easant Bay Nursing and Rehabilitation Center  







By Anne Raver
Sunday New York Times

BREWSTER, Mass. -- It was a sunny day in the garden at the Pleasant Bay Nursing and Rehabilitation Center in Brewster, Mass. So sunny that Kaleigh, a yellow Labrador, would not leave the shade of his favorite zelkova tree, where he kept an eye on his human, Bill Ellis, 69, reading in a wheelchair.

Mr. Ellis, a former manufacturing executive from Wisconsin, found out he had Parkinson's disease six years ago, and has been a resident of the center for more than a year. His wife, Pam, visits daily, along with Kaleigh. The garden, they have found, is a cheerful place to congregate. Just off the dining room, it is nestled in the northwest corner of the X-shaped complex. The triangular space measures about 5,000 square feet, with views of pines and sky to the west. ''When it's nice, we have our lunch and dinner out here,'' Mrs. Ellis said.

“Out here, you have birds all around, you feel the sun on your body. I think it's a semblance of having your own backyard.''

A wide trellis, planted with honeysuckle, serves as a portal into another part of the garden where a concrete path loops around an oval of grass and yellow marigolds.

These flowers might look garish to a sophisticated eye, but they have been planted with a purpose. ''I wanted something bright and colorful, almost as a landmark,'' said David Kamp, the landscape architect who is designing a series of gardens for the center, which serve a wide variety of needs. ''It might be an urn or a Christmas tree. Some people with Alzheimer's disease, for example, see only a small sphere, not the trees beyond. They can't comprehend something on a big scale.''

Trees might actually look threatening to some Alzheimer's patients. ''Like a forest where you could get lost,'' Mr. Kamp said. ''So there should be clear avenues where you can decide, 'I won't go there.' ''

Portals, or clear entrances, can help, he noted. Tinted concrete cuts glare, while a gradual transition from bright sun to dappled light to shade helps those whose eyes adjust slowly to changes in light.

The Ellis family moved to Cape Cod from Wisconsin. They settled in a little town near Pleasant Bay, knowing that Mr. Ellis would eventually need its nursing and physical therapy services, which have received high marks from state and federal health inspectors. The complex serves a mixed population of short-term patients undergoing rehabilitation, long-term residents and people with mild dementia.

A day care center within the building provides contact with children; Mr. Kamp plans to redesign the playground. An assisted-living complex of 40 units will be built in the adjacent woods, a rolling terrain of scrub oak, pine and high bush blueberry.

If Mr. Kamp has his way, that natural landscape will be as undisturbed as possible. ''Some people will say, 'Well, it looks like you didn't do anything,' '' he said. ''But I think we should celebrate the fact that we're out on the Cape.''

Mr. Kamp's firm, Dirtworks Inc., is one of the few in the country specializing in gardens for people with AIDS, Alzheimer's or other illnesses. Here at Pleasant Bay, he is drawing on as much of the natural landscape as he can.

The north garden, for example, is flanked by a steep berm thickly planted with juniper, Scotch broom, shadblow, beach roses and other shrubs that evoke the Cape's salty, sandy landscape. ''I look down on that from my room,'' said Dorothy Harthan, an avid gardner from Wellfleet, Mass., who is here recovering from a back injury. ''It looks so soft, I want to lie down on it.''

Nature's healing powers were evident to the ancients, who fled to sacred springs and mountains when they were injured or ill. The Egyptians and Greeks built labyrinths for walking meditations; the Persians made paradise gardens, where rills of water flowing through fruit trees served as reminders of the Creation. By the Middle Ages, cloistered gardens with flowering trees and water fountains soothed the sick.

In later centuries, monasteries that were used as hospitals offered shady courtyards and airy rooms with views of greenery. But with the advent of surgery, radiation therapy and the miracle drugs of the 20th century, hospitals turned from nature to concentrate their space and staff on machines, laboratories and surgical wings.

''There is a growing dissatisfaction internationally with traditional health-care environments,'' said Dr. Roger Ulrich, an environmental psychologist and professor at the Center for Health Systems and Design at Texas A & M University.

Dr. Ulrich's 1984 study of patients recovering from gall bladder surgery found that those who could view trees and sky recovered faster, with fewer painkillers and complaints, than those viewing brick walls. His findings jolted medical administrators out of their windowless corridors.

Mr. Kamp is bringing these changes to Pleasant Bay, working closely with its executive director, Joshua Zuckerman, who opened the center five years ago with 135 beds. He had been impressed by a garden that Mr. Kamp designed for AIDS patients at the Terence Cardinal Cooke Hospital in East Harlem.

Mr. Kamp designs by talking with patients, nurses, therapists, families and maintenance workers -- everyone associated with a space. ''You have to be sensitive to the emotions of illness,'' he said. Some residents, for example, might feel a wave of pleasure touching a fragrant rosemary plant. Another might be nauseated by the smell. And needs can vary greatly from day to day for the same person.

Roxanne Solimini, a registered nurse with 15 years' experience at nursing homes and rehabilitation centers, is the operations director at Pleasant Bay. She is particularly looking forward to completion of the rehabilitation garden. Opening out from the physical therapy rooms, on the ground level of the complex's southwest corner, the space will include a ramp for wheelchair users to practice maneuvering slopes that descend to different surfaces, like concrete or cobbles.

Patients learning to walk again will be able to practice going up steps that lead to an inviting pergola. There will be room for stretching classes and tossing beach balls, having cookouts and socials. Residents will be able to grow flowers, vegetables and herbs in raised beds. ''Maybe we'll start some tomato plants,'' said George Simmons, the activities director, who has seen people's self-esteem rise with useful work, like growing what they can eat.

He has also seen how familiar plants can comfort people. ''I have one resident with dementia who looked out on the daisies and said, 'Wow, I used to pick those with my brother,' '' Mr. Simmons said.

''So I'm going to take him out one day. Picking two or three would make all the difference to that guy.''

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