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“Why Don’t We Go Into The Garden

Introducing the Care Culture Map

Debbie Carroll and Mark Rendell from Step Change Design Ltd

The Care Culture Map and accompanying 50 page Handbook is the culmination of the self-funded research project we carried out in 2013 to answer a deceptively simple question, “Why aren’t care home gardens being used more actively, especially when they have been designed to the latest guidance?”

We are garden designers who got together when we realised we were both asking the same question. We were concerned about this as we didn’t want to be associated with garden designs that didn’t work or didn’t represent good value for money to the care setting so we set out to find out why.

With invaluable assistance from Sylvie Silver at NAPA, we were overwhelmed by the level of interest in our research by care homes across the UK and Ireland. Debbie’s phone went into meltdown within minutes of the ad going out.. 50 care homes wanted to take part in our research – it clearly wasn’t just us asking the same question!

We recruited 24 homes across England and Wales into the study over the summer of 2013. 17 remained to the end. All homes carried out a month of diary-keeping, recording interactions with the outside space by residents. We visited 7 of the homes ourselves 3 times over the summer carrying out our own observations. In total we gathered nearly 1500 pieces of data that helped explain how residents (particularly those living with a dementia) and their carers interacted with the outside spaces around their care setting.

Unexpectedly, we didn’t find the answer to our question where we expected to – in the garden – but hidden away behind the elusive and hard to measure cultural practices of the care settings themselves.

How often (and indeed whether or not) residents in care settings engage with their outside spaces has very little to do with the condition of the garden, how pretty it is or the features it had in it, but in the attitudes, procedures and habits of the care setting (and organisation).


We found that those settings that were practising what we came to describe as ‘relationship-centred’ care were already using their gardens, whether designed or not, and to great effect.

Those homes that we described as having a more ‘task-oriented’ care culture often blamed their garden and its condition for not going outside. These homes also tended to have more fearful attitudes towards Health and Safety and had more restrictive or conditional Open Door policies making it much harder for staff and residents to easily engage with their outside spaces.

We are not academics so we decided not to go down the traditional route of producing a worthy tome of our findings. Instead we deployed our visualisation skills and created an engaging and innovative Map tool to help care settings work out what their care culture looks like, and where they would be located on a ‘spectrum’ of care culture towards relationship-centred care at the top of our Map and then to plan their route forwards.

This Map is also designed to be used by outside specialists, like garden designers, who need to work with where the care setting is currently located, in order to provide design support that will be useful and cost-effective.

Our ultimate aim is for this Map tool to be helping care settings to find ways to overcome the obstacles and hindrances that prevent their residents from engaging meaningfully with the outdoors, as and when they choose to, and at any time of the year.
For more information: contact Mark and Debbie at info@stepchange-design.co.uk or go to: http://www.stepchange-design.co.uk/publications/care-culture-map-handbook



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