitals.

Western Health’s (WH’s) Dementia Assessment and Management unit at Sunshine Hospital did have an outdoor area for patients, but it was little used having developed in an ad hoc way and didn’t have protection from the weather. When the Best Care for Older People (BCOP) project completed its environmental audit of the hospital, they saw a need for the area to be redeveloped into a space specifically designed with the needs of those with severe dementia and their families in mind.

This patient group often stays for a significant amount of time in the unit, and most of these patients also exhibit behavioural and psychological symptoms of dementia (BPSD). The project aimed to create a space based on the latest evidence that would help improve mood, social interaction, sleeping patterns, spatial orientation and provide opportunities to participate in meaningful activities.

The garden features different spaces to allow for reflection, activities or interaction, depending on need and inclination.

Realising such grand ambitions was not going to be cheap! Aware that their vision was beyond their means with existing funding, the BCOP team sought to gain support from WH’s impressive community and volunteer support base.

First up, they approached the Western Health Foundation for funding. They were provided with an impressive $100,000 from the Sunshine Hospital Auxiliary and Opportunity Shop, which is run by a dedicated group of volunteers. Next they partnered with Paul de la Motte, President of the Horticultural Therapy Association of Victoria and a Holmesglen TAFE manager, whose expertise was invaluable in planning and installing the garden. Partnering with the Engineering Department of WH was also instrumental to the success of the project, as well as having the ongoing benefit of an understanding between the two groups about how the other operates and what is important to their work.

Opened in 2013, the garden features different spaces to allow for reflection, activities or interaction, depending on need and inclination. There are raised garden beds containing vegetables and herbs, encouraging patients to reminisce through access to familiar smells and sights. An undercover barbeque area is frequently used for communal meals. The garden also has various defined spaces within it, such as a ‘tranquility area’ where patients and visitors can have some seclusion and privacy. Other areas are designed with patients’ former lives in mind – such as a ‘bus stop’ where patients often enjoy waiting, and a Mediterranean section with mosaics and plants from the region. Seating is available throughout so that groups or individuals can find their own space within the larger area.

The success of the garden has inspired the redevelopment and creation of other garden spaces within the hospital, including redeveloping another outdoor space for the geriatric assessment and management unit (GEM) and planning a garden for the palliative care unit.

The students consult with staff, patients and families as part of their project planning, giving them an understanding of the needs of patients with dementia and a chance to interact with them, breaking down some of the barriers between the groups.

The ongoing dedication of volunteers and nurturing of community partnerships has been essential to the success of the project. The therapy garden, as well as the GEM unit’s outdoor space, is tended by a group of volunteers who maintain the plants and continuously work to improve the garden. Other community groups also help with maintaining and improving the garden, including primary school students, gardening clubs and staff from a local Bunnings hardware store.

WH also has a partnership with a local high school, Copperfield College, whose students undertake projects as part of their VCAL work. Up to 50 students work in small groups on defined projects with the help of a mentor. Projects have included making furniture and artworks, and a group is currently working on creating a workbench (inspired by men’s sheds) for patients in the garden. The students consult with staff, patients and families as part of their project planning, giving them an understanding of the needs of patients with dementia and a chance to interact with them, breaking down some of the barriers between the groups. In fact, this side of the project has been so successful that it has been recognised by WH with an excellence award.

Others who volunteer and spend time in the garden also experience this same increase in understanding, something the BCOP project managers see as an added bonus of the program. “They’ve purely volunteered I think to maintain and develop the garden, but slowly just through informal connections with patients… they’re starting to interact with patients in their own way,” says Amy Parker. Kate Mangion agrees, and adds, “Because you’ve got the right people in those roles it’s a natural evolution”.