Access to the Outdoors for Care Home Residents
Throughout my experience as a post-doctoral researcher and a registered nurse in various care homes, I have noticed that many care home residents rarely go outside, and that some are prescribed vitamin D supplements in order to compensate for their minimal exposure to sunlight. Thus, while most of us will be hoping to make the most of the outdoors as the weather improves, for care home residents, this is an opportunity that is often not available. This lack of outdoor access is apparent in the wider community, with resident trips beyond the confines of the care home often being a rare occurrence. It is also apparent within the care home environment, despite many homes having outside spaces, such as gardens, courtyards and patio areas. In this blog, I will consider some of the benefits of accessing these spaces, barriers to this access, and potential ways in which these barriers could be overcome.
Benefits to being outside
The benefits of accessing outdoor spaces include opportunities to participate in physical exercise, a sense of freedom and community belonging, as well as the chance to engage in specific outdoor activities, such as gardening, that can promote active ageing and other meaningful activities. For those living in care homes, a further benefit to be gained from access to fresh air and open spaces may derive from the opportunity to enter a peaceful space far removed from the often hectic or claustrophobic care home environment. As such, research has found that those who go out daily are less likely to be isolated, and more likely to be healthier than those who do not go out. When people do not engage in outdoor activities, they are more likely to experience decline in physical health, mood, cognitive functioning and social connectedness. In recognition of the benefits to outdoor access, human rights legislation recommends the elimination of barriers to this access for people with disabilities which may serve to reinforce their social exclusion (Argyle et al., 2016).
Barriers to getting outside
For care home residents, their exclusion from outdoor access can be due to physical or cognitive impairments (such as mobility, eyesight, or memory problems) making it difficult for people to go outdoors unaided. However, as it has been recognised by the disability movement, some of these barriers are ‘socially constructed’, which means that they are influenced by social practices. Contextual factors may also play a role. For instance, the availability of staff support to facilitate outdoor access may be lacking due to inadequate staffing levels, while the design of outdoor spaces may be inappropriate to the needs of residents. This can be due to such things as the lack of appropriate seating, lighting and negotiable pathways. In addition, risk-averse care practices, which focus on maintaining the physical safety of residents rather than on their social and psychological wellbeing, can also play a role.
Over-coming these barriers
So what can be done to break down these barriers to outdoor access for care home residents? An obvious step would be to recognise and address each resident’s rights to this access and how this can best be achieved in order to meet their specific needs and aspirations. A further step would be to improve the availability and accessibility of the existing outdoor spaces of care homes. As most homes already have such spaces, this would be relatively easy to achieve. In doing so, it would make optimum use of an existing resource for residents while potentially strengthening links with the local community by facilitating the availability of outdoor events such as garden parties. With these goals in mind, organisations such as the Sensory Trust have published guidelines on the creation of accessible care home gardens. On a wider level, organisations such as Natural England and Paths for All provide guidance on promoting access to outdoor spaces more generally.
Dr Elaine Argyle is a practitioner and researcher in health and social care
