The Therapeutic Gardens

at Hôpital Glengarry Memorial Hospital
Alexandria, Ontario

Written by Sarah Good

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Interviews conducted May – October 2015

CASE STUDY HIGHLIGHTS

HGMH is situated on a 23 acre property in the heart of eastern Ontario
Dozens of patients per week visit the Horticultural Therapy garden
Staff champion, collaboration of kitchen staff, grounds department and students was essential to success of program
Modest but increasing production has generated significant enthusiasm from staff and patients
Model demonstrates potential of patience, cautious development and expansion

PROJECT OVERVIEW

Hôpital Glengarry Memorial Hospital (HGMH) is home to an expansive therapeutic garden producing a variety of fruits and vegetables. This garden was established as an extension of the Stroke Rehabilitation department, and is open for use by anyone who visits the hospital. The garden provides a space for patients’ activities, as well as for family visits and staff breaks. In 2015, the garden produced over fifty varieties of fruits, vegetables, herbs and edible flowers. The produce harvested from the garden is used primarily in the hospital kitchen, but is also used in the rehabilitation activity room, and some is sold in small markets on the property, as well as to a local cafe.

The project’s start-up funds came from Ontario’s Healthy Communities Fund, which aims to encourage the development of “local healthy eating and physical activity policies.” The HGMH garden operates with a motto: “Stretch your Limbs, Grow your Food, Lift your Spirit”.

The therapeutic garden offers a variety of benefits to the hospital and community, including incorporating fresh food into patient and staff meals and improving patient experience. While there has been no systematic evaluation of the garden’s outcomes, patient surveys and staff observations suggest that the garden has contributed health improvements from physical activity and socialization, to memory and concentration (particularly important for stroke recovery), motor skills, mood, and disposition to the overall program of treatment.

By incorporating SPIn (Small Plot Intensive) farming methods, the long term goal for the garden is to provide sustainable produce to the hospital kitchen, and establish itself a leader in green health care, while maintaining fiscal responsibility and becoming a key player in the “buy local” movement.

History

In 2010, the HGMH started seeking ways to distinguish itself as a leader in stroke rehabilitation therapy. Ultimately, the options were narrowed to either constructing an apartment, which would be used for rehabilitation activities, or constructing a therapeutic garden. The garden won primarily because of cost, in addition to the significant funding opportunities offered through the Healthy Communities Fund. It was determined that the best site would be on the west side of the property, adjacent to the existing indoor therapeutic pool.

Construction for the therapeutic garden began the following year, and at time of writing the garden team is wrapping up its fifth successful season. Louise Quenneville, the Project Manager and Emergency Preparedness Coordinator at HGMH, has worked tirelessly to expand the garden, secure student support, involve patients and staff, and find ways to incorporate garden produce into hospital meals. Since 2013, the HGMH garden project has also been a partner on Project SOIL, a three-year province-wide study that explores feasibility of on-site food production for institutions. More details on the historical developments of this garden are found in the following sections.

PROJECT RESOURCES

Human Resources

With the support of the Senior Management team at HGMH, the Project Manager has —for the past 5 years—been able to include the garden planning and expansion within her portfolio. In collaboration with the Auxiliary, the Project Manager led a team of volunteers in planting and garden maintenance from 2011 until 2013, when a summer student was secured for a Garden Coordinator position. The Auxiliary volunteers continue to participate in the start-up and tear down of the garden as well as assisting patients to the garden, as the rehab schedule and weather permits. According to the 2014 HGMH Garden Business Plan, the intention was to have ten hours per week time-commitment from the auxiliary volunteers. The garden is working towards securing that commitment, but as is often the case with organizations that offer multiple services, the garden is not the only area of HGMH’s work in need of volunteer support.

Figure 1: Elissa (Garden Coordinator) spreading soil in one of the extended beds

The position of Garden Coordinator, which has been subsidized through Service Canada, increased from 120 hours in 2013, to approximately 200 hours for the following two years; this position has been filled by university or college students working from May through August. In 2015, through Project SOIL, a research student was provided to plan and maintain the garden, as well create the case study for the project. This increased the amount of labour by 300 hours, including time allowed for planning, research, and writing. The addition of an extra person made the management of a larger area much more feasible and allowed for work to continue into October.

