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Green Care Farms as an alternative living arrangement for people with dementia?

Traditional nursing home care for people with dementia is developing more and more towards small-scale, homelike care environments. In these facilities, a small number of residents (usually six to eight) live together in a familiar and homelike environment. Nursing staff have integrated tasks and are not only responsible for personal and medical care, but also organize activities and run the household together with residents. Normalization of daily life and participation in meaningful activities is encouraged. Worldwide, several similar concepts have been identified (Verbeek et al., 2009). All concepts emphasize individualized care, build on residents’ personal strengths, and support the overall well-being of residents. The most important element is providing a high quality of life, and values such as autonomy, individualization, preservation of the individual’s sense of identity and personhood are of vital importance to realizing this goal.

This article presents an example of a green care farm as a specific type of small-scale, homelike care environment for people with dementia as an alternative to traditional nursing home care. Green care farms are a new initiative and originated outside the healthcare sector. They aim to enable clients to live independently and to participate in society for as long as possible. Green care farms combine agricultural activities with care services for a diverse range of client groups from the healthcare and welfare sectors, such people with psychiatric conditions, addiction, mental disabilities, children with autism, and older people with dementia. As opposed to regular health care institutions (e.g. residential and nursing homes), green care farms offer care activities in a homelike and small-scale setting. Green care farming is an upcoming phenomenon in Europe and Japan and mainly focuses on day care activities for people with dementia and other populations.

In the Netherlands, there are over 1,000 green care farms, of which approximately 250 provide care activities for people with dementia. Recently, some green care farms were established that provide 24-hour care and are seen as an alternative to other institutional long-term care settings. One of these is a dairy farm, which has provided day care activities for people with dementia since 2005. The owners are a husband, the farmer, and wife team who are responsible for the care management. She is a nurse by background and has previously worked in traditional nursing home care. Since the opening of the green care farm for daycare activities, the owners received many questions from their clients regarding why they couldn’t stay at the farm as care needs increased and admission to a nursing home was inevitable. In the Netherlands, the level of care needed is determined by a standardized assessment procedure, carried out by a government agency. Admission to a nursing home setting is based on this assessment, both for small-scale homelike care settings and traditional nursing homes, and is in accordance with family caregivers or clients’ legal guardian. The farmer and his wife wanted to expand their caring activities and have therefore established two small-scale, homelike settings for 20 people with dementia at their farm. The official opening was in March 2013. Two homes for eight people with dementia are established downstairs, and four apartments are created upstairs. Activities at the green care farm include domestic chores (e.g. peeling potatoes, cooking, growing own vegetables, getting milk at the dairy farm) or involve animals and outdoor activities (e.g. sowing, feeding the cattle and other animals such as sheep, chickens, dogs and cats).

Residents’ mean age is 83 years, ranging from 53 to 96. Overall, 62% women live at the green care farm, which is lower compared with other nursing home environments. Relatively many men live at the farm. Some residents have a background in farming while others do not. Residents have a moderate to severe impairment in cognitive and functional status, with a mean score on the Resident Assessment Instrument – Minimum Data Set of 3.7 and Activities of Daily Life Hierarchy scale of 3.0. Overall, family members were positive about the activities done at the green care farm and the personal approach of care being provided. First experiences indicate more opportunity for meaningful activities for residents, as these are integrated in the physical environment.

However, more insight is needed in this new care concept and the impact it has on its’ residents. Currently, we are conducting a study comparing two green care farms providing 24-hour nursing home care for people with dementia with other small-scale, homelike care facilities and traditional nursing homes. Outcomes relate to quality of care, costs, effects and experiences for residents, family caregivers and nursing staff. Data collection will finish mid 2015. The concept and preliminary results will be presented at the IPA regional meeting in Brussels (3-5 December 2014).

Please find here a link to a short film (English subtitles) on green care farms, which was produced in our Academic Collaborative Centre on Care for Older People, Maastricht University, in collaboration with Zon-MW, the Netherlands Organization for Health Research and Development.

Hilde Verbeek, MD, Assistant Professor; Bram de Boer, MSc, PhD student; Jan Hamers, PhD, RN, Professor of Care for Older People – all from CAAPHRI School for Public Health and Primary Care, Maastricht University, Netherlands

Excerpted article as reprint from IPA’s newsletter, the IPA Bulletin, Volume 31, Number 4

Acknowledgements

Acadia Pharmaceuticals Otsuka Pharmaceuticals Cambridge University Press Avanir Pharmaceuticals
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