Patients find grass is greener on the roof
Donors create garden and town as therapy
Few people who have spent time running their fingers through dirt while planting flowers and bulbs will dispute the therapeutic value of gardening. But is horticulture worth the time and expense it might entail if used in a rehab facility as part of the therapeutic plan of care?
To Magee Rehabilitation in Philadelphia, the answer is yes. The 96-bed hospital has a horticulture therapy program that began informally in the mid-1970s. It started as a volunteer program but has expanded with a full-time coordinator, a variety of planter areas, and a rooftop garden.
"We have some indoor grow-light units to grow plants and a large patio that staff and patients both use," says Linda Ciccantelli, HTR, coordinator of horticulture therapy. The program’s costs are minimal because most of the plants are donated, and what horticulture work isn’t done by Ciccantelli and patients typically is done by volunteers.
Here’s what to include
Here are some other features of the program:
• Incorporate horticulture therapy in reimbursable therapy sessions. Ciccantelli’s work with patients is not reimbursed by Medicare and other payers unless it’s part of co-therapy with an occupational therapist, physical therapist, or recreation therapist, but the horticulture therapy itself can be reimbursed any time it’s part of a regular OT or PT or other therapy visit, she says.
Horticulture therapy addresses every aspect of rehab, including functional living skills and activities of daily living, she says. For instance, suppose a stroke patient needs to work on improving balance and standing tolerance. The patient’s physical therapist can help the person work on strengthening the side of the body affected by the stroke by giving the patient some gardening tasks. Or the patient can work on compensating for paralysis by using the other hand in gardening.
"Say someone has had a stroke that affects the left side," Ciccantelli says. "It may affect the person’s vision, causing a field cut, so just the way we place the gardening activity, maybe in front of them or to the left, may encourage them to compensate for that neglect."
Stroke and other brain injury patients also can work on writing gardening plans and following instructions. They can work on sequencing and planting seeds, beginning with large seeds that are easier to handle. "So I might say to the patient who has six bean seeds, Put one in the middle and put five around the perimeter,’ and with just that activity they’re working on so many different things," she says.
As another example, a patient might be working on increasing standing tolerance. Time may seem to move very slowly when patients are required to simply stand for five minutes. But if patients are in the horticulture therapy area and are working on potting a plant, their standing time might increase because their focus is on the planting and not on the standing.
"All of these things contribute to the patient’s rehab process and to reducing the patient’s length of stay," Ciccantelli says. "Patients are making faster improvements and gaining ground they might not otherwise be as motivated to gain because they enjoy their work with plants so much more than traditional therapy exercises."
• Develop gardening areas that fit into facility’s overall plan. The rooftop garden is the crowning jewel of Magee’s horticulture therapy program. It gives patients a view of the city and has excellent lighting for a variety of annuals, perennials, herbs, and Pennsylvania native plants.
"We also have a rooftop complex that now encompasses a streetscape, called the Jerry & Carolyn Segel Center for Community Skills, with a simulated street that has potholes, curbs, a mailbox, telephone, cash machine, a porch, and a car," Ciccantelli says.
The cityscape area is landscaped with shrubs, perennials, trees, and gardens. The next project will be a low-maintenance garden. "Now we have daisies blooming and Sweet Williams coming up, and pretty soon we’ll have irises, and we have an azalea bush that blooms in a huge container," Ciccantelli said during a spring interview. "We have a whole lot of lilies that bloom throughout the summer." The hospital also has a variety of containers for growing plants, which are accessible to rehabilitation patients in wheelchairs.
In addition to the cityscape gardens, there is a greenhouse that was bequeathed by a former patient who wanted the hospital to develop a greenhouse for patients, she adds. The greenhouse is climate-controlled for humidity and temperature at 70 degrees. Inside are movable benches to accommodate patients with varying levels of physical disability.
Patients grow a variety of plants
The greenhouse’s lighting units enable the facility to grow a wide variety of useful plants from seeds, including basil, okra, tomatoes, string beans, oregano, dill, and mint. "Patients take home everything they start growing, and that’s a very integral part of what I see in my role as horticulture therapist," Ciccantelli says. "So patients who are here, even if only for a week, have an opportunity to start a plant, maybe cuttings for a basket or seeds to transplant in their garden."
• Use horticulture therapy to improve quality of life. Therapists use the hospital’s garden area when they want to take patients on walks or in their wheelchairs as part of ambulation training. The patients enjoy having a natural green area to visit because it gives them a chance to get away from the more sterile atmosphere of the hospital and their rooms, she adds.
"Being outside and seeing something living and growing and changing has a huge impact on patients’ psychological and spiritual well-being," she says. Patients often leave the program saying the horticulture therapy has had a huge impact on their recovery, she adds.
Need More Information?
% Linda Ciccantelli, HTR, Coordinator of Horticultural Therapy, Magee Rehabilitation, Six Franklin Plaza, Philadelphia, PA 19102. Phone: (215) 587-3200, ext. 3925. Fax: (215) 568-3533.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content