Hospice care is generally provided to patients who have just six months or less to live. But a terminal illness shouldn’t stop them from smelling the roses, or the lavender, or from watching butterflies or listening to birds, enjoying the teeming life of a well-designed garden. By providing access to or views of gardens, hospice facilities are able to reinforce their aim of offering a comfortable, homelike setting that maximizes the quality of life for its patients.  

In a number of hospices across the country, landscape architects and volunteer gardeners have created spaces that offer patients, as well as visitors and staff, that amenity, supporting them with features such as secluded nooks for quiet conversations or areas for contemplation and spiritual renewal.

A space for all
Hospice of the Western Reserve in Cleveland has two sites offering garden access: the 42-bed David Simpson Hospice House that overlooks Lake Erie and the 18-bed Ames Hospice House, which opened in 2012 on a 24-acre wooded site. “It takes a couple of years for a hospice garden to really fill out. Until then, it’s a work in progress that needs to be humanized,” says Lu Little, president of landscape architecture firm Little & Wells (Cleveland Heights, Ohio), which has provided landscape services to Hospice of the Western Reserve for 13 years.

“Our goal is to have destination spaces that make people feel embraced,” she says. Fountains offer the soothing sounds of running water, while plantings emphasize the familiar, such as lilacs, hyacinths, and roses. “Make the garden as homey as possible. You design for everybody—visitors of all ages. The stones and fountains have soft edges. This needs to be a garden that anybody can walk in,” with wide paths and gentle slopes. The plants are fragrant, and nothing is terribly prickly, adds Laura Martin, the hospice’s director of operations for communications and development and liaison for the garden program. “The landscapers chose plants for the garden that require little watering or fussy management.”

The hospice is now adding the Hershey’s Children’s Garden for visitors and those attending its children’s bereavement program. “Kids of all ages will want to play in it,” Martin says. “It’s enclosed with a living wattle fence of 200 saplings woven together, with a large fountain and a couple of bridges where people can sit and put their hands in the water.”

Hospicare and Palliative Care Services in Ithaca, N.Y., opened the Nina K. Miller Hospicare Center Residence 18 years ago, and gardens were an important part of the original design, says executive director Dale Johnson. “I’m not sure we’d do it exactly the same way again. We have a koi pond and some built elements that haven’t been as well-received as we thought they would be. I really think the green stuff is more important, and in some ways, less is more,” he says. Johnson has found that patients prefer elements that are simple and pleasing to the senses, not necessarily elaborate. “It’s the nature and not the design of nature that seems to work best.”

Overcoming limitations
Most hospice services are provided within the home, where possible, and generally only the most acute patients are admitted into a hospice facility. That means that oftentimes patients are close to death, bedbound, and less able to interact with nature, says Christy Whitney, CEO of Hope West in Grand Junction, Colo., where a sensory garden has gone largely unused. “These can be very soothing places, but you need to be clear who you are creating them for,” she says, advising to keep things simple for patients who are too sick to explore esoteric features and to keep concepts of sensory gardens for families. And sometimes families will have different needs than patients, says Little. “They may want to take a walk and get away for a little while but still be able see back up the path and feel like they’re still connected,” she adds, recommending circular paths and figure-eight walkways for that purpose.

At its 18-bed Custead Care Center in Orange Park, Fla., Haven Hospice takes a similar approach. “We don’t really incorporate a therapeutic [care] model in our hospice garden, but it’s a therapeutic setting, and families use it as they see fit,” says administrator Al Rizer. “We have several gardens, and we’ve found them to be very useful. We’ve had patients say to us: ‘I just want to get outside one more time.’”

That was the case for one patient at Ames in Cleveland, which features wide doors that open onto patios that overlook its gardens for easy patient egress, even for those who are in late stages of their illness. “Last year we had a patient who spent almost all of his days outside, with his golden retriever lying on the bed with him,” Martin says. “He died outside.”

Johnson says it’s important for hospice patients and families to experience a connection with nature, but they don’t necessarily have to be in the gardens to enjoy them. “All of our rooms have glass doors facing the gardens and, beyond that, a pond with geese. We have deck birdfeeders for putting on a show. All sorts of people ride bikes or go running or walking on our trails. Yesterday someone went cross-country skiing across our pond,” he says. “You don’t feel you’re cloistered away from the world here, but part of the larger community. It normalizes the place of hospice care in the community, without the sense of it being a scary place.”

Beacon Place, a 14-room hospice in Greensboro, N.C., is one of few to employ a registered horticultural therapist, Sally Cobb, although she says advanced illness does limit what can be accomplished. “Digging in the garden is pretty rare for patients, less rare for families. But the beds are raised if they want to try. My role is to enable them to get out and work in the garden if they wish,” she says. Cobb is also responsible for choosing the plants and shaping the gardens on the agency’s 15-acre, four-building campus, which includes a counseling center for bereavement. “Interaction is the key word. We try to invite people into the garden, using elements such as swings, wind chimes, boulders, and fountains.” All patients are offered fresh-cut flowers for their rooms, and Cobb has a “sensory basket” packed with flowers and fragrant herbs that she takes from room to room.

Open house
Despite four decades of steady growth, hospice remains a last resort for most and, subsequently, a place that’s often avoided rather than embraced. A well-designed hospice house with attractive landscaping and walking trails can be a visual representation of the services offered to the community, providing a peaceful glimpse inside.

Beyond a glimpse, though, the gardens can serve a vital role in community engagement, for example, featuring pathways paved with donated bricks bearing the names of loved ones. Memorial services, both for individuals and to honor all of the patients who died at a hospice, along with public ceremonies to honor veterans, might also be held in outdoor spaces. Gardening clubs could be invited in or Boy Scouts asked to build birdfeeders.

At Custead Care Center, holiday festivities are hosted in its garden and a wedding for the daughter of a patient was even held there. “We use every opportunity for people to come into the center in different ways and learn a little more about hospice care,” Rizer says.

Larry Beresford is a freelance writer based in Alameda, Calif. He can be reached at larryberesford@hotmail.com.