Treatise

Field Session as part of 2005 Annual Meeting of American Society of Landscape Architects

Hosted by Miami Veterans Affairs Medical Center Miami, Florida October 11, 2005

Facilitated by ASLA Therapeutic Garden Design Professional Practice Network and the Acer Institute

Therapeutic Garden Design

and Veterans Affairs:

Preparing for Future Needs

Treatise | Therapeutic Garden Design and Veterans Affairs: Preparing for Future Needs

ba

ck

toh

om

e

“… to care for him who shall have borne the battle, and for the widow and his orphan.” — Abraham Lincoln

Forward Thinking: Gardens at Veterans Affairs FacilitiesVeterans comprise a large segment of our population – 26 million people. Based on current active combat statistics, a sharpspike in need for healthcare services is likely to result in a great number of veterans requiring short or long term stayswithin Veterans Affairs (VA) facilities.

With approximately 1,300 care facilities, VA has begun the largest and most extensive restructuring of its healthcaresystem in history and has changed dramatically in the past several years. VA facilities are being modernized and expanded,treating more veterans in more places than ever before. With 25,000 fewer employees, VA provided care to one millionmore veterans in 2001 than in 1995. More than 4.8 million people received care in VA healthcare facilities in 2003: out-patient clinics registered approximately 49.8 million visits and approximately 14,000 veterans received care in nursinghomes. VA strives to provide quality, timely and excellent patient care in the shadow of impending world events.

An estimated $2 trillion is forecasted for national healthcare expenditures by 2008. In July 2005, both the House and theSenate passed a bill that would provide an additional $1.5 billion to compensate for a massive budget deficit in VA’shealthcare budget, totaling over $28 billion in the VA healthcare budget.

How can therapeutic gardens support the VA healthcare system and buffer the impending strain?• Aid in clinical treatment (horticultural, occupational, recreational therapies) from injury and illness (e.g. Post Traumatic

Stress Disorder, physical disabilities)• Provide a positive distraction from illness and concerns• Reduce stress and blood pressure• Aid in seamless transition from wartime duty in a home-like setting• Normalize the environment; “de-medicalize” the setting• Improve mood, function and socialization, increase natural absorption of Vitamin D, and balance circadian rhythms

Models of medical care are changing. Cost-effective complementary treatment modalities are becoming a significantcomponent of the healing equation. Sound practice indicates therapeutic gardens are used in the clinical healing andrehabilitatio for patients. These gardens offer additional venues for therapeutic activity and become integral in the com-prehensive healthcare delivery system, thus having a profound effect on the “bottom line” (Hutton & Richardson, 1995).

Health outcomes research has measured positive, tangible effects of therapeutic gardens:• Shorter post-operative stays, decreases in pain medication requests, and decreases in negative comments by

care staff were noted when views from patient rooms were of natural, green spaces as opposed to brick wallsof adjacent buildings (Ulrich, 1984).

• A decrease in violent behavior in Alzheimer’s facilities was noted when use and exposure to gardens wereintroduced as a care option. A 19% decrease in violent outbursts in one year’s time was noted compared to anastonishing 681% increase in violent outbursts in those facilities with no gardens (Dannenmaier, 1995).

• Rehabilitation patients experience shorter stays in hospitals when room views are either a garden or a woodedarea (Burnett in Marberry, 1997).

• Residents with dementia experience reduced agitation, improved sleep, and increased appetite when exposedto gardens.

The Therapeutic Garden Design Professional Practice Network and the Acer Institute alongside clinical and administrativeVA personnel, must effectively work together to sustain future care challenges. We align to support ongoing advocacyin perpetuity for research and evaluation of the growing effectiveness of therapeutic gardens and allied clinical practices.

Treatise | Therapeutic Garden Design and Veterans Affairs: Preparing for Future Needs

ba

ck

toh

om

e

The Editors, Event Facilitators and Organizers

P. Annie Kirk, MLA, ASLAPrincipal, Red Bird DesignDirector, Acer InstituteTherapeutic Outdoor SpaceConsulting + Design + Education EventsP. O. Box 83Aurora, OR 97002AcerInstitute@comcast.netwww.AcerInstitute.org503.887.3439

Jack Carman, FASLAPresidentDesign for Generations, LLC92 Tallowood DriveMedford, NJ 08055jpcarman1@comcast.netwww.DesignForGenerations.com609.953.5881

For more information on the Miami VA Medical Center therapeutic gardens, please contact

Alee Karpf, HTR, MS, CTRSRecreational Therapist, Coordinator of Horticultural Therapy Program, Miami VA Medical Center1201 NW 16th Street, Miami, Florida 33125Alee.Karpf@va.gov305.575.7000 ext. 6017

Sources:http://www.patientsafety.gov; VA National Center for Patient Safetyhttp://www.va.gov/; U.S. Department of Veterans Affairshttp://www.whitehouse.gov/news/releases/2005/11/20051110-15.html

“Returning Operation Iraqi Freedom and Operation Enduring Freedom Veterans” for Miami VA Medical Center, compiled by Social Work Service at Oakland Park VA OPC,“Department of Veterans Affairs, VA Accomplishments, 2001 to Present”, Office of Assistant Secretary for Public and Intergovernmental Affairs, September 17, 2004.Burnett, J.D. (1997). “Therapeutic Effects of Landscape Architecture.” In S.O. Marberry (Ed.), Healthcare Design. New York: John Wiley and Sons, Inc., pp. 255~274.Dannenmaier, M. (1995). “Healing Gardens.” Landscape Architecture Magazine, Vol. 85, No. 1, pp. 56~79.Hutton, J. D. & Richardson, L. D. (1995). Healthscapes: The role of the facility and physical environment on consumer attitudes, satisfaction, quality assessments andbehaviors. Health Care Management Review, 20, 48~61.Ulrich, R. S., 1984. “View through a Window may Influence Recovery from Surgery.” Science 224, 420~421.

Our intention for a one-day conference was to set a benchmark for the advancement of exemplary therapeutic landscapesin healthcare by aligning with the largest healthcare institution in the United States, the Department of Veterans Affairs.Organizing a conference at the Miami VA Medical Center underscored the need to focus attention on a particular sector ofthe medical community within the United States. We were pleased to have joined with the Miami VA and staff on October11, 2005, for the opportunity to exchange knowledge and promote the advancement and use of therapeutic gardens. Manydoors were opened to a wide range of possibilities. Partnerships were forged between professional organizations.

Our purpose for this CD is to highlight the results of this initial effort and the need for therapeutic garden programming,design, research and application in VA medical and related care facilities. This endeavor and information compiled within areintegral “steps” along the path of outreach extended by ASLA Therapeutic Garden Design Professional Practice Network andthe Acer Institute to horticultural therapists, medical professionals and architects. This CD marks the “first step” taken infacilitating a long and fruitful dialogue between the ASLA Therapeutic Garden Design Professional Practice Network inconjunction with the Acer Institute, the Miami VA, and the Department of Veterans Affairs at-large.

Please review and find useful and important information contained within and join us in our undertaking to advocate forexemplary outdoor spaces in healthcare facilities.