What are cookies?

Our site uses cookies. A cookie is a small text marker stored on your computer that enables us to track the use of our website. We use cookies to help us understand what our users' interests and preferences are to ensure the website is as user friendly as possible.

This site only uses cookies in order to provide a service to visitors. No personal data is stored in cookies and cookies are not used in order to provide advertising. Cookies are used for the following purposes:

Learn more about cookies on aboutcookies.org

If you have any concerns about the processing of your personal data by the Dementia Action Alliance, please contact the Secretariat, c/o Alzheimer's Society, 43-44 Crutched Friars, London, EC3N 2AE.

Accept and continue

Step Change Design Ltd

We are Garden Designers who completed a research project to understand why gardens were not more effectively used for residents with dementia in care settings, even when designed to meet the latest guidance. Our findings led us deep inside the care home itself and found a correlation between greater use of the outdoors in those homes with more relationship-centred care. We created a diagnostic tool, The Care Culture Map & Handbook, to help Care Homes, and Garden Designers, to understand where they are culturally, what may be hindering their use of the outdoors and how to move forward to a more active and meaningful use of their outside space. We share our work through this tool, inspirational workshops, presentations and on-site consultations to create greater engagement with the garden and cost-effective investment where design is needed.

27 November 2019
Care, Communication, Hospitals and Hospital Trusts, Local Authorities, Other, Recreation, Community organisations, Faith Groups, Hospices, Charity, Clinical Commissioning Group, Commissioners Sector, Education Sector, Local DAA Members, Research Sector, Social Care
Local Alliances:
Dementia Friendly Southampton (Southampton DAA)

1. Action Plan

1. The National Dementia Declaration lists seven outcomes that the DAA are seeking to achieve for people with dementia and their carers. How would you describe your organisation’s role in delivering better outcomes for people with dementia and their carers?


Through links with NAPA, Journal for Dementia Care and other care support organisations, we aim to share our key research findings to empower care homes, and garden designers and other specialists who support them, to enable them to create more actively used gardens. We are helping to open their eyes to the opportunities the outside can provide and the simple ways it can be used to gain the benefits for those with dementia including:  relaxation, exercise, fresh air and purposeful and meaningful activity.


Working through local DAA groups from our Southampton and North Wales offices and other local organisations we aim to share our key findings to help the understanding of the role of care culture on creating wider use of the outside spaces to benefit those living with Dementia to live their lives as they choose to do so.

We are also working to share our key finding with our peers in the Garden Design sector, and related specialists,  to aid them in providing appropriate design support to care homes based on our finding ensuring actively used gardens and cost effective use of resources. We call this new approach 'Relationship-Centred Design'.


2. What are the challenges to delivering these outcomes from the perspective of your organisation?

Our findings often find us having to dispell some commonly held myths that show that it is the role of the people in an organisation and not the need for more money, staff or even a pretty space that makes the most actively used gardens. This puts the role of design into a context of Care Cultural practices and ensures that money spent on outside improvements is well spent and that care settings understand their pivotal role on the on-going active engagement of the space. 

We initially focused on sharing our findings with the care sector to empower them to better inform the designer, if they need them. Since 2017 we have also been sharing our work more widely into tthe wider design sector and are now working on a Designer handbook to compliment this.

2. Actions

  • Publish the statistical findings from our research on what makes care setting gardens more actively used.

    Our original qualtative study was published in 2015 in Journal for Dementia Care and in our diagnostic tool the Care Culture Map and Handbook. This work contained statistical data that had an initial investigation but has recently been revisited to provide a deeper accompanying qualative analysis.

    The intention is to publish the findings of this quantative data to further support enabling residents to engage outside as and when they choose by supporting those who care for them with information to help them achieve this.

    Being implemented

    2019 - Third Quarter Update

    We have published an infographic poster sharing some of the key statistics from our research with the aim of inspiring, and providing fresh thinking, to carers in enabling residents to engage outside more easily. This is available at https://bit.ly/2WZQ240

    We are currently writing an article for publication in a Journal in the comming months with an overview of the findings in the context of our early wider qualataive work.

