Debbie Carroll is celebrating 10 years since she first set up Step Change Design. The garden designer formed the company with Mark Rendell after they’d carried out research on how to make care home gardens more actively used and were keen to share their findings with the industry. Over the last decade, that learning has only continued. Here, Debbie Carroll highlights 10 key things she has picked up in that time on how to design care and dementia gardens.

1 Actively used care setting gardens are driven by people, and those care settings delivering person-centred care are engaging outside more as a natural part of delivering care to their residents.

2 Care settings – and designers – with fearful attitudes to health and safety will effectively cap future long-term use of a garden space unless those fears are overcome. Fears need to be replaced by knowledge and a shift to positive risk assessments, based on risk versus benefit, embedded in the care setting’s practices, if the garden is to become a much-loved resource.

3 Designers need to understand the current organisational culture of a care client and match this, supporting a move towards more active engagement outside driven by person-centred care.

4 Designing accessible spaces for all ensures it works for older frailty, dementia and visiting families too.

5 People living with dementia have varied wishes as to how they want to enjoy the garden and so new spaces need to remain flexible so that they can evolve in the hands of the care setting after us as designers have left.

6 Domestic and familiar feeling gardens work best for dementia care settings; avoid adding confusion or hard to interpret elements.

7 Generationally familiar plants are more likely recognised by people living with dementia; ‘good doers’ are often the much-loved plants with strong connections from past gardens.

8 If people living in care settings are to feel ownership, then they need space to add their input, and not only in productive areas; a ‘gaps are good’ approach of not filling all the planting areas from the outset provides this opportunity.

9 Avoid overly conceptualised schemes, particularly for people living with dementia; the space needs to be easily understood without explanation.

10 The care setting must remain the real expert throughout the process. As a designer, we need to take care to not introduce fears or obstacles from our designer thinking that can be at odds to truly person-centred care. Care settings working at this level are assessing risk at an individual level while designers often have to think in the generic. We need to flag up risks while accepting that the final decisions must be made by the care setting themselves, as they are required to work to a different, much more personal level, approach.

These learnings are based on the extensive research project into what it takes to create actively used care setting gardens as shared in the series of books authored by Debbie Carroll and Mark Rendell, ‘Why don’t we go into the garden?’. This series contains material to support care settings on improving practices to more person-centred care – and so greater engagement outside – and designers working with them to provide their support alongside improving care practices to ensure gardens are used long after they have left.

Step Change Design was formed following this research project with the aim of sharing the findings to both the care and design sectors through these books, speaking events and works with the aim of enabling residents living in care to engage with the garden as and when they choose. Their publications are available from Step Change Design’s website and to order via Waterstones.

• Carroll D & Rendell M (2016), Why don’t we go into the garden? The Care Culture Map and Handbook and
• Carroll D & Rendell M (2022), Why don’t we go into the garden? A Designer Handbook for Creating Actively Used Care Setting Gardens