Care Farming for People with Dementia; What Can Healthcare Leaders Learn from This Innovative Care Concept?

Figures & data

Box 1 Evolution of Care Farming in the Netherlands and Norway

The Netherlands

From the 1990s onwards, the agricultural sector has been increasingly involved in offering health and social care services to different client groups. Several societal changes have contributed to this development. Increasing pressure on the agricultural sector and changing demands from society changed the focus of farmers in the Netherlands. It generated an increasing interest in innovative diversification activities of farms such as recreation, food processing, home selling, and care farming. Additionally, in the health and social care sectors, there have been trends towards socialization and normalization of (long-term) care services. These trends required adaptations of existing care environments or innovative design of new ones. Care farms are an example of this. Finally, there has been a demand for reconnecting society and rural areas. Care farming has given new social roles to farms and farmers and contributes to inclusion of vulnerable groups and thereby fulfils the demand for social reconnection.^Citation19

The number of care farms in the Netherlands has increased rapidly, from 75 in 1998 to more than 1100 today. Important for the development of the care farm sector was the initiation of the National Support Centre Agriculture and Care in 1999. Its activities included supporting care farms, embedding agriculture and care in society and policy, developing a quality system, and facilitating exchange of information, experience, and knowledge. These activities increased the familiarity and acceptance of care farms by the health and social care sectors. Further, the funding structure of care services provided by care farms has been important for the expansion of the sector and its legitimacy. Before the 1990s pioneers found creative ways to obtain sufficient finances (eg labour integration funds, social assistance regulations, care innovation funds). From 1995 onwards, other types of funding systems became available for people using services of care farms such as national payment schemes for citizens in need of long-term care and personal care budgets.^Citation19

Initially, the main client groups of care farms were people with a learning disability and people with mental health problems. Care farms offered assisted workplaces to these client groups. It was gradually acknowledged that care farms could also be beneficial for other vulnerable client groups such as people with dementia. At the care farms, people with dementia could participate in adult day services programs which included involvement in different types of farm-related activities. The average numbers of clients and staff members and the income generated by care providing care services per farm increased in time. Regional organisations of care farms were established throughout the country and have developed into professional accredited organisations which give them access to long-term care budgets.^Citation20

Today, care farms are fully embedded in the health and social care systems and have developed sustainable funding structures. There is now a very diverse sector with care farms initiated by professionals with different types of backgrounds and competences (eg farmers, health or social care professionals, social entrepreneurs) providing services at different types of farms and providing services to a wide range of client groups.^Citation19

Norway

In the 1990s, first care farming initiatives were established in Norway offering a sheltered workplace to people with mental health problems. Satisfaction of clients participating in this initiative was high.^Citation21,Citation22 Following these positive experiences, the Norwegian Labour and Welfare Administration (NAV) decided to permanently support these prevocational training services and labelled them ‘green work’ (www.nav.no). Gradually, care farms broadened their scope to different client groups with farms directing their services at school children as most common. Other prevalent groups include children in kindergarten, people with special needs and mental health issues, and people with dementia.^Citation27 A recent study identified 33 farms offering adult day services to people with dementia.^Citation14

In one of the first attempts to quantify the number of care farms in Norway, 325 farms were registered.^Citation23 Later studies estimated the number of care farms between 650 and 950.^Citation24,Citation25 In 2012, a national register was established which included a quality approval scheme for farms. Farms that are approved by this scheme are certified and can use the brand “Inn på tunet” (meaning: Into the farm yard) for their services. About 400 farms distributed across all counties in Norway are certified (www.matmerk.no). It remains, however, difficult to estimate the exact number of care farms since not all of them sign up for the quality approval scheme.

Client groups attending services at care farms are referred from health and social care agencies, the school system or NAV. Services are all funded by the municipality. Most farmers are self-employed. A small proportion, however, is employed by the municipality as a care professional or a teacher at his/her own farm. As part of quality development of care farming, the County Governors in Norway represented by the agricultural department contributed to establishing networks of care farmers on county level facilitating exchange of information, experiences, and knowledge. In recent years, regional cooperatives owned by farmers are established with the aim to further professionalize the sector to facilitate the promotion of the care farm concept and to facilitate contract negotiations between care farms and purchasers of the services.

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