  • Create Garden Designer tool to aid intergrating Care Cultural practices within a brief and applying appropriate support to Care settings

    Create a tool to support Garden Designers at the very beginning of working with a care setting to understand the key influence of the role of care practices (care culture) on what kind of support is appropriate, particuarly with residents living with dementia. This is to ensure that any changes made will go onto be well used and well loved beyond the novelty of any new garden and that it supports a homes efforts to enable residents to live meaningful lives and to step outside as and when they choose, within a care setting.

  • Ensure all members of the organisation are Dementia Aware

    Attend appropriate Dementia Awareness session/training eg Dementia Friends,  SCIE Dementia modules on-line etc


    Being implemented

    2015 - First Quarter Update

    Sadly have still not managed to find a date that works for formal Dementia friends training.

    However, 1x Director attended Hampshire Dementia Action Alliance conference. They also spent time with a local champion sharing their work and gleaning much in return.

    Work continues to keep upto date on Dementia current information with both Directors reading Journal of Dementia care regularly.

    Will continue to look to attend an event.

    2014 - Third Quarter Update

    All members of the organisation have watched the Dementia friends video and recieved thier pack.

    Suitable dates to attend a session are being looked out for to attend these too.

  • Seek to incorporate the DEEP 'We' statements into our work

    We already ensure that the person living with dementia is at the heart of our work.Our research was carried out with people living in care settings with dementia either directly capturing their input or through observations. Our Care Culture Map tool contains 204 statements, each one is related to this captured information, informing how to improve engagement with the outside.

    Our workshops has so far deliberately focused on supporting the change in care culture needed in Care Settings and the way Design sector support is delivered in light of our findings.

    Our recent workshop for the RHS enabled us to revisit our research to look at it in the light of the domestic home setting and for those transitioning into care. This information will be used to create a future workshop/event we hope to create specifically for people living with dementia, and their carers, to support continuing engagement with their gardens for as long as they wish within the domestic home environment. We hope to involve DEEP in this creation and delivery.

  • Work with Care homes using the Care Culture Map diagnostic tool and workshops to increase the use of the outside space for the benefit of residents living with dementia

    We continue to seek to support care homes or care home groups to understand why they may not be using the garden more by identifying thier cultural position along a spectrum of care through and beyond person-centred care. We do this through an empowring workshop and our diagnostic tool 'The Care Culture Map and Handbook' tool. This tool helps care settings, and designers, to understand:

    Where they are culturally on the journey to Relationship-centred care What may be hindering their more active use of the outside space Quick wins within their existing homes’ practices and space that can be implemented easily What the journey ahead may look like and the next steps to increase the active use of the garden If design support may be needed, how and when this may be most cost effectively utilised

    We continue to actively seek opportunities to run our 1/2 day workshop 'Why don't we go into the garden?'. This empowers care staff of all levels to look afresh at why the do not use the garden more. It is a thought provoking, fun and inspiring event with many quick and easy solutions to take away and put straight into practice. This event is a CPD accredited event with NAPA.


    2018 - Fourth Quarter Update

    We have now run our workshop many times and are beginning to evolve it into a more targeted event that can be run for specific in-house care settings. Using the Care Culture Map tool alongside this more interactive delivery of our 'Why don't we go into the garden?' workshop we drill down into the real reasons engagment outside is not taking place and seek to explore how to overcome these issues so residents can benefit with more opportunities to step outside as and when they choose. We were fortunate to run for a 2nd year in a row a workshop with the Royal Horticultural Society, through the London College of Garden Design, a workshop on Designing Dementia Gardens. This included not only designers but delegates from the Care sector and family members of people living with dementia. We have continued to share our 'Care Culture Map tool' and have recently recieved feedback on its use which has benefit converesations and changes around what has hindered engagment outside. The Map tool has even in recent weeks informed us, its creators, revealing even more about care culture and how stepping outside can be unlocked more effectively. As with any Map it shows where you are, whats en-route or in the way and helps you plan your route through culture change forwards to where you wish to go. Uniquely it can sit alongside any other culture change model, making this visual and aiding conversations and actions. We are pleased to have now had this tool listed as a resource within the Eden Alternatives Culture Change handbook.

