Executive Summary

Green in the body, honey in the heart: exploring the roles of nature and friendship in long-term healthcare

Rachel Betesh

Bachelor of Arts in Environmental Studies with Honors

December 2005

This thesis is an argument for subtlety, compassion, and creativity—all of which facilitate the seeing and making of connections. As a written document it is built by connections made between disciplines and as a realized idea it is reinforced by connections developed between human beings.

My research focuses on community-based gardening in long-term healthcare facilities, a concept which forges an unlikely connection between what is wild and what is often deemed sterile. Residential long-term care is a highly regulated system whose purpose is to provide medical and social support to elderly, chronically ill, or disabled people who can no longer live independently. The current “long-term care crisis” receiving significant media coverage hinges on two obstacles faced by the long-term care system: the need for more care and the need for better care. The former is a result of the gradual aging of the United States population. The latter is fueled and made public by the advocacy movement for improved “quality of life” in long-term care. Citing significant organizational, regulatory, social, and interpersonal flaws in the lived experience of long-term care, advocates call for ethical accountability as well as innovative approaches to health and wellbeing.

One such innovative approach is horticultural therapy, the use of plants and gardening for rehabilitative purposes. Though its principle belief that interaction with the natural world is a source of therapy and empowerment is widely accepted, its official practice is not currently reimbursable by Medicaid. Horticultural therapy is often instigated and carried out on a project-by-project basis by registered nurses, occupational therapists, or social workers. The “Eden Alternative” template for long-term care reform incorporates the concept of horticultural therapy through its inclusion of plants-- as well as pets and childcare-- in the nursing home. Dr. William Thomas, the founder of the Eden Alternative, explains that all three offer much-needed opportunities for residents to give care instead of simply receiving it.

The case study application of this thesis used a community-based garden as an activity for growth, interaction, and fun at Sunrise House, a long-term care facility for people living with HIV/AIDS in Providence, Rhode Island. I worked with residents and staff to grow organic vegetables and flower gardens on the property. Through structured workshops as well as unstructured, one-on-one “garden time,” nearly all of the residents participated in a full season of planting, maintaining, harvesting, and cooking from the garden. Using participant observation memos and tape-recorded interviews, I maintained a record of the meanings and benefits of the garden for members of the Sunrise House community.

The findings of the case study at Sunrise House suggest that a garden, in addition to its basic value as an enjoyable activity, also carries distinct significance in its ability to strengthen connections that are often strained in the lived experience of urban long-term care residents. First, the garden defies the relegation of “nature” to pristine, rural places, instead bringing beauty, agriculture, and a sense of discovery to a piece of lawn smaller than a parking lot. As a forum for interaction, visible activity, and resident pride, the garden helps build community with neighbors and volunteers. With magnificent beauty and abundant produce, the garden also instills a feeling of luxury—without requiring significant monetary input. In a system and setting which can easily characterize residents as “receivers” of care, the garden offers unique opportunities to nurture, share, and give to both plants and other people. Finally, the garden’s cycles, metaphors, and chances to learn are a source of spiritual and mental health—and a reminder of life’s interactive potential. Among residents and staff members at Sunrise House, the garden was so enjoyed and appreciated that its continuation next season is already assumed and planned for.

I align myself with advocates for “better” care in a recommendation that long-term care reform should emphasize positive incentives and innovation, not simply more regulation. As an example of such innovation, I advocate low-cost, community-based gardens on the grounds of long-term care facilities as a physical and experiential forum for interaction, integration, and growth (and fresh tomatoes). My broader recommendations include the training of medical professionals to be as aware of social and interpersonal health as they are of the functions of the body. I also recommend that long-term care facilities seek out and encourage community interaction, reaching out beyond facility walls rather than giving them a new coat of paint. Community members must meet facilities and residents halfway by acknowledging the true worth and gifts of the elderly and chronically ill.

The realization of these recommendations would ideally cultivate a more functional, visible niche for the elderly and chronically ill who are part of our communities. Over time and with momentum, long-term care facilities might one day be associated with the growth of food and flowers. This is a revolutionary vision, full of life, and it is the opinion of this writer that each snapdragon planted towards it is a revolutionary act.