The Life Enrichment Center is located in the foothills of the North Carolina Mountains. It is a sustainable community-based Adult Day Care facility, serving adults of all ages with a range of physical and mental disabilities and neurological conditions. The Center’s philosophy is to do “whatever it takes” to help families keep adult loved ones at home and engaged in their community.
Enriching and supporting a dignified quality of life is never more poignant than when that life involves degenerative disease. Complex neurological conditions, including Alzheimer’s disease, require concepts of treatment that incorporate both pharmacological as well as non-pharmacological approaches. Medications, the first and often last step in treatment, offer meager solace for people who live daily with these conditions. Like other chronic illnesses that require lifestyle changes such as diabetes, manic depression and AIDS, Alzheimer’s requires a paradigm of care beyond medication that emphasizes living with existing abilities. Key to realizing this necessity is understanding a recent finding in today’s neuroscience: that much remains active and vital in the brain of a person living with dementia and other neurological disorders.1
One such care modality can be a physical environment that promotes safety and reduces fear by directing cognition even without the person’s awareness. It involves a designed environment that helps people find their way, engages them, and jogs their memory. The therapeutic settings provided within this supportive environmental design facilitate activities that compensate for cognitive defects. Ultimately, such a design setting should support both participation with the environment and independence, permitting a caregiver to recognize and respond to an individual’s interests, abilities, and skills.
Dirtworks, PC was tasked with developing an outdoor setting that would complement the Center’s varied programs of care. Emphasizing both individual and environmental health, the 1.15-acre garden implements a number of sustainable components including an integrated pest management system and organic garden. Accommodating the range of cognitive abilities and complex medical conditions required close collaboration with the managers and staff in programming, design, and construction. The staff and our mutual interest in emerging investigations within cognitive science informed the specifics of the design.
Key to the garden’s development was establishing design strategies that would give support to those with neurological losses. Its conceptual framework is based upon an exploration of “natural mapping”, a principle in cognitive science where the designed environment contains cues more helpful for its proper use, rather than relying on our standard problem solving responses or the individual knowledge of its users.2 (For example, in dementia care settings a well-designed pathway can transform wandering into walking. Providing thoughtful connections that avoid confusion, interesting features along the path, and a destination establishes goals, anticipation, and purpose.) Such design interventions are intended to reduce demands on already challenged perceptions and facilitate levels of functioning while promoting feelings of security, mastery, and belonging.
The resulting garden is comprised of three distinct spaces that vary in size, complexity, physical demand, and degree of sensory engagement. Its deceptively simple overall aesthetic belies complex considerations. The garden’s basic elements, including domestic scaled structures and spaces, native plants, and local fruits, vegetables and herbs are familiar to residents who have lived their entire lives in this agricultural region. The experience is therefore understandable and manageable. Seen cohesively, the garden offers opportunities and choices for everyone, regardless of ability, to engage with nature by their own terms, in their own way, and at their own pace.
The Executive Director of The Life Enrichment Center speaks about our collaboration: “Our partnership has taken our ‘whatever it takes’ philosophy beyond the four walls to the outside environment… not a day goes by that the participants and their families don’t thank us for the therapeutic garden and our understanding of what it takes to offer truly holistic care.”3
Comprehensive interventions in care, involving partnerships between medicine, research, and design, explore how environment can address the symptoms of disease and support basic human rights: dignity, independence, participation, self-fulfillment, and care.
1Zeisel, John. Inquiry by Design: Environment/Behavior/Neuroscience in Architecture, Interiors, Landscape, and Planning. New York: W. W. Norton, February 2006. Print.
2Norman, Donald A., The psychology of everyday things. New York: Basic Books. 1988. Print.
3Kennedy, Suzi. Statement of support. August 2005.
by David Kamp, FASLA, LF, NA, President of Dirtworks PC. David has dedicated his career to creating environments for individuals with special needs and exploring the restorative qualities of nature and its role in health and well-being.