Therapeutic Garden Design and Veterans Affairs: Preparing for Future Needs

1. Therapeutic Garden Design
and Veterans Affairs: Treatise
Preparing for Future Needs
Field Session as part of 2005 Annual Meeting of American Society of Landscape Architects
Hosted by Miami Veterans Affairs Medical Center Miami, Florida October 11, 2005
Facilitated by ASLA Therapeutic Garden Design Professional Practice Network and the Acer Institute

2. Treatise | Therapeutic Garden Design and Veterans Affairs: Preparing for Future Needs
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“… to care for him who shall have borne the battle, and for the widow and his orphan.”
— Abraham Lincoln
Forward Thinking: Gardens at Veterans Affairs Facilities
Veterans comprise a large segment of our population – 26 million people. Based on current active combat statistics, a sharp
spike in need for healthcare services is likely to result in a great number of veterans requiring short or long term stays
within Veterans Affairs (VA) facilities.
With approximately 1,300 care facilities, VA has begun the largest and most extensive restructuring of its healthcare
system in history and has changed dramatically in the past several years. VA facilities are being modernized and expanded,
treating more veterans in more places than ever before. With 25,000 fewer employees, VA provided care to one million
more veterans in 2001 than in 1995. More than 4.8 million people received care in VA healthcare facilities in 2003: out-
patient clinics registered approximately 49.8 million visits and approximately 14,000 veterans received care in nursing
homes. VA strives to provide quality, timely and excellent patient care in the shadow of impending world events.
An estimated $2 trillion is forecasted for national healthcare expenditures by 2008. In July 2005, both the House and the
Senate passed a bill that would provide an additional $1.5 billion to compensate for a massive budget deficit in VA’s
healthcare budget, totaling over $28 billion in the VA healthcare budget.
How can therapeutic gardens support the VA healthcare system and buffer the impending strain?
• Aid in clinical treatment (horticultural, occupational, recreational therapies) from injury and illness (e.g. Post Traumatic
Stress Disorder, physical disabilities)
• Provide a positive distraction from illness and concerns
• Reduce stress and blood pressure
• Aid in seamless transition from wartime duty in a home-like setting
• Normalize the environment; “de-medicalize” the setting
• Improve mood, function and socialization, increase natural absorption of Vitamin D, and balance circadian rhythms
Models of medical care are changing. Cost-effective complementary treatment modalities are becoming a significant
component of the healing equation. Sound practice indicates therapeutic gardens are used in the clinical healing and
rehabilitatio for patients. These gardens offer additional venues for therapeutic activity and become integral in the com-
prehensive healthcare delivery system, thus having a profound effect on the “bottom line” (Hutton & Richardson, 1995).
Health outcomes research has measured positive, tangible effects of therapeutic gardens:
• Shorter post-operative stays, decreases in pain medication requests, and decreases in negative comments by
care staff were noted when views from patient rooms were of natural, green spaces as opposed to brick walls
of adjacent buildings (Ulrich, 1984).
• A decrease in violent behavior in Alzheimer’s facilities was noted when use and exposure to gardens were
introduced as a care option. A 19% decrease in violent outbursts in one year’s time was noted compared to an
astonishing 681% increase in violent outbursts in those facilities with no gardens (Dannenmaier, 1995).
• Rehabilitation patients experience shorter stays in hospitals when room views are either a garden or a wooded
area (Burnett in Marberry, 1997).
• Residents with dementia experience reduced agitation, improved sleep, and increased appetite when exposed
to gardens.
The Therapeutic Garden Design Professional Practice Network and the Acer Institute alongside clinical and administrative
VA personnel, must effectively work together to sustain future care challenges. We align to support ongoing advocacy
in perpetuity for research and evaluation of the growing effectiveness of therapeutic gardens and allied clinical practices.

3. Treatise | Therapeutic Garden Design and Veterans Affairs: Preparing for Future Needs
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Our intention for a one-day conference was to set a benchmark for the advancement of exemplary therapeutic landscapes
in healthcare by aligning with the largest healthcare institution in the United States, the Department of Veterans Affairs.
Organizing a conference at the Miami VA Medical Center underscored the need to focus attention on a particular sector of
the medical community within the United States. We were pleased to have joined with the Miami VA and staff on October
11, 2005, for the opportunity to exchange knowledge and promote the advancement and use of therapeutic gardens. Many
doors were opened to a wide range of possibilities. Partnerships were forged between professional organizations.
Our purpose for this CD is to highlight the results of this initial effort and the need for therapeutic garden programming,
design, research and application in VA medical and related care facilities. This endeavor and information compiled within are
integral “steps” along the path of outreach extended by ASLA Therapeutic Garden Design Professional Practice Network and
the Acer Institute to horticultural therapists, medical professionals and architects. This CD marks the “first step” taken in
facilitating a long and fruitful dialogue between the ASLA Therapeutic Garden Design Professional Practice Network in
conjunction with the Acer Institute, the Miami VA, and the Department of Veterans Affairs at-large.
Please review and find useful and important information contained within and join us in our undertaking to advocate for
exemplary outdoor spaces in healthcare facilities.
The Editors, Event Facilitators and Organizers
P. Annie Kirk, MLA, ASLA Jack Carman, FASLA
Principal, Red Bird Design President
Director, Acer Institute Design for Generations, LLC
Therapeutic Outdoor Space 92 Tallowood Drive
Consulting + Design + Education Events Medford, NJ 08055
P. O. Box 83 jpcarman1@comcast.net
Aurora, OR 97002 www.DesignForGenerations.com
AcerInstitute@comcast.net 609.953.5881
www.AcerInstitute.org
503.887.3439
For more information on the Miami VA Medical Center therapeutic gardens, please contact
Alee Karpf, HTR, MS, CTRS
Recreational Therapist, Coordinator of Horticultural Therapy Program, Miami VA Medical Center
1201 NW 16th Street, Miami, Florida 33125
Alee.Karpf@va.gov
305.575.7000 ext. 6017
Sources:
http://www.patientsafety.gov; VA National Center for Patient Safety
http://www.va.gov/; U.S. Department of Veterans Affairs
http://www.whitehouse.gov/news/releases/2005/11/20051110-15.html
“Returning Operation Iraqi Freedom and Operation Enduring Freedom Veterans” for Miami VA Medical Center, compiled by Social Work Service at Oakland Park VA OPC,
“Department of Veterans Affairs, VA Accomplishments, 2001 to Present”, Office of Assistant Secretary for Public and Intergovernmental Affairs, September 17, 2004.
Burnett, J.D. (1997). “Therapeutic Effects of Landscape Architecture.” In S.O. Marberry (Ed.), Healthcare Design. New York: John Wiley and Sons, Inc., pp. 255~274.
Dannenmaier, M. (1995). “Healing Gardens.” Landscape Architecture Magazine, Vol. 85, No. 1, pp. 56~79.
Hutton, J. D. & Richardson, L. D. (1995). Healthscapes: The role of the facility and physical environment on consumer attitudes, satisfaction, quality assessments and
behaviors. Health Care Management Review, 20, 48~61.
Ulrich, R. S., 1984. “View through a Window may Influence Recovery from Surgery.” Science 224, 420~421.