The Enabling Garden is focuses on the specific physical needs of elderly patients undergoing rehabilitation, but the benefits of the garden are more than just physical. According to Sarah Herron, an occupational therapist at the hospital, the garden is used to help patients with "mobility, arm strength, coordination and balance, cognition, sequencing, problem-solving and pathfinding." However it also serves as a beautiful space where "patients and visitors tend to gravitate [...] to connect with each other and nature." (Brown 2020). 

• • • Senior patients have specific physical needs that can be accommodated  through design elements.

    • Horticultural therapy can be part of an effective treatment plan for elderly patients.

    • A design for and senior care facility should include comfortable and accessible seating for both individual relaxation and group gatherings.

    • Attention to detail is important -- different materials have different effects on patients and should be chosen carefully (i.e. certain paving patterns can confuse depth perception and lead to falls) (Brown 2020). 

    • Sensory elements, like brightly colored flowers and strongly scented plants, help to engage patients. 

For more information:

https://www.nm.org/locations/marianjoy-rehabilitation-hospital 

https://www.westsuburbanliving.net/archives/healing-gardens/article_04132c9e-3440-577c-9a10-17a9696f9bf0.html 

https://production.nm.org/healthbeat/healthy-tips/the-healing-power-of-gardens 

https://www.hitchcockdesigngroup.com/portfolio/hospital-courtyard-design/ 

The outdoor space at Charnley Fold is separated into seven differentiated areas, deemed the "Seven Meaningful Spaces", each meant for different skill-building activities. Extensive gardens and chicken houses allow patients to undergo necessary daily chores, like weeding, planting, pruning, and caring for the animals. Elements like this allow patients to fully participate in the space, and that "participation and ownership becomes therapeutic".   Many circulation loops wind throughout the space, connecting open doors and archways to encourage movement. This also encourages a sense of "ownership" as users can choose their own path through the garden (also aiding in path-finding skills), but are never out of sight of a caretaker. Elements are all "tightly integrated" in the space, allowing patients to feel a sense of participation even if simply sitting near an activity, encouraging them to join in. Two water features create a sense of "flow" throughout the site and help to build a sense of natural wonder.  A "bubbling boulder fountain" is chest-height, encouraging users to interact with the feature physically and providing a sensory ambiance to the space. A "flow form" also swirls water in "energetic" patterns, which is pleasing to watch and adds to the "flow of life" metaphor that guides the design. Diverse plantings provide year-round sensory interest and require little maintenance. However, plantings are intentionally sparse to give the garden a sense of being "undone", encouraging users to plant what they like in the space. All design features are placed with windows in mind, creating open views of plants and wildlife (and chickens) from each courtyard-facing window, creating a sense of participation in the space even when sitting inside the facility (Garuth 2011).

A case study done through interviews of staff members found that patients at Charnley Fold who utilized the outdoor space seemed to exhibit improved communication and mood from participating in group activities and spending time in a pleasing outdoor envrironment. Memory seemed to be reinforced from visiting the garden over time. Skills and mobility improved, and patients seemed more motivated to perform tasks independently. Happiness, enthusiasm, calmness, and confidence were also terms used to describe the improvements of patients who participated in the gardens (Garuth 2011). 

• • • Designs for the elderly should follow the basic guidelines of Universal Design -- spaces should be accessible, comfortable, participatory, ecological, legible, multi-sensory, predictable, and walkable/traversable (Bianchini et al. 2019). 

    • Gates that always remain open help to invite people to explore and utilize spaces. 

    • Natural elements should be more than just visually pleasing. They should also encourage participation in nature and appeal to multiple senses. 

    • Features that give patients opportunities to perform daily tasks create a sense of ownership over the space and help to build mental skills.  Patients do not feel they are participating in "busy work", but instead feel necessary to the daily operations of the space (Garuth 2011). 

    • Attention should be paid to the views created from inside the facility and should allow those stuck inside to enjoy the healing benefits of the space. 

    • Pathfinding ability and memory skills can be built through implementing winding pathways with multiple options for circulation, though patients should never have the opportunity to be too far from a caretaker if they get lost. 

For more information:

https://www.chalfontdesign.com/media/Charnley_Fold_Design.pdf

https://www.researchgate.net/publication/238045212_Charnley_Fold_A_practice_model_of_environmental_design_for_enhanced_dementia_day_care

https://thefield.asla.org/2021/10/14/healthcare-therapeutic-gardens-interview-series-dr-garuth-chalfont/