    2017 - Second Quarter Update

    We have delivered our workshop 'Why don't we go into the garden?' to a  new care group this spring and revisted one we ran this for last year to new staff. Its exciting to hear the impact our workshops have on engagement for residents with the garden as well as being a catalyst for culture change towards a more person-centred care practice.

    Excitingly we are also booked to return to a group and run a Manager focused event which will certainly highlight how the garden can be a tool to support culture change in care.

    2017 - First Quarter Update

    We are booking workshops within a number of care groups to support their greater engagment with their outside spaces.

    Our 'Care culture Map and Handbook' has just celebrated its 1st year since publication. It has been used to support homes in understanding what hinders thier use of the outside within their organisational culture and move forward to greater engagment.

    2015 - First Quarter Update

    Carried out 1/2 day workshop introducing the Map diagnostic tool to a group of mixed staff from various care homes groups. Helped them understand the link between cultural practices and how to increase engagement with the outside for people with dementia.

    Writing a book to accompany the diagnostic tool so it can be used without our support and be used by a wider audiance. Aim to be published in time for the NAPA conference in October 2015

    2014 - Fourth Quarter Update

    The diagnostic tool, called The Map, has now been produced.

    Our first presentation to 15 Care home managers for a Faith based Care home group was carried out in September and included an introduction to this tool. It was well recieved and the managers indicated they felt it did reflect reality and they went away with some easy quick wins to help them make more of the outside space they already have and to enable thier residents use the outdoors more if they wish.

    We are booked to attend the NAPA conference on 15 October and have a stand and short slot on the agenda to share our diagnostic tool to 120 Care home managers/Activity co-ordinators.

  • Publish our top 10 key findings from our research

    Seek out a variety of routes to share our Top 10 key findings from our research to help care homes use their outside space more actively and cost effectively. 

    Some possible routes to investigate achieving this via include:

    Living Life magazine – National Activity Providers Association - Journal for Dementia Care– Hawker publishing - Vitis/ Garden Design Journal - Society of Garden Designers members newsletter. Handouts to: HDAA members, Contacts made during our research project (approximately 250)


    2015 - First Quarter Update

    March 2015 - full article published of our work, findings and the Top 10 in Journal of Dementia care.

    Spring NAPA Living Life edition - a 2nd article sharing some key findings to avoid the additon of gimmicks and infantilising when adding elements or doing new activities in the garden.

    2014 - Fourth Quarter Update

    We have shared our Top 10 Findings through the following routes:

    NAPA living life magazine, distributed to a large number of care homes across the uk.

    At a presentation to 15 Care home Managers at their conference for a faith based Care home group.

    This is now available to download via our website www.stepchange-design.co.uk.

  • Seek speaking opportunities to share our key findings

    Seek out a variety of routes to share our key findings from our research to help care homes, dementia organisations and garden design sector to better understand what makes for an active outside space using financial and other resources effectively to achieve this.

     Some possible routes to achieve this:

    Judging Garden categories at awards to promote the use of the outside space – NAPA and others, to be announced Presentations – care organisation conferences, Garden designer networking meetings workshops/training – to specific groups like: Activity co-ordinators, Garden Designers, Care home Managers, Commissioners of services and those providing Specialist support people living with Dementia that may use or impact on the use of the outdoors i.e. Architects, Dementia Adventure, Thrive


    2018 - Fourth Quarter Update

    It has been an important quarter for sharing our findings with the opportunity to judge the best dementia garden, with the winners demonstrating that is is all about the people and not just what is in the garden. We presented a culture change focused workshop at the UK Dementia Congress focusing on how 'Weather-ready' are care settings, enabling residents to engage outside as and when they choose whatever the weather.

    We are also working with a care home to redevelop thier gardens as a result of a new extension and have delivered our work in a 'Relationship-centred Design' way, with workshops and consultations to unpick cultural practices and beliefs hindering engagment and to input into the final design ensuring this goes onto be well used and well loved.

