Integrating outdoor environments into health service delivery at residential care facilities for older adults

Journal article, 2026

Background: Outdoor environments may support everyday activities, person-centred care and rehabilitation, and health and well-being among older adults in residential care facilities (RCFs). However, how they can be integrated into routine health service delivery remains underexplored. This study aimed to explore how outdoor environments can support everyday activities and person-centred care and rehabilitation in RCFs, and to identify perceived benefits and barriers to their use in routine health service delivery. Methods: A qualitative study was conducted using individual walking interviews with older adults and focus group walking interviews with care workers at three Swedish RCFs. Data were organised according to the model of four zones in contact with the outdoors: indoor environments with windows (Zone 1), transitional outdoor environments (Zone 2), gardens (Zone 3), and the surroundings (Zone 4). Everyday activities, care and rehabilitation were identified across the zones, together with perceived benefits and barriers. Practices were distinguished as either currently occurring or potential uses. Results: All four zones offered opportunities for everyday activities, care and rehabilitation, including social interaction, recreation, physical activity, contact with nature, health conversations, and assessments. Perceived benefits included stimulation, enjoyment, social interaction, sensory experiences, and contact with nature. However, use was limited by physical, seasonal, organisational, informational, and social barriers. The findings indicate a gap between the opportunities outdoor environments offer and their integration into everyday routines. Conclusion: Outdoor environments are a valuable but underutilized resource in RCFs. Their integration into routine health service delivery requires access to accessible environments, supportive organisational routines, and care workers with sufficient time, knowledge, and support. The identified practices across the four zones may provide practical inspiration for using outdoor environments in everyday activities and person-centred care and rehabilitation.