Senior Pathway- Age Friendly Dementia and Sensory Garden.

Description

This is the Laois/ Offaly services covering clients over 65 years of age across both counties suffering from mental illness. This includes anxiety, depression, loneliness, psychosis and care for clients who suffer with dementia/ Alzheimer’s disease. We are running a Day Hospital Programme within our service, which includes Therapeutic and Recreational Groups.

We run groups Monday-Friday with up to 50 clients attending at present from different areas in Laois/Offaly for socialisation and intensive therapy groups like anxiety management and Wellness Recovery Action Plan. We have had numerous feedback sheets from clients who have expressed interest in gardening groups, poly tunnels, green house etc. Most clients within this age category would consider gardening as a long-term hobby and find this very relaxing and feel that being part of a gardening club will gives them a purpose to their day and creates healthy routines.

As the over 65 population is currently the fastest growing population. We are gaining up to 100 new referrals monthly and massively increased caseloads within the past 2 years. Day Centres and Men Sheds are currently limited in spaces. Covid-19 has had a lasting impact on this population. Social groups and interaction has hugely improved the client’s mental health. We have started creating a safer garden for clients.

We have the Irish Countrywomen’s Association and a horticulturist attending groups giving great support and advice in the advancement of the garden. We are looking to develop a sensory dementia garden, which will have colour, touch and scent, which we hope, will encourage the recollection of memories. We are hoping for a functioning greenhouse that can continue through all seasons. We have the input from the horticulturist as to what fruit and vegetables would be best suited.

Aim of Initiative

The vision for the project:
-To grow enough produce to sell and eventually build on this as long-term plan for the future.
-The development of a Sensory Dementia Garden, which will have colour; touch and scent, which we hope, will encourage the recollection of memories for clients.
-We are hoping for a functioning greenhouse that can continue throughout all seasons.
-We are have secured the input from the horticulturist as to what fruit and vegetables would be best suited.
– To provide enjoyable, caring outlet for the people in our society that require support, socialisation and friendship.

Who is it aimed at

This initiative is aimed toward clients within the Laois/Offaly Mental Health service for the over 65 year old age category.
As a service, we have recognized the impact Covid-19 had on our society. This had a huge negative influence on the this age group due to social isolation, early retirement, loneliness, depression, loss of hobbies and this also was the most targeted age group during covid-19 pandemic due to high restrictions in place due to fear of becoming sick or unwell.
The level of referrals to our service have increase up to one hundred new referrals monthly. Majority of these referrals are due to lack of socialization and the availability of age appropriate outlets.
We completed lengthy research into the need for this and have noticed that no other area within the service has this facility in place as of yet. The main thing we noticed was that this age group have huge interest in outdoor activities and gardening.
With the addition of a greenhouse that his will be a functioning garden all year round. this would maintain interest and continue to provide a safe environment for people to attend socialize, develop new skills and a sense of achievement.
The long term vision is to sell the produce from the greenhouse and to gather funds for planned outings or social events for service users.

3 Steps critical to success

1. Through feedback sheets and verbal feedback from service users the most common hobbies /interests identified within our weekly groups was outdoor activities and gardening. We have developed a garden committee within our service, members consisting of a Psychiatric Consultant, Advanced Nurse Practitioner in Dementia, Occupational Therapist, Social Worker, Speech and language Therapist, 2 x Clinical Nurse Managers, Health Care Assistant and three service users are attending regular meetings. We have two information groups weekly (Monday and Thursday) dedicated solely to gardening information sessions and the care and maintenance of plants.
2. During our initial meeting we discussed hopes and the short term goals and the long term plan for the garden, what safety risks we have to take into consideration and the proposed layout of the garden. We research at length the benefits this initiative would have for our service users and the community. We completed and submitted an up to date risk assessment, business proposal and three quotes to our general manager and financial manager to seek funding for this project to commence. We met with three landscapers who also brought new ideas in relation to the layout.
3. To maintain momentum we ensure at all times that all clients and and staff were fully aware of this project, the progress we were making and the benefit and positivity this will bring. It was vital to gain support from everyone. While this was essential part of the project this also lead to our initiative gaining traction from other people within the community and across the service.Tesco Store Manager in Portlaoise got in contact to add this initiative to the blue token fund, people donated new benches, table and chairs, garden decorations, high planters, garden tools, garden knee pads and flower bulbs. The local vintage rally has added this initiative to donate one third of proceedings to aid in this development. Staff within our service had a BBQ and donated to this, we also have organized a table quiz locally which will also be accepting donations. We have many offers from local community members offering to help with garden refurbishment. However, due to health and safety concerns we could not accept this. HSE staff have dedicated time outside working hours for garden clean up including power hosing and painting.

