*Friluftsliv; a handy word meaning open-air living, capturing the Scandinavian approach to living life in harmony in nature.

How do you imagine your life when you are older?  Perhaps you picture a retirement of travel and adventure, more time devoted to your family or pottering in your garden.  But beyond that, how do you picture your life when you get even older and functional abilities start to decline?  If we are lucky enough to get that far, we know that we may need help with everyday tasks  in the form of professional care.  When that happens to us, I think most of us would hope that we can continue to experience the things we love and that our days will still have meaning.  But if age or illness prevents us from having full agency over our lives, how can we be sure that will happen?

I have come to Norway on a Churchill Fellowship to learn more about enabling nature connection for older people, from a country that takes outdoor living so seriously they have a word for it*.  I’ve been lucky enough to be able to visit a number of care homes that are doing innovative work to maintain quality of life for their elderly residents, including enabling access to nature.

Strømmehaven in Kristiansand and Carpe Diem near Oslo are both new nursing homes inspired by the ‘dementia village’ concept, started at the Hogeweyk in the Netherlands.  Strolling through the peaceful outdoor spaces in April sunshine, the gardens are starting to come to life, with blossom blowing from the trees and tulips causing a riot of colour.  The bedrooms and wards are arranged on the outside with gardens in the middle, so residents are free to access outdoors as they wish, safe from the possibility of getting lost.  This contrasts with traditional nursing homes where the gardens are often on the other side of locked doors, and lead to the car park, necessitating busy staff to find time to accompany residents outside.  The gardens at Strømmehaven and Carpe Diem include winding paths, beds of sensory plants and seating areas for families to sit with their loved ones.  Neighbours from the area are welcome to enjoy the facilities too.  In the UK, when running sessions in nursing homes, our requests to have a campfire with residents have been firmly refused, so I am pleased to find a fire pit area at every home I visit.  And it makes sense because for Norwegians, grilling sausages outdoors in any weather go together like a barbecue and a hot UK bank holiday!

“If you are living in care for years, you need to have meaningful experiences” Kjetil Senum, Wellbeing Coordinator from Strømmehaven explains. Creating ‘meaningful days for each resident’ is the concept at the heart of Livsglede for Eldre, a quality assurance scheme that translates as ‘joy of life for the elderly’. I was able to spend some time at two Livsglede homes and experience what the programme looks like in practice.

At Kamfjordshjemmet in Sandefjord residents from all the wards poured into the outside space and took a seat at the tables or in the campfire hut.  A team of active volunteers served coffee and hot dogs and mingled with staff and residents who were engaged in conversations, games of ring toss or singing.  The sun was starting to peek out and the event had the atmosphere of a jolly garden party.  Kamfjordhjemmet is a well established Livsglede home.  At its heart is a person-centred approach that places great importance on knowing the individual.  Livsglede homes run life story mapping exercises, not just when a resident comes to live there, but throughout their time in the community to ensure that an individual’s day continues to have meaning and moments of joy.  The mapping covers everything from education, job and family through to what pets they may have had and how they like to spend their time outdoors.  This is because amongst the nine principles of Livsglede for Eldre are the requirements that every resident will have regular contact with animals and will spend time outside at least once a week.   The details are transferred onto a weekly planner which allocates time for fresh air and hobbies and experiences are monitored and evaluated as part of the scheme and continually updated as tastes change. New insights that might be picked up from spontaneous moments, such as a resident enjoying a tuneful robin toy I had brought, cascade down through the life story documents, the calendars and weekly planners, so they always remain current and relevant.

I was given guided tours by Cecilie Bolsø Langeli from Kammfjordhjemmet and Ann-Charlott Borge Vik Nystad from Plankemyra nursing homes, who alonsgside nursing duties, coordinate Livsglede activities at their respective nursing homes.  They talked in similar terms about the process of registering. At beginning, it was seen as more work, but eventually it became part of the system and then gradually staff started to really enjoy it and found they could weave their own life stories into the life of the home too.  Cecelie showed me some pictures of residents cuddling a couple of fluffy Pomeranian dogs, who a staff member had brought in the day before, the photos serving as reminders to residents of the fun they had yesterday.

“Its more fun to go to work.  I can do my hobbies here, I can bring my animals.  You feel more valued.  The day is full of joy”  Cecilie Bolsø Langeli

Ann-Charlott raised the valuable point, that before they focused on the life story mapping, sometimes they only really got to know about the life of a resident when they attended their funeral, but now they know details, right down to what music they like to get up to in the morning.

“We can use this to our advantage, and make it a good day, because we know who they really are.  Ann-Chalott Borge Vik Nystad

I am told that most Norwegians grow up outdoors, from babies left to sleep outdoors in their prams, to outdoor kindergartens, through to active family weekends hiking or sailing.  Many of this generation of old people grew up in rural areas and remember the cycle of work on a farm.  Staff work with the residents and their families to find out how they have enjoyed fresh air in the past and work this into their week, with an eye on marking the changing seasons, (another of the nine Livsglede principles).  This can be going out to collect eggs from the chickens or picking berries and making jam in summer or sweeping the paths and handling snowballs in winter.   This helps prompts engagement and conversations.  At Plankemeyer, in the seaside town of Arendal, a palliative nurse described how they had wheeled a terminally ill ex-fisherman down to the seafront in his hospital bed, while Ann-Charlott remembered how a residents’ son had taken a group from the home out on his fishing boat.  But it doesn’t always have to be big things – it can be as simple as knowing who likes to have a fresh breeze come in through an open window.

“Its easier to talk when we are outside.  They are happier when we are out” Kristina Kopperud, Carpe Diem

In the garden at Plankemeyer, all the residents of one ward have come outside for a cup of coffee in the in the sunshine.  Not everyone can describe how they are feeling or what they need, but its clear on their faces and in their body language that everyone is feeling calm and relaxed today.  It costs money to factor in access to nature for people living in care, whether that’s the design of the outside space or monitoring a quality assurance scheme.  Talking to the staff its apparent that the benefits are many; residents are happier and calmer, less anxious and agitated and therefore medication can be reduced and staff are happier at work so stay in their jobs for longer, which both reduce costs in the long run.  And if we are to chose how we will spend our old age, wouldn’t we want it to be a continuation of our lives and the things that bring us joy, or as they say at Livsglede for Eldre;

“Leve hele livet, livet ut”  (“Living you whole life, all your life”)

With grateful thanks to Carpe Diem, Strømmehaven, Livsglede for Eldre, Kammfjordhjemmet and Plankemyra Bo og omsorgssenters for allowing me to see the wonderful work you are doing.