    We continue to seek to share our Care culture Map tool and are now working on a Designer handbook to help other Garden Designers and other specialists work more effectively with care settings.

    2018 - Second Quarter Update

    We have had the chance to share our findings to enable residents in care settings to engage more with the outside and care setting gardens via a number of routes over the first half of the year including:

    A number of Care focused workshops in Stockport, Barnsley with Making Spaces and Chelsford at Dementia Adventures HQ, with thier input in sharing thier work too.

    Two Garden Design sector focused workshops. An open event in Oxford and most recently our 2nd visit to deliver our full day event at RHS Wisley.

    We are also excited to have secured a 4th chance to speak at this years Dementia congress and also part of a bid in support of delivery of culture change for 15 care settings in Angus, Scotland later in the year.

    2017 - Third Quarter Update

    What a busy period we have had and are just entering.  We have delivered our 1st, sold out, workshop for the RHS at Wisley, and have been booked for two events already in 2018. We were part of a panel on 'Improving quality of life' at DemFest for Romsey Dementia Friendly community event. We presented our findigns to a mostly design focused event run by Liverpool DAA,  'Doing Dementia Design''.

    In the coming weeks we will be extremely busy as we have been actively invited to speak at: Landscape show(19/9), 'Landscape, Gardens and Health Network Conference' (22/9), David Robinson Memorial Lectoure, Dublin (12/10). At the NAPA conference (18/10) we'll be sharing our Map tool as an audit to care culture and once again we're at Dementia Congress (9/11) for our 4th time to explore 'How open door is your open door policy'.

    2017 - Second Quarter Update

    We've been fortunate to speak at the recently formed Southampton Dementia Freindly Community event, which as Debbie's home city was a great event to feel a part of, making a difference close to home. We have also been confirmed to speak at several events for later in the year including: RHS Wisley workshop on dementia design (22/7), DemFest a Romsey Dementia Friendly community event (10/9), 'Doing Dementia Design'' a Liverpool DAA event(14/9), Landscape show(19/9), 'Landscape, Gardens and Health Network Conference' (22/9). An exciting and inspiring year ahead.

    2017 - First Quarter Update

    2017 has already got some great opportunities confirmed to share our work, see below and we'll update this as other events are confirmed:

    July - RHS Wisley we will be running a workshop about out work for RHS members and the public based on thier work aroudn the role of teh garden in health and well being. We have been booked via Andre Fisher-Tomlin's London Garden Design School to deliver this day long event.

    September - Landscape show, our 2nd chance to speak to our Garden Design peers.

    2016 - Third Quarter Update

    Several amazing opportunities to share our work have included at:

    Eden Alternatives conference - theme being 'Changing the Culture of Care' and we explored how the garden can be a mirror of the cutlure of an organisation inside.

    Landscape Show, Battersea - a chance to share our findings to our Garden Design peers.

    Dementia Care Congress, Brighton - we were fortunate to be able to run an interactive workshop exploring some of the most common areas hindering use of the outside within care settings for dementia.

    2015 - First Quarter Update

    Have given overview presentations of our key findings at Portsmouth University for thier Health and social science networking group. Recently selected as a speaker as a part of Solent Southampton University's first Health and Wellbeing conference under the heading "Innovation in health & wellbeing".

    Planning to give a talk to a similar type of event to be run in North Wales as a part of encouraging more people with dementia to access the National Parks there.

    All talks so far have been amazingly well recieved with feedback showing that our research and the approach to our findings are really accessible and achievable.

    2014 - Fourth Quarter Update

    We have shared our the headlines to our findings to the following routes:

    NAPA gala - we acted as judge to their most active garden award and were able to speak with some key Mangers in two of the largest care home groups who felt our work may benefit thier support of staff in greater use of the outdoors.

    Presentation to a Care home group - shared key findings and our diagnostic tool plus gave them some quick wins on making more of the outside space they already have to benefit their residents living with dementia

    A further judging opportunity is ahead to spread best practice in the use of the outdoors.