Characteristics and Challenges for the Development of Nature-Based Adult Day Services in Urban Areas for People with Dementia and Their Family Caregivers.

Nature-based adult day services (ADSs) for people with dementia (PwD) are well-known in rural areas. In recent years, a number of providers have started offering these services in urban contexts, e.g., in city farms and community gardens, where people with dementia participate in outdoor activities, such as gardening and caring for animals. At the moment, little is known about these services within an urban context, and the aim of this study is to characterize different types of nature-based ADSs in urban areas for PwD living at home, as well as to identify general and specific challenges with regard to the development of different types of ADSs. An inventory was carried out and 17 ADS providers in urban areas were interviewed about their initiatives, settings, client groups, motivations for starting their nature-based ADS, and their experiences with, competences for, and funding of urban nature-based ADS. The interviews were recorded, transcribed verbatim and thematically analyzed. Five types of nature-based ADSs were identified: (1) services offered by social entrepreneurs, (2) nursing homes opening their garden to people with dementia, (3) social care organization setting up nature-based, (4) community garden set up by citizens, and (5) hybrid initiatives. Common activities were gardening, preparing meals, and taking care of farm animals. The main activities organized by nursing homes included sitting and walking in the garden and attending presentations and excursions. General challenges included the availability of green urban spaces and acquiring funding for the nature-based services. Initiatives of social entrepreneurs depended strongly on their commitment. Challenges for nursing homes included a lack of commitment among nursing staff, involvement of PwD living at home and a lack of interaction with the neighborhood. Volunteers played a key role in the initiatives organized by social care organizations and in community gardens. However, it was a major challenge to find volunteers who know enough about care and gardening. Specific challenges for the hybrid types were related to differences in work culture between social entrepreneurs and care organizations. Different types of care-oriented and community-oriented nature-based adult day services in urban areas for people with dementia have been developed, facing different types of challenges. Care oriented initiatives like nursing homes opening their garden focus on risk prevention and their nature-based services tended to be less diverse and stimulating for people with dementia living at home. Collaboration between such care-oriented initiatives with initiatives of other types of organizations or social entrepreneurs can lead to more appealing community-oriented nature-based services.