Maintenance staff were a critical support for the 2015 expansion: they removed the sod on the new areas and helped to spread out several truckloads of soil; built a washing station for the garden; helped to cut lumber for the construction of a compost station; and installed a second water tap on the side of the building.

The occupational therapist has also been crucial in engaging the patients with the garden and finding tasks that both contribute to the garden and assist with the patients’ rehabilitation. The kitchen staff have overall been very receptive to the introduction garden produce to their repertoire. Garden staff made every effort to ensure that the produce being brought to the kitchen was well rinsed and ready to be prepared, to minimize the preparation challenges for the supportive kitchen staff.

Some patients are able to help with tasks around the garden, and they come outside to help with weeding or watering, but their ability and availability is inconsistent. Patients must rely on either a family member, a nurse or therapist to bring them out to the garden. The hospital’s staff are encouraged to engage with the garden through activities such as seed planting on Earth Day, attending markets held in the garden, and annual fundraisers. Volunteering is always a possibility that is open to staff. Continuing to present opportunities for involvement may yield more participation in the future.

Infrastructure Resources

The physical structures in the garden have grown steadily over the past five seasons. In 2011, four wheelchair-accessible 3’x 10’ raised beds were built in the first stage of construction, surrounded by sturdy 4’ wide composite decking. The following year, an 8” high L-shaped raised bed was installed along the southwest side of the existing four beds with interlocking stone surrounding it. This provided additional access and seating area. A 14’x 60’ wooden post fence was built along the southwest perimeter of the interlocking stone, serving as a trellis for the newly planted grape vines.

Figure 2: West view of the garden in mid-season showing primary built structure

Figure 3: Washing station on north side of shed – built in 2015

In 2013, the lower area surrounding the fence was dug out by hand, extending the bed 4’ out from the fence. This bed slopes downward significantly and is quite rocky from the gravel used during construction.

Toward the end of the summer in 2013, a greenhouse and eight cold frames were installed to the southwest of the existing garden plot. Expansion continued in 2014, to the west of the existing garden area, including two 47’ long beds and two 12’ long beds. In 2015, the expansion continued to join the lower beds together, and add an additional 12’ x 20’ bed, and two more 8’ x 3’ raised beds. By the end of 2015, the total growing area, excluding all pathways, will be about 1/15th of an acre.

Figure 4: Wooden compost bin in forested area west of the garden – built in 2015

In addition to the expansion of the beds in 2015, a washing station (see Figure 3) was installed to the north side of the shed, and a 2-bin wooden compost station was built. There are currently two water taps installed on either end of the garden site, one beside the shed, and one along the west wall of the therapeutic pool.

The greenhouse is currently used only to start seedlings in the spring, but with additional workforce it could also be used to grow or start crops later into the season. The cold frames have not taken well to the last two winters, and are beginning to lose integrity. They haven’t lent themselves to efficiently extending the seasons; however, they have acted as raised beds and have thus been very useful in other ways. They will need to be rebuilt in the next season, and ideally relocated elsewhere in the garden.

Figure 5: Inside of greenhouse showing seedling potting area, workspace

The seating area includes two composite picnic tables designed to accommodate wheelchairs, two picnic benches, and one additional rectangular picnic table. These areas are used regularly by staff, and patients during family visits.

Natural Resources

HGMH is located on an expansive 23 acre piece of property with large areas of mowed lawn, forest, long grassy bog, and water access from the adjacent pond. There is room for an expansion to the south side of the existing garden which could likely double or triple the amount of growing space. The area is mostly in full sun, and although there are some weeds and gravel-filled soil, the land is quite well-suited to growing. There is some wiring that runs underground through that area of the garden, so caution must be exercised when digging any new beds. The water used to irrigate
the garden comes from a well located on site, and is complemented by the use of rain barrels next to the shed.

Figure 6: Chart showing growth in total growing area from 2011 to 2015

Seeds were purchased in several batches from local vendors and were roughly 90% organic. Conventional seeds were only purchased when organic varieties of produce were not available. Some of the plants grown were purchased as transplants, typically only when it was too late to start from seed. None of the transplants were certified organic.

In 2015, the first major seed saving took place, and about 15 different varieties of vegetable, herb, and flower seeds were bagged for use in the following year.

