In August 2019 myself and Julie Garton gained funding from the General Nursing Council for Scotland, and we joined by Mandy Cowan from Alzheimer Scotland for a study tour to the Netherlands to visit Green Care Farms. Green Care Farms for people with dementia are small home-like settings with engagement with farming activities integral to the systems and processes of care delivery. Offered as an alternative to traditional long-term care models, research into Green Care farms have demonstrated the ability to provide a person-centred, meaningful and nurturing environment for people with dementia.
We visited our hosts, Dr Simone de Bruin, from the National Institute for Public Health and the Environment (RIVM), Center for Nutrition, Prevention, and Health Services and Jan Hassink Wageningen University. They kindly shared how the Green Care Farm places for people living with dementia are commissioned, organised, regulated and researched across the Netherlands. Dr de Bruin and Jan Hassink also supported visits to the Green Care Farms day and residential services across the Netherlands.
At the care farms, we saw people come by minibus and spend most of the day involved in farming activity. People chose what they wanted to do that day, from collecting eggs, harvesting fruit and vegetables or caring for an array of animals. In caring for the animals, the people living with dementia experienced the opportunity to increase their physical activity, develop relationships with each other and the animals and gain a sense of accomplishment focused on mutual caring between people and animals and people and people.
The talents, skills and attributes of those attending were paramount and given priority. We observed an enabling approach in action where the days were constructed around what needed doing and a person-centred choice of activity. We saw people living with dementia who appeared fit and supple. They engaged in their work with low-level supervision working alongside each other, the animals and volunteers. When they did have additional physical support needs, these were supported creatively.
The people we met were at different stages of their journey; however, most were experiencing moderate to severe dementia. The focus on peoples talents and attributes, the fostering of relationships, socialisation, meaningful activity and physical health benefits, all cumulated to an environment that felt warm, welcoming and happy. We were privileged to see older people active and engaged in predictable, flexible and reliable farm-focused routines.
The Green Care Farms demonstrated that the animals are a small part of the social environment which a farm or any place caring for animals can provide for people living with dementia. Relationships with the farmers and with peer people living with dementia also contributed to the therapeutic environment. Our next steps are to see if some of the benefits of the underpinning theory to Green Care Farming can be replicated in Scotland and lead to the benefits observed on the study tour.
The Green Care Farms emerge from a social enterprise approach in the Netherlands and give an additional option for daycare services for people living with dementia and other client groups. Funded by the municipalities under contract, the Green Care Farms also provides the farmer with a single or additional funding stream. Green Care Farms are embedded in their local communities. Scotland has 20,000 smallholdings, farms operating on 50 acres or less, with farmers who could consider Green Care Farming as a possible future income stream contributing to increasing the community-based care options for people living with dementia.
Any future developments in community care options for people with dementia could contribute to the education of health, social care, animal care and farming professionals by providing practice placements. Supporting professionals to develop creative and flexible approaches to care in their early education which reflect the lives and loves of people with dementia could result in reciprocal living and learning for everyone one.
Experiencing the tour reminded me of the implicit knowledge and skills I possess and which resurfaced. I had forgotten the nuances and joys of my early rural life; yet I remembered how to close and lock a gate quickly, how to hand feed the animals, how to talk to the animals and recognised crops and planting patterns in the landscapes. Animals have always been a part of my life, and they are everpresent now. This tour confirmed my wish as part of this network to enable people with dementia now and in the future to have animals continue to be part of our lives.
Simone de Bruin outlining her research work. https://www.youtube.com/watch?v=dVXyswGlM-4
de Bruin, S, R., Stoope, A., Molema, C, C, M., Vaandrager, L., Hop, P, J, W, M., Baan, C, A. (2015) Green Care Farms: An Innovative Type of Adult Day Service to Stimulate Social Participation of People With Dementia. Gerontology & Geriatric Medicine. Jan-Dec, 1-10.
de Bruin, S. R., Oosting, S. J., Tobi, H., Blauw, Y. H., Schols, J. M. G. & De Groot, C. P. G. (2010). Day care at green care farms: a novel way to stimulate dietary intake of community-dwelling older people with dementia? Journal of Nutrition, Health & Aging, 14, 352-357.
de Bruin, S. R., Oosting, S. J., van der Zijpp, A. J., EndersSlegers, M. J., & Schols, J. M. G. A. (2010). The concept of green care farms for older people with dementia: An integrative framework. Dementia, 9, 79-128.