Promoting Agency in Residential Dementia Care Environments: Learning from Green Care Farms

This article explores how nursing homes for people with dementia can shape their environments in ways that promote agency. Compared with traditional nursing homes for people with dementia, Green Care Farms (GCFs) provide a radically different residential care environment-physically, socially, and organizationally. This study examines the specific agency-promoting characteristics of GCFs and explores whether, and how, these can be implemented in other settings. We conducted a multi-method qualitative study at two care sites: a GCF and a "regular" nursing home (RNH). Data collection included participant observation and interviews with staff at both locations. Additionally, at the RNH, we participated in a co-creation process in which its environment would be redesigned by incorporating elements of a GCF. Our analysis revealed that the GCF environment promoted agency in three key was: by stimulating physical activity to retain physical functioning; by encouraging participation in meaningful activities; and by enabling residents to enjoy freedoms and risks. In principle, each of these agency-promoting characteristics could be transferable to other (traditional) settings. However, our study suggests that this will require profound organizational changes in RNHs, as staff would need to adopt values and practices that stand in stark contrast to traditional ways of working.