Figure 7: Seeds saved from garden in 2015

In 2015, most soil was purchased in bulk truckloads and delivered from a local farm. Some bags of non-organic soil were purchased locally, and the family of an ex-patient donated about 12 bags of organic soil. All of the compost in 2015 was purchased in bags from local vendors: some was organic, and some was not. By spring 2016, there should be a few wheelbarrow loads of compost ready to be used from the pile on site. Caution was taken to avoid adding any diseased or pest-ridden plant matter to the compost pile to avoid contamination.

Figure 8: Truckload of soil being dropped off in new one of the new beds

The kitchen has a bin for compost with a list of acceptable items, which is collected as frequently as possible by the garden staff. Sometimes there are fresh vegetable scraps, however for the most part the consistent items that get composted are spent coffee grounds and eggshells. Luckily, all of the green and brown plant matter from the garden gets added to the compost and adds up to a fairly substantial amount by the end of the season. Attempts were made to encourage staff to compost any leftovers from their lunch trays, however, there were problems with people dumping plastics and other non-compostable items, so that effort was suspended.

Figure 9: Compost collected from kitchen

Figure 10: Bird’s eye (Google Earth) view of HGMH with significant areas noted

Financial Resources

Under the initial Healthy Communities Fund, $25,000 was granted towards the project in order to assist with initial cost associated with planning, building, and maintaining the therapeutic garden. This grant helped to cover the majority of the costs required to build the hard infrastructure, including the raised beds, walkways, shed and greenhouse. An additional $2500 was provided by through Project SOIL in order to help expand the garden to incorporate SPIn (Small Plot Intensive) farming techniques and evaluate the feasibility of producing significant amounts of food onsite. In addition to this funding, the HGMH hospital foundation contributed $24,000 toward construction costs.

Securing summer student support through Service Canada has been another key financial resource—wages for the Garden Coordinator have been subsidized using these funds for the past three years. Student support from Project SOIL in 2015 was also significant in making the garden expansion possible and designing a new garden layout (see Figure 29).

The garden team has also been creative with fundraising. In 2014 and 2015 they sold recycled rain barrels through a program that allowed them to get a share of the profits ($10 per barrel sold, and they sold 50 barrels).

In 2015 an open house event served as a fundraiser as well, with a “pick your own” vegetable sale and tickets sold for a draw (for a hand painted rain barrel). While the budget needed to run the garden is relatively small, the team must continue to be creative, especially if the garden is to continue to expand in its size and its role at HGMH.

Figure 11: Sarah (Project SOIL research assistant, gardener and composter) showing off produce from the first market held at the HGMH therapeutic garden

Over the last couple of years some of the extra garden produce has been sold, informally, to interested staff. In 2015, the first markets were held at the garden where produce was made available to the public. Although the markets were relatively successful, the attendance was rather low. Money made from the sales went back to the hospital’s primary account, as the garden does not have a separate account. Potential was discovered toward the end of the season to make use of the Gift Shop in the hospital to sell off extra produce. They appear to have the space and the means to allow for such an operation, however fine details still need to be worked out. The Gift Shop is operated entirely by volunteers, and the money earned is directed back into the hospital where needed, as determined by the auxiliary volunteer group.

Community / Social Resources

The Therapeutic Garden provides a very unique environment within the hospital grounds for patients, visitors, and staff. There are tables and benches throughout the raised area where people sit and talk or eat their lunch or dinner. It is an escape from the sterile environment within the hospital walls, and provides a safe space where patients can relax. As it is a rural hospital, many of the patients already have connections to (or experience with) food-growing. This not only makes the garden a natural fit for rehabilitation treatment, but also signals that the hospital is a part of the community in many different ways.

Figure 12: Patient being brought to the garden during the open house

The HGMH Therapeutic Garden had a presence at the 2015 International Plowing Match, where a 3-foot by 8-foot bed was installed and filled with a variety of plants from the garden. Informational pamphlets about the garden were also available. The local newspaper, Glengarry News, has enthusiastically been covering garden developments and increasing community awareness. They attended the open house in 2015 and interviewed staff and patients who participated at the event. The Open House attracted approximately 75 people throughout the day, touring the gardens and sampling some of the garden produce.

