In Holland, people with dementia can work on a farm

Four days a week, Kees Oranje's 81-year-old mother, Paula, gets up and goes off to work on a farm in the neighboring village of Brielle, just west of Rotterdam.

Depending on the day, Paula might feed the chickens, assist with chores, or help prepare hot lunches. The farm raises pigs for meat, and grows pumpkins, beans, kale and more in a large vegetable garden. In many ways, Boerderij Op Aarde — "Farm On Earth" — resembles a typical Dutch working farm, but with one key difference: Paula and most of her fellow farm workers have dementia.

Boerderij Op Aarde is one of hundreds of Dutch "care farms" operated by people facing an array of illnesses or challenges, either physical or mental. They provide meaningful work in agricultural settings with a simple philosophy: rather than design care around what people are no longer able to do, design it to leverage and emphasize what they can accomplish.

It's an approach that research has shown holds many benefits. For people with dementia, who are often less physically active and more isolated, farm settings promote movement and social interaction. And care farms can have emotional benefits, too, giving participants a sense of purpose and of making a meaningful contribution.

"We don't focus on what's missing, but what is still left," says Arjan Monteny, cofounder of Boerderij Op Aarde, "what is still possible to develop in everybody."

Garden project grows in Minnesota

That generous mission is also playing out closer to home. Since 2017, the University of Minnesota Master Gardener Volunteer Program-Hennepin County has partnered with the Alzheimer's Association of Minnesota to offer Growing Connections. The free gardening program — with materials provided — was created exclusively for people living with early dementia, and for their care partners.

"It's not just about growing and plants, but about connecting people," said Ann Thureen, a University of Minnesota-Extension Master Gardener who developed the program after volunteering at the Alzheimer's Association.

"It's not a support group," she said. "It's a safe space where people come to learn about gardening ... and use nature to help with their health and well-being."

Twice a year, in the spring and fall, Growing Connections offers multi-week classes for people living with memory loss who are accompanied by a partner, typically a spouse, sibling, adult child or friend. Together, they learn about many aspects of gardening, and enjoy the tactile experience of pulling up dirt and the sensory pleasures of planting herbs.

Class feedback, Thureen said, "often makes me cry. One woman said that watching her mom dig in the dirt was her favorite part of the class."

The next two four-week sessions begin the week of April 18 at the Hopkins Activity Center. There is no cost but pre-registration is required. For more information, call the Alzheimer's Association Helpline at 1-800-272-3900.

A right to remain active

Care farming started growing in popularity in the Netherlands in the late 1990s. According to Wageningen University researcher Jan Hassink, farms, squeezed financially as agricultural costs increased and food prices fell, were looking for ways to become more multifunctional. At the same time, a movement was emerging in the Netherlands to reduce the use of institutions, part of a growing recognition that people with disabilities had a right to be active in society.

A few decades on, care farming is well established in the Netherlands, and interest in the model for people with all kinds of disabilities is growing across Europe, in the U.S., and in many other countries, Hassink says. As an option for dementia care, it is a solution that grows more relevant with each passing year. Rates of dementia are projected to more than double worldwide by 2050. Yet how to best care for those people remains a question many countries are still grappling with.

A desire to contribute

In traditional dementia care settings, says Hassink, the focus tends to be on preventing risk. There's often a fixed schedule of simple activities, like games or movies, and the only choice attendees are given is whether to participate or not. In the course of his research, Hassink has spoken to countless people with dementia. Common to many of them is a desire to not only participate in society, but contribute to it.

At Boerderij Op Aarde, participants start every weekday morning discussing the day's work. There's no shortage of tasks: goats and pigs need feeding, gardens need tending, hot lunches need to be prepared. A weathered bench in the workshop might need to be repainted. The workers get to choose which duties they'll take on. That's important, Monteny says, because people with dementia don't have many opportunities to make decisions in their lives.

"It's a small question," he says, "but it has a great meaning for the people."

Even bigger, more consequential decisions are made with everyone's input. Recently, participants were involved in discussions about how last year's bad pumpkin crop should impact plans for what to plant in 2022. Almost everything the farm produces is used on the farm; lunches include vegetables from the farm's gardens and sausage and ham from the pigs.

Today, there are roughly 1,350 care farms in the Netherlands, serving a diverse range of people, according to Maarten Fischer, director of the Federation of Agriculture and Care. About 400 of these farms offer care for older people with dementia, he said, many in settings that also include participants with other needs.

"They're focused on what needs to get done that day, which is what takes them out of their current disease process," Fischer says.

Boosting social involvement

The model is borne out by research. Studies in Norway and the Netherlands found that people with dementia at care farms tended to move more and participate in higher-intensity activities than those in traditional care, which can help with mobility in daily life and have a positive impact on cognition. Dementia is often linked to social isolation, and care farms were found to boost social involvement, especially among those who wouldn't opt for traditional assistance options. Spending time outdoors in nature, often part of a day on a care farm, can also improve well-being among people with dementia. Farms are not only good for individuals; their families also benefit: studies find caregivers experience less guilt when their loved ones are supported by services they consider to be nurturing and fulfilling.

Hassink says that even institutional care facilities could replicate some of these benefits by incorporating elements common to care farms into their programs. Instead of a fitness class, for instance, they could offer more productive activities that build in movement. Institutions could also empower their attendees with more opportunities to decide which activities they'd like to do.

"I think the realization that people still like to do useful things, useful work, and to be valued and contribute is really important," he says.

Before Kees Oranje's mother started coming to Boerderij Op Aarde in 2018, she was largely isolated, he says, living alone in the family's farmhouse a few kilometers from the nearest village. Oranje noticed she seemed to "bounce back" after she started at the farm when she was 77. He believes part of what makes her days fulfilling is that, just like in life, they involve activities that inspire a range of emotional responses: frustration, joy, surprise, even anger.

"What the person needs is not only care," Oranje says. "A person needs emotions, too."

The model has its challenges, and it isn't for everyone. Care farms generally aren't a good fit for people with advanced dementia, whose condition makes it difficult to participate. As a small organization, Monteny said, keeping up with health regulations designed for larger institutions can be difficult, and funding, which the farm gets from the municipality and a regional care institute, is tight. Farm environments also have the potential for injuries. Monteny acknowledges that accidents happen, though they've only ever had minor incidents, like a hammer dropped on a toe.

"We make it as safe as possible," he says, "but risk is part of life. That's one of our mottos."

Oranje says he doesn't worry about such risks at Boerderij Op Aarde. As his mother's dementia has progressed, she has lost the ability to tell him at the end of the day what she did at the farm. But she continues to live independently in her own house, which Oranje believes is possible because her work at the farm keeps her active.

"She has to be alert all day long, and it's the best environment. She can maintain the best mental condition as possible in her situation now," he says. "And that's very, very, very, very important because that gives her a reason to live."

This story is part of the SoJo Exchange from the Solutions Journalism Network, a nonprofit organization dedicated to rigorous reporting about responses to social problems.

Star Tribune reporter Gail Rosenblum contributed to this report.