3 Challenges in Planning / Delivery

1. The first challenge we found was getting the funding approved by the HSE. Due to major changes within the acute settings, this project did not appear as a priority within our service. The initial quote to revamp the garden was extremely high. We have since got 3 more quotes which were only a third of the costing and we have since submitted this again to the HSE and are awaiting hopefully positive feedback.However, despite this initial setback. We turned it into a positive and created a large group of people to work together. Everyone has a role to play, voices and opinions are heard. It has created a great atmosphere within the service. Service User’s are enjoying the planning and organising thoroughly. This would not be attainable without all the support and resources people have kindly donated. This project has been in consideration for 12 months and working towards getting this initiative up and running. Accepting donations only began 6 weeks ago and already with have 1000 euro and all of the above mentioned equipment, staff giving up time to help with cleaning, locals cleaning and refurbishing benches. Input from the Irish Country Association, Horticulturist and Occupational Therapist. This is a very successful start in which we hope to continue.
2. The second challenge that remains slightly difficult is the organisation of committee meetings, due to the the availability of staff and service users on the same day. However, we continue to plan with whoever is available and send the minutes of each meeting to all members following the meeting. We spoke with all members and agreed this is the best option going forward.
3. Skills and knowledge surrounding choosing plants/ flowers and potting plants was at a low level initially. Through research and the use of the local organizations and the skill mix of both staff and service user’s this has expanded quiet quickly. it has become a learning opportunity for everyone. We are all very excited to continue and achieve the goal of having a social, safe environment for the over 65 population in Laois/Offaly and to enjoy the journey also.

3 Outcomes / Benefits

1. The main outcome:
   Part of planning for this garden for the elderly is ensuring we are meeting the needs of all clients with taking into consideration mobility issues and possible other physical concerns:
   -The garden would require area levelling off and the laying of non-slip tiles in place of the decking that is removed.
   -Clearing of moss, liner and bark. Removal of trees and cutting back of trees. Skip to remove excess.
   -We currently have low beds that are over-grown; we require raised beds for clients to access easily and can cater for any existing injuries or mobility concerns.
   -We have a cobble lock pathway to fountain, the cobble lock appears in good stable condition and would just require power wash, sand and seal.
   -Railings both sides of the pathway due to safety risk.
   -Greenhouse and implementation of the greenhouse.At the end of this project we will have a fully functioning garden with something for everyone of this age category to participate in. It will encourage people to become more social and to engage in the service while also doing something they love on a regular basis. Progress up to date since commencement six weeks ago has been the removal of the decking that was a hazard concern, the fixing of the gazebo and painting of it. Spraying of weeds and removal of same. Commencement of memorial garden including potting of plants and the making of ribbons and small plaques to individualise these as needed. Service user’s have began sowing herbs and vegetables during group activities. New bench in place in rememberence of a member of staff whom passed away following a very short illness. Two other benches have been taken by a local carpenter for renewal including sanding and painting. Flowers have been potted for outside main entrance. Shed has been cleared out for storage and new garden furniture has been assembled. Next Part of this initiative is the removal of liner and bark, cleaning of the patio and the sealing of this. Also, the pruning of tress and plants and the hiring of a skip.
2. Dementia Friendly Garden:This service also has a cognitive assessment clinic. This has an extensive waiting list due to the lack of this service in other areas.

   Our Advanced Nurse Practitioner and a Consultant Psychiatrist run a weekly clinic, this includes a memory technology room and also have regular group for the carer’s of people with cognitive impairment including Alzheimers/Dementia. This is a service that is vital for both the person suffering with memory loss along side their family members and close friends. In response to the Government’s National Dementia Strategy The garden project is designed to ensure we cater for everyone’s needs. This will ensure evidence based practice and research is incorporated to ensure a therapeutic place for people with Dementia to attend. Access to an outdoor area is a pertinent factor in relation to people’s health and wellbeing. This garden will ensure high standards are met and that it is safe, with easy barrier free access. The ground will be level with non-slip tiles and will have railings both sides of pathway and small ramp for access to take into account mobility issues. This will allow clients to go outdoors into nature, socialise and get involved in gardening if they wish with simple easy tasks. Dementia friendly Garden will include colour, touch and scent which is utilized to calm and relax people. This also enhances the recollection of memories and provides excellent sensory stimulation.

   -We will have seating/resting areas placed throughout the garden and a sheltered seating area.
   -There will be vibrant color’s with the inclusion of a a decorative planting area.
   -Ornamental animals will be placed on both sides of paths as visual features, also we will have pet therapy on a weekly basis which is approved by the HSE and awaiting start date.
   -The area can provide opportunities for outdoor games, afternoon tea and barbeques.
   -We have sourced age friendly games which are bigger in sizes for visual impairment. These include Domino’s, Jenga, Cards and Come Together Kite.
   -This garden will be fully supervised by staff members when in use.
   -High Planting areas will be in place.
   -A variety of plants will be sown to to stimulate all senses including see, smell and touch a favorite flower. this can contribute greatly to emotional well being.
   – With the ongoing input from the horticulturist and research we will ensure all plans are safe.
   – The path will lead to memorial garden with ongoing visual aspects including signage, ornaments and adequate rest areas. Then it will conclude the journey at the Greenhouse.

3. All staff and service users have full involvement in this project. This is giving people a focus, a sense of belonging and self-worth. Since this project began, we have had numerous groups and information sessions in relation to gardening. Coffee morning and afternoon tea has become a regular occurrence where we sit and discuss the garden project, bringing people together. We have commenced the development of small area for clients to pot plants and this will be individualized to each person for memorial garden. We have clients whom attend the service with recent bereavement or perhaps family members who have died due to mental illness. The clients felt that this would be special to them and feel like this is a place they can visit and be close to their loved ones. This is all part of our recovery process within our service. We have ongoing meetings, creation of garden decorations during or garden and arts and crafts classes. We also have developed a financial barometer with the service users so everyone can see the progress being made and feel a sense of achievement.This is giving our service users a focus and sense of hope for the future. We are setting small regular goals to achieving this initiative using the SMART tool to plan and achieve goals. Specific, Measurable, Attainable, Realistic and Timely.