The hospital was invited to take part in the 2015 Stormont, Dundas Glengarry & Prescott Russell Local Food Challenge, which took place just after the Open House that was held in early August. Although the timing didn’t quite work out this year, there is now plenty of time to prepare for next year’s event. In 2013, the Garden Coordinator also sought out some services from the Seaway Valley Community Health Centre, and had one of their representatives come to show patients how to use some of the garden produce to make meals in the rehabilitation activity room. Further work is needed to ensure that these relationships remain strong and productive into the future.

The auxiliary volunteers have been instrumental to the success of the garden, especially in the outset of the project. However in recent years, it seems that participation from the volunteers has decreased somewhat, likely due to a lack of engagement and other areas of hospital work also needing volunteer support. The garden is looking for more ways to include the volunteers in garden planning, financial management, and activities.

Figure 13: Guests enjoying the open house

Policy / Program Resources

A number of policies and programs both within HGMH and at various other levels have been instrumental for the success of the garden. Within HGMH, there is a genuine desire to improve patient care and “green” various hospital practices. The garden contributes towards those goals. Wheelchair accessibility policies also mean that garden team was encouraged to make the garden as accessible as possible, including wide access paths and raised beds.

Figure 14: late- September harvest: potatoes, beets, butternut squash, cabbage, eggplant, peppers, tomatoes, and peas

The Champlain Local Health Integration Network (LHIN), to which HGMH belongs, has adopted a Healthy Food Strategy which has initiated various changes to how food is purchased and prepared in the HGMH kitchen. There is now a greater emphasis on fresh, nutritious foods and many of the foods procured from the food suppliers are local when feasible. These improvements make the garden more of a complement to the general LHIN efforts. Rather than merely being a challenge for the kitchen staff to work with, the garden produce is a component of this larger shift in the way that food is integrated within institutions in the Champlain LHIN.

The Service Canada summer student program is another valuable resource and though it is a well-established national program, it has proven flexible and timely for the HGMH garden. Similarly, the support from Project SOIL was made possible with provincial funding (through the Ministry of Agriculture, Food and Rural Affairs) signalling that policy supports for this type of endeavour may be on the rise.

Future Community Connections

HGMH has partnered over the years with several different organizations for funding and educational purposes. As noted above, the Seaway Community Health Centre has provided cooking classes. This and other connections to health care facilities in the region (through the Champlain LHIN) are valuable assets for an initiative like the HGMH garden.

HGMH connected with Project SOIL after making network news within the Canadian Coalition for Green Health Care, which is also a partner on the project. Project SOIL has provided advice on techniques of food production and a network of similar projects to use as reference for future growth. Financial support in the form of a $2500 infrastructure/equipment grant, as well as a Participant Action Researcher for 300 hours of work in 2015 to manage the garden and create this case study came from Project SOIL. The highly collaborative relationship has developed between Louise Quenneville, the primary garden contact, and Phil Mount (Wilfrid Laurier University) and Irena Knezevic (Carleton University), the principal researchers for Project SOIL. This relationship continues to grow, and is already exploring future research opportunities and further collaborations.

In 2015, the garden staff approached a local restaurant (Quirky Carrot) and proposed to provide vegetables regularly for the following year. The arrangements are still being worked out, but sales have already begun, and the future looks promising. The owner has also offered to provide some cooking demonstrations to the kitchen staff if management can accommodate that.

CONSTRAINTS and REQUIREMENTS

Human-power is the most immediate constraint of the project, especially as the garden has now grown to over 20 times its size since 2012. The garden coordinator is tasked with the planning, planting, harvesting, washing, delivering, selling, and general management of the garden, and is the primary connection between the rehabilitation department and the therapeutic garden. In 2015, with two staff working approximately 500 hours combined, the garden was managed quite efficiently, although more hours would allow for better organization and collaboration with the rehabilitation department.

