By Amanda Beales, Registered Dietitian & Interprofessional Educator, and Jennifer Ireland, Occupational Therapist, Toronto Rehab, Bickle Centre

Every year around March, as we start dreaming about warmer weather to come, we start planning our GROW (Garden Rehab on Wheels) wheelchair accessible garden for the season at Bickle.  This year of course was different, as COVID hit and everything changed.

The first question on our minds was, ”will we even be able to plant a garden at all this year?”  With so much energy needed to implement proper PPE practices, support patients while the doors closed to visitors, and figure out a “new normal”, this question was initially put on the back-burner.

Once things began to settle down, we raised the question with our leadership team.  The answer was unanimous that the garden would be a wonderful initiative for patients and staff, perhaps more so than ever this year, with patients not allowed to leave hospital property or have visitors and stress at an all-time high.  Re-thinking and modifying our usual garden practices however would be needed to ensure safety. 

The Bickle Garden- A “backyard away from home” for our patients and staff

One major change was cancelling our patient garden group as proper social distancing would not be possible– but as a trade-off, we encouraged more staff to take patients outside to the garden on a 1:1 basis for therapy or a wellness visit.  Hand sanitizing pre and post gardening, disinfecting shared tools, using single-use gloves instead of shared gardening gloves, were other modifications made. 

Planning

Before the weather warmed up, therapists were encouraged to consider using planning a garden box as a cognitive therapy activity with their patients.  For some patients with an interest in gardening, this provided a meaningful activity.  It also gave the patients who participated an extra sense of ownership over the garden, and something to look forward to in getting outside to see how it is growing.

Bickle staff planned the remaining boxes.  We wanted to make this year’s garden extra-special, and strategically chose a mix of familiar favorites for our patients (tomatoes, peppers, callaloo, etc.) to help generate memories, and plants with sensory properties (lavender, herbs, etc., that can be smelled).  A few unique varieties (such as purple-podded peas and “Blue Jay Bush Beans”) were also chosen, which could act as points of interest and conversation-starters.

Planting

In past years, we would have a big mass planting event with staff over a lunch hour as a fun team-building group activity.   This year, we knew that we would need to spread out the planting for social distancing reasons.  Amanda “baby-sat” the plants in her office (thank you to her very tolerant officemates!) and invited staff to pop by over the course of a workweek and pick up the plants needed to plant a box outside with a patient during a therapy session.  At the end of the week, staff volunteers planted the few remaining boxes.

Plants and seeds organized by box for “grab n’GROW” planting– Amanda’s officemates were very tolerant of plants everywhere for the better part of a week!!
Fortunately, the GROW Garden Boxes are already pretty well-spaced out for socially distant gardening!
Gardening essentials in the time of COVID: Hand sanitizer, disinfectant wipes for shared tools, single-use gloves, and corporately-donated flavored water.

Garden maintenance

To keep our garden looking happy and healthy, a group of dedicated staff volunteers currently implement a “divide and conquer” approach, by taking turns watering and tending to the plants each week.  Staff also take patients outside during therapy for further maintenance.  As an occupational therapist, Jenn is fully aware of the benefits of engaging in meaningful activities, and the GROW initiative allows provides fun and functional opportunities to practice both cognitive (planning, discussing plants, etc.) and physical skills (walking, standing, reaching, outdoor mobility, harvesting, etc.).

Patient and Staff Impact

Now that we are enjoying summer weather, it is fun to see patients outside enjoying the garden, either on their own if they are able, with a staff member, or now that visitors are gradually being allowed back, with a loved one.

A recent patient of Jenn’s would request to walk around on the path which circled the planter boxes as part of his physical therapy post cardiac surgery. He would then come inside and report on how the plants were growing and if he felt anything specific needed attention or more water.

Gardening in the time of COVID – Masks and Social Distancing!

The garden has been enjoyable for both patients and their therapists.  Jenn was able to recently enjoy the garden with a patient who is over 100 years old. This individual shared their years of experience gardening and enjoyed reminiscing about planting potatoes, discussing the benefits of companion plating, examining the set-up of the garden boxes and smelling a sprig of dill and rosemary.   This patient remarked to Jenn:

“It’s truly amazing. Who would have thought this wonderful activity is available at rehab. The way the gardens are raised and built with a V shape so the wheelchairs can come up close – so thoughtful! I have really enjoyed this experience. Thank you for allowing me the opportunity to enjoy something I haven’t done in years. I really miss gardening. I haven’t been able to be outside in my backyard for over 3 years.”

It is a sad reality that some of our patients have been inside for extremely long periods of time (4 weeks to 6 months or more), with only a few seconds of fresh air during their transfer from acute care to rehab. This spring especially staff have also felt confined with the added PPE. Even though staff still wear  PPE outside, we can instantly feel more relaxed with the fresh air.  The garden offers a few minutes of distraction and respite from the challenges of the pandemic for patients and staff alike. It is amazing to witness the profound change in mood, energy, interactions, motivation when we (patients and staff) ‘stop and smell the roses’—or the lavender and dill.