Outdoor environments at residential care facilities: Needs, wishes, and access for older adults and care workers

Abstract

Introduction: Research studies have shown that contact with nature and outdoor stays can improve health, especially for older adults and care workers. However, statistics from the Swedish National Board of Health and Welfare, 2024, reveal that 80% of the Swedish residential care facilities (RCFs) lack supportive conditions for movement to and within outdoor environments, and 92% of operators lack routines for outdoor interventions. The overall aim of this thesis is to increase knowledge concerning needs and wishes of older adults and care workers in contact with the outdoor environments at Swedish RCFs and the access to these environments at a national level. Methods: Study I is based on individual walking interviews with twelve older adults from three RCFs to explore their needs and wishes regarding outdoor environments. In Study II, focus group walking interviews with eleven care workers at the same three RCFs as in study I, were used to explore their reflections on using outdoor environments for person-centred care and rehabilitation. Study III developed a matrix and manual to map access to outdoor environments, and in Study IV, the matrix and manual were used to map the access across all Swedish RCFs, approximately 2,000. Results: The older adults expressed needs and wishes for outdoor environments at RCFs to be a part of their everyday lives. Care workers saw the potential of these environments as arenas for person-centred care and rehabilitation. A matrix, which included 26 variables, and a manual were developed to map access to outdoor environments. The national mapping revealed limited access to outdoor environments, such as balconies, patios, own gardens, and squares. Furthermore, lack of, and variations in, access were found to be related to geographic location, growing zones, and differences between public and private operators. Conclusion: Both older adults and care workers acknowledge the value of using outdoor environments as everyday environments and arenas for person-centred care and rehabilitation, recognizing their positive impact on health. However, at national level, access to these environments is limited. The results can be used as support in improving public health among Sweden’s oldest population and care workers at RCFs.