When we consider the spaces where care happens in nursing homes and assisted living communities, we likely picture resident rooms, dining areas, therapy spaces, and common rooms. Gardens, patios, and outdoor walkways tend to fall into a different category. They are places for recreation, relaxation, or special activities, rather than places where everyday care happens.
New research published in BMC Health Services Research suggests that outdoor environments may be an underutilized resource for supporting everyday activities, person-centered care, and rehabilitation. More importantly, the research raises a question for aging-services providers: Are our outdoor spaces truly accessible parts of residents’ daily lives, or are they amenities that residents can only enjoy when circumstances allow?
The Research
Researchers in Sweden explored how outdoor environments could be incorporated into everyday care at three residential care facilities. They conducted individual walking interviews with older residents and group walking interviews with care workers, examining both existing practices and opportunities for using outdoor spaces differently.
The researchers organized their findings around four environmental zones:
- Indoor spaces with outdoor views: Windows and other opportunities to experience the outdoors from inside.
- Transitional spaces: Entrances, patios, balconies, and areas connecting indoor and outdoor environments.
- Gardens: Outdoor spaces located within the residential care property.
- Surrounding environments: Neighborhoods and other areas beyond the facility grounds.
Rather than focusing exclusively on the benefits of spending time outside, the researchers examined what activities could occur in each space and what prevented those opportunities from becoming part of routine care.
Research Findings
The study identified opportunities to use outdoor environments for much more than recreation.
- Everyday activities: Outdoor spaces provided opportunities for social interaction, relaxation, recreation, and meaningful engagement.
- Physical activity and rehabilitation: Gardens, walkways, and surrounding environments offered potential settings for movement, walking, and rehabilitation activities.
- Person-centered care: Different environments created opportunities for sensory experiences, personal preferences, and connection with nature.
- Clinical interactions: Researchers identified opportunities to incorporate health conversations and assessments into outdoor settings.
- Barriers to access: Physical accessibility, weather, organizational routines, staffing availability, information, and social circumstances could all limit outdoor participation.
One of the study’s most important findings was the gap between what outdoor environments could support and how they were actually incorporated into daily routines. There was a difference between what was possible and what was happening. The researchers concluded that making better use of these spaces requires more than simply providing a garden or patio. It also requires accessible environments, supportive organizational routines, and care workers with sufficient time, knowledge, and support.
Why Does This Matter for Kansas Providers?
Many Kansas nursing homes and assisted living communities already have outdoor spaces. They may have gardens, courtyards, walking paths, or patios. Others may have little more than a small seating area or an accessible entrance. The research encourages us to consider how these spaces fit into the everyday experience of care.
For example, a garden might be available to residents, but is it incorporated into their daily routines? Can residents access it independently? If someone needs assistance, are staff available to help? Are there opportunities to use the space for activities that might otherwise happen indoors? These questions are particularly relevant when we consider the relationship between physical environments and organizational practices. A beautifully designed courtyard may offer little practical benefit to residents who cannot reach it. Similarly, an accessible walking path may remain underused if outdoor activities are treated as something separate from normal care responsibilities.
Kansas weather introduces another consideration. Extreme heat, cold, wind, and seasonal changes can all affect outdoor access. The study’s four-zone framework offers a useful way to think beyond the assumption that meaningful outdoor engagement requires spending extended periods outside. Windows, covered transitional spaces, gardens, and surrounding environments offer different possibilities depending on residents’ needs and conditions. The larger implication is that access to outdoor environments is not just a building-design question. It is also a question of staffing, routines, care planning, and organizational priorities.
What Can You Do?
The researchers’ findings offer several opportunities for Kansas providers to examine their existing environments and practices.
- Look at your four zones. Identify how residents currently use indoor views, transitional spaces, gardens, and surrounding areas. Consider which spaces are available but rarely incorporated into everyday activities.
- Examine barriers to access. Consider whether physical design, seasonal conditions, staffing availability, or organizational routines limit residents’ opportunities to use outdoor spaces.
- Think beyond recreation. Explore whether existing outdoor environments could accommodate everyday conversations, social interaction, physical activity, or appropriate rehabilitation activities.
- Include residents and care workers. Ask how they currently experience outdoor spaces, what prevents their use, and what opportunities they see for incorporating them into daily life.
- Review organizational routines. Consider whether outdoor engagement is supported by existing workflows or depends on individual staff members finding additional time.
These are opportunities for organizational reflection based on the study’s findings, not interventions that have been demonstrated to improve clinical outcomes.
Thinking about Space Differently
Perhaps the most useful contribution of this research is a shift in perspective. Outdoor environments do not necessarily need to be treated as separate destinations for special activities. They can also be considered part of the broader environment in which residents live, interact, receive support, and participate in everyday life. For Kansas providers, the question may not be whether a community needs a bigger garden or a more elaborate courtyard. It may be whether the spaces already available are being used in ways that reflect residents’ needs, preferences, and opportunities for meaningful engagement.
Read the Research
Liljegren, M., Bengtsson, A., Lindahl, G., & Wijk, H. (2026). Integrating outdoor environments into health service delivery at residential care facilities for older adults. BMC Health Services Research.
Published: October 14, 2026
Access: Open Access
