Fostering an active daily life: An ethnographic study unravelling the mechanisms of Green Care Farms as innovative long-term care environment for people with dementia

Objectives: Green Care Farms (GCFs) are gaining attention as innovative dementia care environment. Compared with regular nursing homes, first studies suggested a more active daily life, more social interaction and a higher quality of life of GCF residents. Regular facilities aiming to redesign and implement GCF elements might be hindered to do so by a lack of space for meadows or regulations prohibiting animals. Therefore, this study explored the underlying mechanisms by which GCFs may generate the positive effects. Design: This study is an observational, explorative study using multiple methods. Setting: One GCF and one traditional nursing home aiming to implement GCF elements. Participants: Residents, family members, staff, managers, and other involved individuals of the two nursing homes. Measurements: Ethnographic observations (n = 52 days), semi-structured interviews (n = 67) and a focus group with experts from various disciplines were conducted. Data was analyzed thematically and triangulated. Results: We identified six possible mechanisms of GCFs encouraging an active daily life. These are: 1) stimulating the senses, 2) promoting engagement in purposeful activities tailored to the individual, 3) creating a community, 4) promoting freedom and autonomy in a responsible way, 5) integrating the vision in all actions, and 6) continuously transforming to carry out the vision in practice. Conclusions: Our results provide first insights into environmental working mechanisms, which are relatively generic and have the potential to be transferred to other settings. Hence, this study provides other care organizations with guidance on implementing the care vision of GCFs in their local context. What is already known: • The long-term care sector is transforming from a medical model of care towards a more psychosocial one. Innovative approaches, such as Green Care Farms for people with dementia, are developing world wide. • First studies indicate positive effects on residents who live in this radically different care environment, such as a more active daily life. • The elements contributing to these improved resident outcomes are well studied; however, they might not be transferrable to other, more regular nursing home settings. What this paper adds: • This study explored the mechanisms, by which innovative care settings, such as Green Care Farms, put their vision to practice. • Mechanisms can be triggered with varying elements in the physical, social and organizational environment, making it possible for other care organizations to reach the same outcomes within their unique setting.