The first summer Garden Coordinator (in 2013) had a background in kinesiology, as well as experience and familiarity working with patients. However in the following year, some nursing staff raised concerns when the coordinator brought patients outside, learning to walk with them, and perform certain tasks, which could be deemed nursing assistance. Because of liability and patient assistance issues, the Garden Coordinator was provided clarification on the transportation of patients to ensure that patient mobility requirements were being met. In 2015 there was a challenging period—later resolved—where neither of the garden staff could bring patients out from inside, but could remain with patients if someone else brought them out. Patients also rely on family members, nurses, or therapist to bring them outside of the hospital. Although the rehabilitation staff are encouraged to bring patients outside to work, there are no prescribed rehabilitation activities that are mandated to take place in the garden. According to the rehabilitation manager, the staff lack the time and resources to incorporate outdoor activities on a regular basis. Being out in the garden is low on the long list of priorities, although the staff certainly recognize the benefits.

Figure 15: View facing north onto lower garden in late July

As with any operation attempting to follow organic guidelines, pest and disease management is a delicate balance. Various concoctions were created using soap, hot sauce, oil, sulphur, and even beer; some were more effective than others, and some production suffered slightly. All in all though, everything grew very well despite of any environmental constraints. One of the unforeseen garden pests was a resident deer who had an affinity for beet tops, pepper plants, beans, and lettuce. The area is constructed in such a way that a fence isn’t a very viable option, so following an old wise tale, human hair clippings were spread all around the garden to deter the deer, and this seemed to be fairly successful for a time.

Another uncertainty of this project is its future existence; there are plans to build an expansion on the facilities which have a road running right through the existing gardens toward the future ‘Carrefour Glengarry Hub.’ This Hub is intended to host emergency services such as fire and ambulance, health services such as a Community Care Access Centre, a nursing home, and more. The hub is yet to be built, and there is still hope that plans could be made to redirect the route around the garden, however, as it stands the architectural drawings have not accounted for the existence of the garden.

Figure 16: Layout for potential Carrefour Glengarry Hub as shown on the HGMH website

SUCCESSES

This project has been very successful from its very beginning. By securing funding through the Healthy Communities Fund, the team was able to move forward quickly with construction, and has kept the momentum going ever since. The collaboration with Project SOIL has allowed for much further expansion of the gardens, as well as an additional body to tend and manage.

The garden has grown every year, and has supplied a small but continually growing amount of food to the hospital kitchen. In 2015 the kitchen staff were able to incorporate a great deal more cooked food than in previous years, and to incorporate the produce into patient menus from time to time.

Figure 17: mid-May harvest: rhubarb, chives, sage, and oregano

The produce gap identified in the 2014 Business Plan has largely been closed up, and the vast majority of crops were harvested in time to provide them to the kitchen. It is becoming clear which items are most easily used in the kitchen; anything that can be put in the salad bar will definitely be used, as well as herbs, and some other surprising crops such as rhubarb and zucchini were readily incorporated as well. Hospital staff were always giving praise to the success of the garden, and were excited to see when things were incorporated into the lunch and dinner menu.

CHALLENGES OVERCOME

Since garden expansions affect several hospital departments—including grounds maintenance, rehabilitation, and kitchen—acquiring approval for such expansions was an administratively complicated process. However, the effort was worthwhile: the expansion has been well received, as indicated by the overwhelmingly positive response to the gardens by both the patients and staff.

Pest and disease management using organic methods continue to progress as different methods are attempted. Guidelines or procedures should be established in the future to direct such management and track differences from year to year. Although fencing the area would prove difficult, fencing off a small portion may allow for the protection of some of the deer’s favourite snacks.

The garden team secures organic inputs whenever possible, but that has presented some challenges, since certified organic inputs are not always easily available. The garden team must often weigh the advantages and disadvantages of using products or materials that are not certified as organic. These decisions are made on a case-by-case basis, and depend on factors such as the availability of similar organic inputs (e.g., seeds, compost), and the desire to maintain a pesticide-free environment. Such decisions can be especially difficult when the non-organic materials are offered as donations.

RELEVANCE TO OTHER PROJECTS

The HGMH Therapeutic garden is a shining example of a successful food garden on an institutional site—providing a valuable space for staff and patients, as well as food that can be incorporated into the meals on-site. Through growth, patience and continual networking with similar initiatives, this project provides a model of cautious development and expansion. This case also demonstrates the value of engaging and enabling students, as well as how a champion within the institution can play a critical role in the success of the project. Hopefully, through future collaborations, this project will be able to demonstrate the measurable therapeutic benefits of gardening to patients’ recovery.

Figure 18: Louise showing the sensory garden to a mother and child during the open house